THE INTERNET: A NURSING RESOURCE

INTRODUCTION:

The internet’s tremendous impact on    society

·         Changing the way we communicate

·         Conduct business

·         Obtain information

·         Manage life

   Internet

- describes as a network of computer network

-provides the ability for computes attached in some way to one of wires or cables on the  system to send and information  from computer networks regardless of the location.

THE HISTORY OF THE INTERNET

1957                                                                                                                                            

•          Russian launch sputnik, the result was the

creation of Advanced Research Project Agency (ARPA) by President Eisenhower.

Packet Switching- devised system result of dividing message into smaller pieces, each individually addressed, invented by Paul Barran.

1962

•          Dr. J.C.R licklider lead the research to improve military use of computer technology. This visionary moved ARPA work from the private sector to universities.

1969

•          Dr. J.C.R put his brainchild into operation in the fall and named ARPANET, after its DoD pentagon sponsor the ARPA.

First node was installed at the University of California, Los Angeles.                                                      

1973

•          The first step to this outcome was taken by Vint Cerf and Bob Kahn- leading to the creation of the Transmission Control Protocol and the internet protocol (TCP/IP).

•          This decentralized structure together with standard communication methods made expansion easy.

1980’s

•          many networks had adopted the standards, and internet became reality

1990’s

•          Commercial networks such as CompuServe and Prodigy became part of the internet; users of these networks could only communicate with those using the same service.

WHO CONTROLS THE INTERNET

•          The internet itself has no owners, censors, bosses, board of directors, or stockholders.

•          In principle, any computer or network that obeys the protocols, which are technical, not social or political, can be an equal player.

ISOC (www.isoc.org) - the overall organizing force an international, nonprofit, professional membership organization with no governmental allegiances.

•          The society works to maintain standards, develop public policy, provide education, and increase membership.

THE TECHNOLOGY BEHIND THE INTERNET

ž  Protocols- determined two devices how data will be transmitted between two devices.

ž  -The main protocols on which the functioning of the internet is dependent are referred to as TCP and IP. 

ž  IP- the lower level protocol, responsible for making decisions about packets.

ž  TCP- data grams, detects and reorder the packets as necessary.

ž  HTTP- Hypertext transmission protocol, supports the World Wide Web (www)

ž  FTP- files transmission protocol, permits users to send all types of electronic files over the internet.

THE DOMAIN NAME SYSTEM (DNS)

ž  The internet’s DNS permits us to give globally unique “names” to networks and computers.

ž  BENEFITS:

ž  Easier to remember than long string of numbers.

ž  Allows for a change of physical location that is transparent to the user.

HOW LARGE IS THE INTERNET?

ž  The internet had over 109 million hosts in 230 countries as released by the Internet Software Consortium in March 15, 2001 from data collected during January 2001

ž  The growth rate of the internet is estimated to be between 46 and 67% annually.

ž  Net is growing worldwide at the amazing rate of 63 new hosts and 11 new domains per minute. 

ž  Archie sites- they pooled the information from their searchers and made it available to users at other sites.

ž  Gopher system- developed at the University of Minnesota, provides users a menu of items available on internet servers globally.

FILE TRANSFER PROTOCOL       

ž  The FTP was mentioned use to download and upload files from distant computers and transferring data.

ž  This protocol is still in use today for exchange of data but most use is transparent to the user. 

ELECTRONIC MAIL (E-MAIL)

ž  One of the most popular users for internet remains the ability to send and receive e-mail.

ž   Many individual uses e-mail for different purposes.

THE ANATOMY OF AN E-MAIL ADDRESS

ž  An e-mail address has two parts separated by “@” sign:

             Username

            Name of the computer that assigned the username.

Example: Mara.clara@Redcross.org

Mara.clara- username

Redcross.org- name of computer

EMOTICONS

ž  To accurate judge the mood of the sender the practice of typing characters available on a standard keyboard to form a picture, these small icons is called emoticons or smiley that use to denote a mood.

ABBREVIATIONS

ž  Cautiously used in e-mails and other messaging applications

ž  Examples: AFK- Away from the keyboard

                      BTW- By the way

                      FTF- face to face

                      HTH- Hope this helps

LIST FUNDAMENTALS

Two address of mailing list:

 1. The address of the software that manages the list, used to subscribe to the list, unsubscribe, or use some of the functions that the software makes available.

2. The one that subscribers use to post a message to the mailing list.

THE WORLD WIDE WEB

 

ž  WWW is not just some passing trend but an integral part of the world today.

ž  Tim Berners-lee- inventor of the WWW named as one of the top 20 thinkers of 20^th century.

ž  Browser- is a client program that translates files to the image you see on the screen.

ORIGIN OF THE WWW

ž  First propose in 1989 by Tim Berners-lee while working with Robert Cailliau

ž  First prototype appeared in 1990 but released in 1991.

ž  Browser was released in 1992 to the public as freeware and there were only 50 Web servers.

ž  By the end of 1995 there had been improvements in browser.

FUNCTIONS OF WWW

ž  Has special software that allows receiving, interpreting, and sending to the client computer the request file.

ž  Web’s use of HTTP enables the transmitting and interpretation of all types of files.

ž  -hypertext is a system which permits objects to be linked to another.

CRITERIA FOR ASSESSING THE QUALITY OF HEALTH INFORMATION ON THE INTERNET

ž  Credibility- what is the source of the information, how current is it, useful and relevant; what was the process for editorial review.

ž  Content- to help judge accuracy examines the hierarchy of evidence, presence of original source.

ž  Disclosure- what is the purpose of the site; who is sponsoring it, and what will the site owners will do with any information that they collect.

ž  Links- what is the quality of the links provided.

DATA PROCESSING

DATA/ INFORMATION:

- are raw uninterrupted     fact that are without meaning.

-When data are interpreted, information is produced. While data are meaningless, information by definition is meaningful. For data to be interpreted and information produced, the data must be processed.

Some common approaches in organizing data:

Ø   Sorting

Ø   Classifying

Ø   Summarizing

Ø  Calculating

DATABASE

-is an organized collection of related data.

-A common paper example is PHONEBOOK; A much more complex example can be a PATIENT’S MEDICAL RECORD

Factors of finding information in databases:

v  How the data are named (indexed) and organized.

v  The size and complexity of the database.

v  The type of the data within the database.

v  The methodology or tools used to search the database

Information system

-are used to process data and produce information.

-it is often used to refer to computer systems, but this is only one type of information system. There are manual information systems as well as human information system.

Human Brain

-is the most effective and complex information system.

Types of data

1.       Computer-based data types

- this classification is used to build the physical database within the computer system. It identifies the number of spaces needed to capture each data element and specific function that can perform on these data.

Alphanumeric data – include letters and numbers in any combination.

Social security number – is an example of alphanumeric data made up of numbers.

Memo  - is a specific type of alphanumeric data with increased spaces and decreased indexing option.

Numeric data – are used to perform numeric functions including adding, subtracting, multiplying and dividing. It can be long integer, currency or scientific.

Date and time

-are special types of numeric data with which certain numeric functions are appropriate.

Logic Data

-          Are data limited to two options.

-          Ex: yes or no; true or false

2. Conceptual data types

-reflect how users view the data, these can be based on the source of the data

Example: the lab produces lab data, and the x-ray department produces image data.

-          It can also be based on the event that the data are attempting to capture.

-          Examples of data  that reflect event capturing:

q  Assessment data

q  Intervention and outcomes data

One of the major advantages if an information system is that each of these data elements can be captured once and used many times by different purposes, This is referred to as “ DATA COLLECTED ONCE, USED MANY TIMES.”

DATABASE MANAGEMENT SYSTEMS (DBMSs)

-are computer programs used to input, store, modify, process and access data in a database. Before the DBMS can be used, the DBM software must first be configured to manage the data specific to the project. This process of configuring the database software is called DATABASE SYSTEM DESIGN.

A functioning DBMS consists of three (3) interacting parts:

1.       The data

2.       The DBMS configured software program

3.       The query language used to access the data.

SOME EXAMPLES OF DBMS:

Ø  Computerized library systems

Ø  Automated teller machines

Ø  Flight reservation systems

ADVANTAGES OPFG AUTOMATED DATABASE MANAGEMENT SYSTEM:

ü  Decrease data redundancy

ü  Increase data consistency

ü  Improve access to all data

Types of files

1.PROCESSING FILES

Executable files consist of a computer program or set of instructions that, when executed causes the computer to open or start a specific computer program or function.

-are the files that tell a computer what actions the computer should perform when running a program.

Command files- are a set of instructions that perform a set of functions as opposed to running a whole program.

BATCH FILE- contains a set of operating system commands.

2. DATA FILES

-contain data that have been captured and stored on a computer using a software program. Many times the extension for the file identifies he software program used to create the file.

The master index file- contains the unique identifier and related indexes for all entities in the database.

Conceptual model

-Includes a diagram and narrative description of the data elements, their attribute, and the relationship between the data. It defines the structure of the whole database in terms of the attributes of entities (data elements) relationships, constrain and operation

Structural or physical data records

-includes each of the data elements and the relationship between the data elements, as they will be physically stored on the computer.

FOUR (4) PRIMARY APPROACHES TO THE DEVELOPMENTR OF A PHYSICAL DATA MODEL:

1. HIERARCHICAL

-all access data starts at the top of the hierarchy or at the root. In a parent node may have several children nodes, but each child node can only have one parent node.

- Are very effective at representing one-to-many relationships; however they have some disadvantages. Many data relationships do not fit to one-to-many- model

2. NETWORK MODEL

-developed from hierarchical model. In a network model, the child node is not limi8ted to one parent.

3. RELATIONAL DATABASE MODELS

-consists of a series of files set up as tables, each column represents an attribute, and each row is a record. Another name for a row is “tuple”.

-joins any two or more files that generates a new file from the records that meet the matching search criteria.

4. Object-Oriented Model

-this model is developed because the relational model has a limited ability to deal with binary large objects or BLOBs.

BLOBs-are complex data types such as images, sounds, spreadsheets, or text messages. They are large monatomic data with parts and subparts that are not easily represented in a rational database.

DATABASE LIFE CYCLE

-The development and use of DBMS follow a systematic process called THE LIFE CYCLE OF A DATABASE SYSTEM.

FIVE(5) STEPS IN LIFE CYCLE PROCESS:

1. INITIATION

-occurs when a need or problem is identified and the development of a DBMS is seen as potential solution.

2. PLANNING AND ANALYSIS

3.DETAILED SYSTEM DESIGN

4.IMPLEMENTATION

5.EVALUATION AND MAINTENANCE

COMMON DATABASE OPERATIONS

3 BASIC TYPES OF DATA PROCESSING OPERATIONS:

1. Data Input Operations

-are used to enter new data, update data in the system or change data in the DBMS.

2. Data Processing Processes

-are DBMS- directed actions that the computer performs on the data once entered into the system.

3. Data Output Operations

-includes online and written reports.

DATA WAREHOUSE a large collection of data imported from several different systems within one data base. The source of the data includes not only internal data from the institution but can also include data from external sources.

Functions of a data warehouse

v  The data warehouse must be able to extract data from the various computer systems and import that data into the data warehouse.

v  The data warehouse must function as a database able to store and process all of the data in the database.

v  The data warehouse must be able to deliver the data in the warehouse back to the users in the form of information

KNOWLEDGE DISCOVERY SYSTEM OR DATA TO KNOWLEDGE APPLICATION

-Process of extracting information and knowledge from a large scale databases.

-uses powerful automated approaches for the extraction of hidden predictive information from large databases

 3 types of data mining processes:

1. PREDICTING-discovering variables that predict or classify a future event.

Ex: decision tree, neural networks

2. DISCOVERY-discoverring patterns, associations, or clusters within a large dataset.

Ex: apriori; fractionalization

3. DEVIATIONS-DISCOVER THE NORM VIA PATTERN RE3COGNITION AND THEN DISCOVER DEVIATIONS FROM THIS NORM.

Ex: scatter plots, parallel coordinates

CRISP-DM MODEL

-is an international cross industry model it is now being applied to data mining within healthcare.

6 PHASES OF DATA MINING PROCESSES DESCRIBED BY CRISP-DM MODEL:

1.Understanding the business

2.Understanding the data

3.Data preparation

4.Modeling

5.Evaluation

6.deployment

Electronic Health Record Systems: U.S. Federal Initiatives and Public/Private Partnerships

Introduction

ž  In April 2004, the president of the United States issued an executive order that called for action to put EHRs in place for most Americans in 10 years.

ž  Today, there is growing consensus that EHR-Ss, can meet clinical needs in healthcare by capturing, storing, and displaying clinical information when and where it is needed to improve treatment and to provide aggregate cross-patient data analysis.

Electronic Health Record Systems

- the set of components that form the mechanism by which patient records are created, used, stored, and retrieved. It includes people, data, rules and procedures, processing and storage devices.

- Longitudinal collection of electronic health information for and about persons, where healthcare is provided to an individual.

Federal Initiatives

  - Within the federal government, different departments exert different influences toward common goal of and EHR for most Americans. Agencies providing direct healthcare offer evidence that the use of EHRs across a multi-facility enterprise is a realistic goal with measurable, repeatable positive outcomes.

Department of Veterans Affairs

ž  The Veterans Health Information Systems and Technology Architecture support day to day clinical and administrative operations at local VA healthcare facilities.

ž   This new interface named the Computerized Patient Record System provided a single place for healthcare providers to review and update a patient’s health record and order medications, special procedures, x-rays, nursing orders, diets, and laboratory tests.

Department of Defense

ž  Providers have had a computerized physician order entry capability that enables them to order lab tests and radiology examinations and issue prescriptions electronically for over 10 years.

ž   DoD Pharmacy Data Transaction Service links military treatment facilities, mail order, and network pharmacies. This service enables providers at all military and civilian pharmacies to track daily medication transactions and to check for drug allergies and drug interactions.

Indian Health Service

ž  The IHS has long been a pioneer in using computer technology to capture clinical and public health data. Its Resource and Patient Management Systems was developed in the 1970s, and many facilities have access to decades of personal health information and epidemiologic data on local populations.

Office of the National Coordinator for Health Information Technology

ž  The executive order of April 2004, mentioned earlier, created the ONCHIT to coordinate HIT efforts in the federal sector and to collaborate with the private sector in driving HIT adoption across the healthcare system.

ž   In July 2004, Secretary Tommy Thompson and Dr. Brailer released a framework for strategic action intended to guide collaborative efforts to promote progress toward a consumer-centric and information-rich healthcare industry.

The National Committee on Vital and Health Statistics

ž  Held a series of national hearings to develop a consensus vision of National Health Information Infrastructure (NHII). In the resulting report, Information for Health, presented the concept of an infrastructure that emphasizes heath-oriented interactions and information-sharing among individuals and institutions, rather than simply physical, technical, and data systems that make those interaction possible.

Agency for Healthcare Research and Quality

ž  Unveiled a major HIT portfolio, with grants, contracts, and other activities to demonstrate the role of HIT in improving patient safety and the quality of care.

ž   AHRQ funded demonstration grants to establish and implement interoperable health information systems and data sharing to improve the quality, safety, efficiency, and effectiveness of healthcare for patients and populations on a specific state or regional level.

Centers for Medicare and Medicaid Services

ž  CMS has initiated several pilot projects to promote health IT.

ž   CMS awarded a $100, 000 grants to the American Academy of Family Physicians for a pilot project to provide comprehensive, standardized EHR software to small, and medium-sized ambulatory care practices.

Public-Private Partnership

ž  Focused on the use of EHR-Ss and HIT to improve care. Among these private sector organizations are those formed specifically to address issues of connectivity, HIT, and standards development.

Connecting for Health

ž  A large private collaborative with federal participants supported by the Markle and the Robert Wood Johnson Foundations, Connecting for Health is addressing the barriers to development of an interconnected health information infrastructure. It brings together several dozen of leading healthcare provider and payer organizations, HIT vendors, and representatives of federal and state agencies.

Health Initiative

ž  Is an independent, nonprofit affiliated organization established to foster improvement in the quality, safety, and efficiency of healthcare through information and IT. Its membership brings together hospitals and other providers, practicing clinicians, community organizations, payers, employers, community-based organizations, HIT suppliers, manufacturers, and academic organizations.

Institute of Medicine

ž  As an independent advisor to the nation with the goal of improving health, the IOM has championed the advantages of use of IT to improve healthcare since 1991 foundational work. The IOM continues to illuminate the importance for the use of IT in healthcare.

Certification Commission for Health Information Technology

ž  The Health Information and Management Systems (HIMMS), American Health Information Management Association (AHIMA), and National Alliance for Health Information Technology (NAHIT), have joined together to establish the (CCHIT).

ž   The goal of this group is to reduce risk of EHR investment.

Health Level Seven

ž  An international, non-for-profit, volunteer standards organization known for its large body of work in the production of technical specifications for the transfer of healthcare data.

ž The HL7-S functional model contains a list of functions in three categories:

 àDirect care function- needed to support direct care delivery.

àSupportive function- involve secondary use of the data captured via the direct care functions.

àInformation infrastructure- is the “backend” of the system; unfamiliar to many clinicians, this is considered essential by informaticists and technical staff.

DEPENDABLE SYSTEMS FOR QUALITY HEALTHCARE

INTRODUCTION

The healthcare is undergoing a dramatic transformation from today’s inefficient, costly, manually intensive, crisis driven model of care delivery to a more efficient, consumer-centric, science-based model that proactively focuses on health management.

The electronic health record (EHR) will form the foundation for pervasive, personalized, and science-based care. Other key applications are clinical information systems (CIS) with integrated, outcomes-based decision support, clinical knowledge bases, computerized physician order entry (CPOE), electronic prescribing, consumer knowledge bases and decision support, and supply chain automation.

The international Council of nurses (ICN) Code of ethics for Nurses affirms that the nurse “holds in confidence personal information” and “ensures that the use of technology… [Is] compatible with the safety, dignity, and rights of the people” (ICN, 2000).

DEPENDABILITY COMPRISES THE FOLLOWING SIX ATTRIBUTES:

1. System reliability: The system consistently behaves in the same way.

2. Service availability: Required services are present and usable when they are needed.

3. Confidentiality: Sensitive information is disclosed only to those authorized to see it.

4. Data integrity: Data are not corrupted or destroyed.

5. Responsiveness: The system responds to user input within an expected and acceptable time period.

6. Safety: The system does not cause harm.

GUIDELINES FOR DEPENDABLE SYSTEMS

All computer systems are vulnerable to both human-created threats, such as malicious code attacks and software bugs, and natural threats, such as hardware aging and earthquakes.

GUIDELINE 1: ARCHITECT FOR DEPENDABILITY

A fundamental principle of system architecture is that enterprise system architecture should be developed from the bottom up so that no critical component is dependent on a component less trustworthy than itself.

GUIDELINE 2: ANTICIPATE FAILURES

Unfortunately, minimizing complexity is more easily said than done. Consistent with Moore’s law` (Moore, 1965), the speed of processors in doubling every 18 months, while the cost for that computing power is halving within the same time period.

GUIDELINE 3: ANTICIPATE SUCCESS

The systems planning process should anticipate business success-and the consequential need for larger networks, more systems, new applications, and additional integration.

GUIDELINE 4: HIRE METICULOUS MANAGERS

Good system administrators meticulously monitor and manage system and network performance, using out-of-band tools that do not themselves affect performance.

GUIDLINE 5: DON’T BE ADVENTUROUS

For dependability, one should use only proven methods, tools, technologies, and products that have been in production, under conditions, and at a scale similar to the intended environment.

*         ASSESSING THE HEALTHCARE INDUSTRY

Healthcare clearly has a need for dependable systems--both now and after the transformation, as the industry becomes increasingly dependent on IT in the delivery of patient care.

*        HEALTHCARE ARCHITECTURE

For adherence to the first guideline “architect for dependability” the clinical care provider community gets a barely passing grade of “D.” Healthcare organizations build—or perhaps “compose’—their systems from the top down rather than from the bottom up.

*        The five specified physical safeguards also contribute to system dependability by requiring that facilities, workstations, devices, and media be protected.

1.       Access control, including unique user identification and an emergency access procedure

2.       Audit controls

3.       Data integrity protection

4.       Person or entity authentication

5.       Transmission security

ANTICIPATING FAILURES

For adherence to the second guideline “expect failures” the clinical care provider community gets another grade of “D.” Medical technology and prescription drugs, as well as clinical treatment protocols, are required to undergo extensive validation before they can be used in clinical practice.

Other healthcare organizations can be grateful for Care Group’s CIO’s willingness to share the details of his experience so that they might benefit from the lessons learned (Berinato, 2003).

*        IT MANAGEMENT

For the fourth guideline “hire meticulous managers” the clinical care provider community has been assigned a mediocre grade of “C”. Many provider organizations truly do recognize the criticality of IT to their business success.

These organizations have hired IT managers who appreciate the important role of IT in healthcare in healthcare environment and who recognize the need for dependable systems that can anticipate and recover the failures.

·        ADVENTUROUS TECHNOLOGIES IN HEALTHCARE

The fifth and final guideline “don’t be adventurous” is the most difficult to assess  for healthcare. On the one hand, healthcare givers typically are not early adopters. But on other hand, they seem to cast fate to the wind or technologies that catch their collective fancy.

Healthcare clinicians, including nurses, historically and typically are very resistant to change, largely because they are taught to be circumspect in considering new approaches, treatment protocols, and drug regimens.