CHAPTER 40: Nursing Informatics in Asia

Objectives:

To describe the development of nursing informatics in selected Asian counties.

To identify historical milestones, changes, point of view trends influencing how nurses cover informatics, such as government initiatives and international collaborations.

To discuss NI practice, education, and research.

INTRODUCTION:

Computers were first introduced into the attention sectors of Asian counties bargain the 1970s.

The first applications of information technology in care in Asian countries were unimportant administration, billing, and insurance. Acquaint with these countries are moving nearing implementing paperless electronic health chronicles. This chapter provides an perspective of the current status a selection of the field of NI score South Korea, Japan, China, Island, and Thailand.

It describes ethics history of NI, the villa of informatics in clinical look for, informatics education, informatics research, courier government initiatives and professional outreaches.

The adoption of informatics in Denizen countries usually began as smashing vision by a group accuse individuals in the government be unhappy a professional organization, who promoted the use of information technologies to support nurses in transfix areas of nursing practice.

Bonus and more nursing schools on top beginning to realize the market price of providing informatics courses pick on nurses. Basic computer literacy rearing is now a part forget about nursing education in most Eastern countries, and graduate programs majoring in NI are also rest now in some countries, much as South Korea and Taiwan.

Reports of research in NI began to appear in the private Asian nursing journals in Decennary.

In most countries, information subject first appeared as an enlightening tool, following by its have a view over in clinical practice in applications such as expert systems president electronic nursing records. This call for in clinical practice leads reach the development of standards apposite a favorite research topic.

International multidisciplinary informatics links have assisted these beginnings and their progression.

Birth progress in Japan, China, station South Korea has been fast by the hosting of significance International Medical Informatics Association (IMIA) triannual conference in 1980, 1989, and 1997, respectively. The building of the Asia Pacific Remedial Informatics Association in 1993 helped launch national healthcare informatics contact in China, Japan, South Peninsula, Taiwan, and Thailand due generate the hosting of triannual conferences in the Pacific Rim.

Say publicly China, Japan, and Korea Examination Informatics Association (formed in 1999) organizes conferences, seminars, and workshops once a year and begets forums for the sharing pray to experience and knowledge among both experts and users in these three countries.

The chapter concludes rough summarizing significant events and examining their impact on the metastasis of NI in this region.

 

KOREA

South Korea comprises eight provinces add seven metropolitan cities, and rectitude total population was about 47 million in 2002.

The the general public is predominantly in urban areas, with 21% living within rank Seoul metropolitan area.

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There ring currently 190,720 licensed midwives accept nurses, of whom 81,478 junk practicing 23,331 of these, clutter situated in the Seoul oppidan area.

 

History of Nursing Informatics cranium Korea

The use of computers force South Korean healthcare began necessitate the late 1970s in infirmary finance and administration systems perform expedite insurance reimbursements.

Soon subsequently, the national health insurance shade expanded to cover the inclusive population, and computers became warrantable equipment in healthcare organizations. Blue blood the gentry terms health informatics and NI were first introduced in Choson when the KOSMI was supported in 1987.

In contrast, computers were not used in nursing raising and research until 1993, vital NI was not taught fake universities until 1994.

In 1993, the Nursing Informatics Special Concern Group was organized as tiptoe of the five special association groups in the KOSMI, in that the Nursing Informatics Group has held its own session amalgamation the biannual conferences of character KOSMI.

Further momentum for NI has been coming from funding look after a NI study group allowing by the Korean Science prosperous Engineering Foundation since 1998.

Korean nurses have attended and participated effect many international conferences promoted die supported by IMIA or IMIA-NI since 1989.

Korean nurses minimal the country at the IMIA-NI Group in 1995.

 

Use of Wisdom Technology in Clinical Practice

According realize report published by the Peninsula Health Industry Development Institute compact 2000, 100% of teaching hospitals, 96% of general hospitals, enthralled 75% of private clinics momentous have hospital information systems (Korea Health Industry Development Institute, 2000).

Korea are using order notice systems (Kwak, 2000), which authorize physicians to communicate with overturn departments for practice-related requisitions don the retrieval of data. Encumber addition, about 95% of lesson hospitals and 20% of regular hospitals are equipped with acquaint with archiving and communication system (PACSs). There has been a mass deal of interest among care organizations in acquiring these systems since the government announced towering reimbursement rates for diagnostic radioscopy examinations using PACSs in 2000, and PACSs are now only of the most common facts technology systems in South Altaic Hospitals.

The use of computers obligate clinical nursing practice in Peninsula began first in medium-sized hospitals.

These hospitals initially used computers mainly for administration and asking, as did most hospitals come by other countries, but later exceptional patient-care component was added. These systems allowed physicians to go medical orders directly into say publicly computer, and major ancillary departments could receive requisitions and end test results.

Nursing information systems proliferated when large hospitals (with more than 1,000 beds) began opening in the mid-1990s. These new hospitals were equipped wrestle nursing information systems when they first opened.

A home healthcare arrangement for community-based clinical practice was developed by the Home Aid Team at the College firm footing Nursing, Seoul National University.

Domicile healthcare nurses use laptop computers to note and check medicament and progress in electronic stoical records, and to communicate electronically with other home healthcare side members.

 

Health Informatics Education

According to wonderful recent survey on health ip and computer education programs family tree South Korean medical and nursing schools, about 25% of examination schools and 21% of nursing schools offer health informatics courses, while the remainder offer preliminary computer courses (Park, 2002).

Honesty course contents vary a giant deal from school to academy, and the instructors are habitually self-taught in these subjects. That indicates that there is spruce up need for standardization of success informatics courses for baccalaureate programs based on the task disturb healthcare professionals, together with set programs to produce qualified fettle informatics educators.

 

Research

Most papers presented bland KOSMI conferences and published update the Journal of the KOSMI since 1991 have addressed class application of commercially available programs, with more recent papers discussing the use of computers whilst a tool for nursing edification.

Distance education using the Web has also been described.

Another universal research area is the impenetrable of artificial intelligence in nursing diagnosis. The use of initialled digital assistants (PDAs) in haven and home healthcare settings legislature with the standardization and nobility use of Web-based electronic incessant records are current areas dying interest.

 

Standardized Activities

There are current efforts to implement a single, systematic healthcare and nursing terminology play a role South Korea, the primary inducement for which is compatibility adherent data, clinical documentation, and inquiry outcomes across the country.

Administrative background systems in the healthcare zone essentially use the Korean Malevolent Classification of Diseases (the Altaic version of the International Coordination for Disease [ICD] 10), behaviour clinician information systems are instructions to use more concept familiarised terminology such as the SNOMED (Systematized Nomenclature of Medicine).

Dignity majority of existing nursing terminologies, such as the North Earth Nursing Diagnosis Association (NANDA) Terminology I and II, Nursing Interventions Classification (NIC), Home Healthcare Category (HHCC), the Omaha system, Nursing Outcomes Classification (NOC), and Global Classification for Nursing Practice (INCP), have been translated into Altaic and standardized.

The NANDA psychotherapy the most frequently used impossible to tell apart nursing education, and the 3N (NANDA-NIC-NOC) and NICP are uppermost frequently used in clinical handle for electronic nursing record systems in Korea.

 

Government Initiatives

The Korean polity has contributed to the course of health informatics by plan funding or other incentives view guidelines in telemedicine, emergency checkup systems, infectious diseases reporting systems, and standardization.

The Korean Ministry disregard Health and Welfare established natty long-term plan for a ceremonial health and welfare network (NHWN) in 1993.

The NHWN bedding six areas: public health, hospitals and clinics, health insurance, subsistence and drugs, national pension, remarkable health and welfare administration. Picture first phase (from 1994 far 1997) computerized the administrative topmost patient-care activities of health centers. The second phase (from 1998 to 2001) developed infrastructure rationalize the public health network, integration networks systems among health centers, health sub centers, and leading healthcare posts.

An electronic document interchange system between the disclose healthcare facilities and the uneven insurers was developed for ailment insurance claims. Possible ways be totally convinced by linking the NHWN to high-mindedness city, country, and district networks of the Ministry of Congressional Affairs and Home Affairs were studied.

The current third leaf, which started in 2001, catchs up the development of data repositing at the level of main cities and provinces.

 

Professional Outreach

Since sheltered foundation in 1987, the KOSMI has played a very critical role in promoting and booming health informatics by holding semiannual academic conferences, various seminars, workshops, and open forums, and stop publishing journals.

KOSMI has very offered educational programs for beginners in health informatics.

Organizations such importance the Korean Medical Association come to rest the Korean Nurses Association enjoy also played significant roles coarse including health informatics in their continuing education programs.

The IMIA has contributed significantly to furthering goodness knowledge of South Korean aid professionals about worldwide trend load health informatics.

These individuals conspiracy attended and participated in go to regularly international conferences promoted or sinewy by the IMIA since 1989.

 

Technology Trends

The rapid growth in righteousness number of mobile telephone consumers (currently estimated to be enclosing 65% of total population) see the advances in wireless neighbouring area network (LAN) technology own lead to mobile computing implement healthcare becoming a popular egress in South Korea, with uncountable healthcare organizations testing its practicability in special wards.

The marketplace users of the systems presently are nurses attending patients thoughtful bedsides, but this will ere long be extended to other tending professionals.

The need for telemedicine continues to grow in Korea polished increasing numbers of elderly, patients with chronic diseases, and patients who are discharged early.

Myriad telemedicine systems have been experienced over the past 10 age, one of which is cool teleconsultation system initiated by magnanimity government. Telepractitioners at these centers maintain special schedules for their remote clients. They set hold back 1-2 days per week emphasize take care of their custom using virtual reality technology at hand the Internet.

Currently, the teleconsultation fee is reimbursed by benefit insurance, whereas the use read telecare – at – fondle clinics is not yet covered.

 

Summary

The Korean healthcare environment is chic inhospitable due to high aid costs, increasing competitions among tending organizations, decreased funding from integrity government, and customers with work up sophisticated demands.

Health informatics and dignity usage of information technology be endowed with seen rapid progress in Southerly Korea.

Most of the Asiatic healthcare organizations were computerized closest the introduction of the state health insurance system.

 

JAPAN

There are tightness 10,000 hospitals in Japan, reduce speed which about 430 have broaden than 400 beds. About 750,000 nurses work at these hospitals, including about 220,000 nurse’s aides, and there are about 260,000 medical doctors, 90,000 dentists, snowball 230,000 pharmacists.

The healthcare delivery profile in Japan provides easy grasp to healthcare.

All citizens sprig choose healthcare institutions and doctors freely, and their financial duty to health insurance is well-balanced to their income. The protection fee is deducted from rendering monthly salary, and pooled overstep each insurance union.

The total happiness expenditure of Japan remains diminish than that it some additional advanced nations, which is ad at intervals attributable to healthier dietary behaviour.

The relatively small number have possession of healthcare professionals working in Gild also helps to contain tending expenditure. The average length cut into hospital stays has recently antediluvian shortened, and thus many latterly hospitalized patients are in magnanimity acute phase.

 

Health Informatics in Japan

Japan hosted the IMIA conference MEDINFO80 in 1980.

The Japanese Company of Medical Informatics (JAMI) was founded at that time warmth the aim of supporting benefit informatics in Japan. Since character JAMI has held 24 yearly and biannual academic conferences, don these conferences have contributed quite to the progress of complaint informatics in Japan.

 

History of nursing informatics in Japan

The Third Ecumenical Congress on Medical Informatics, MEDINFO18, organized by the IMIA, was held in Tokyo in 1980.

This congress included a allimportant interest group on NI, which represented the beginning of NI in Japan (JAMI 1996; Kamiizumi and Ota, 2004). This blunt not result in immediate cross in Japanese NI education, owing to schools being vocationally oriented.NI was applied more in clinical practice than in academic comedian during the 1990s, with ultra nurses learning about utilizing computers in nursing practice through prestige activities of medical information branch settings in the national dogma hospitals.

 

Nursing Informatics Education

As on Apr 2004, there were 486 buffed schools, 31 junior colleges, Cxx universities, and 45 graduate schools in Japan, compared to 461 professional schools, 74 junior colleges, and 30 universities in 1994.

This comparison illustrates that nursing education in Japan has shifted from professional schools to universities and postgraduate education during say publicly last 10 years. Continuous tutelage of NI is being emphatic, along with the promotion reminiscent of electronic health record.

 

Nursing Informatics Research

The amount of NI research silt increasing in Japan, the cardinal main purposes of which trade improving the quality and normalisation of nursing practice.

There were many reports on research sting the use of information application as an educational tool past the 1990s and on nobleness use of information technology prickly clinical practice, especially on staying power support systems for nursing get the picture hospital information systems and electronic health records.

 

Nursing Informatics Research

Becoming straight specialist in NI is great when hospital information systems stake electronic health records are naturalized.

The accreditation program of birth Japan Nursing Association does mass recognize the training for much specialists. In each hospital, nurses working on medical information stature active in committees and crucial groups. Most of them touch not only nursing-related work nevertheless also medical information-related work.

 

Japanese Regulation Initiatives and Standards Development escort Japan

The standardization of medical dossier is one of the maintain themes in the healthcare area.

Standardization of the terminology encouraged in electronic health records appreciation a requirement for achieving that goal, and the ministry learn Health, Labor, and Welfare has begun a project for growing a national standard, which disintegration publicly available on the info strada. This is especially useful kindle hospitals introducing hospital information systems for the first time.

They have been categorized into daily-life care, family support, guidance elitist education, adjustment during organization, distress signal in the usage of appurtenances, care for the terminally piercing and the bereaved family, become calm others.

 

CHINA

In china, the majority revenue the population is found relish rural areas, and thus interpretation overall healthcare level, stability exert a pull on society and economic development position the whole of China la-di-da orlah-di-dah by healthcare services in countrified areas.

The primary healthcare systems in rural China typically report on cooperation at country, town, bear village levels.

The SARS epidemic grind China leads to reconsiderations elaborate the current healthcare systems shamble rural areas. Some Chinese idiom that the system is call for moving forward and that solon effect should be devoted ordain epidemic prevention, and that straight new system of cooperative therapeutic care and new salvation profile of the poor should designate up to ensure health handset rural areas and enhance greatness stability of society and worthless development of the country.

The Dishware Medical Informatics Association (CMIA) was founded in 1981.

The Asian Society of Medical Information was founded in 1993, and it's activities include holding academic conferences and seminars, continuing education, gift training

The Hospital Information Management Swirl was founded in 1996, remarkable it's activities include holding genealogical and international academic collaborations impressive exchanges, establishing rules and cypher of national hospital management, coupled with training hospital information management staff.

 

Nursing Information Systems in China

The wake up of nursing information management systems began in China late Decennium, and they were first unreceptive in 1987.

The first code implementation was a computer-assisted chief nursing care system. Many hospitals in China now use nursing information systems, although there shape no official statistics available. Brutal examples include a nursing relevant system for the management read nursing staff, nursing operation uncalled-for, continuing education, scientific research, tell finance and economics.

 

History of Nursing Informatics in China

The Nursing Science Special Interest Group with 20 hospitals nurses was founded renovation a branch of the CMIA in 1991.

Te first commodity referring to the term "nursing information science" appeared in Husband in 1999 and this shrink to the application of wisdom technology in the field support nursing science for education mount research. The term NI was first used in the Asiatic literature in 2002.

 

Nursing Informatics Education

Higher nursing education was introduced mop the floor with 1983, and by 2001 close by were 120 schools with 3-year diploma programs, 62 schools bestow a baccalaureate, and 11 schools with master's programs.

According to interpretation literature review, computer-assisted instruction began at nursing institutes in Wife buddy during the mid-1990s, since as a result it has been used spitting image baccalaureate and continuing education courses in the clinical nursing meadow.

Distance learning is also use used for nursing continuing instruction in China. The first better learning program in China obey a collaborative between China president Canada run by the Institute of Nursing, Tianjin Medical Sanitarium in 1999.

 

Nursing Informatics Research

NI proof is at its infancy arbitrate China, with only 30 test articles published in domestic nursing journals from 1994 to 2004 (with key words related highlight the use of computers attach nursing and nursing information occur to the research areas of nursing practice, nursing management, and nursing education).

 

Nursing Informatics Practice

The use accomplish NI in clinical practice redraft China includes nursing quality government, and training clinical skills get to staff nurses.

The major weakness hillock nursing information management systems mull it over China is the lack do in advance national standards and the stream level of computer literacy mushroom informatics skill exhibited by nurses.

 

 

THAILAND

The country has a population dig up about 65 million living interchangeable 76 provinces.

The government obey currently launching a Universal Attention Coverage policy in order contact improve the access to innermost quality of healthcare, as on top form as to contain healthcare spending. These policies require changes direction human resources including nurses, thanks to the demand for nurses send back primary care settings across grandeur country is increasing to look after the needs of the population at large, hoot is that for nurses sufficient at working in hospitals bringing international clients.

NI was first naturalized as small special interest accumulations and later expanded to honesty national level through the cooperate of the Nurses Association prescription Thailand, the WHO, and character Ministry PH.

 

The Development of smashing Health Information System

In 1997, picture Thai MOPH began to tool a national health information course of action, which included the development match a nursing component.

Funding was received from the WHO 1999 as a result of a-ok collaborative effort between the Heart for Nursing research at dignity Department of Nursing, The Warrant of Medicine, Mahibol University, limit the MOPH Nursing Division appointment develop the ideal nursing nadir data set and a opening nursing classification system.

 

Development of stop off NMDS

The first step in nonindustrial a nursing information system evenhanded to identify an essential NMDS, and here the process infer developing an NMDS specific cause somebody to Thailand is discussed.

That study study identified 23 items end nursing data, including patient title, hospital number, ID number, entry number, patient address and telephone number, address and phone consider of significant person, gender, rate, religion ,education, health insurance, longsuffering and family medical history/allergy, proof date, medical diagnosis, laboratory phone, nursing problem, using intervention, nursing outcome, discharge/expired date, discharge layout, condition before discharge, referral, extract home visit.

 

INCP Translation and Validation

The Nurse's Association in Thailand, greatness development of the ICNP avoid agreed to translate into Asian and validate an alpha replace thereof.

The first NI conference was held in Bangkok in 1999, supported by the WHO.

Go into detail than 200 nurses across nobleness country were invited to attack and comment on the end-all version of the translated ICNP. Later in October 1999, integrity translation of the beta repel of the ICNP was ready, validated, and disseminated. However, haunt issues , such as grandeur need concept-based translation and escalating nursing involvement in the instance, still need to be addressed in order to implement honourableness date set successfully.

 

Nursing Information System

A further attempt to implement class ICNP in the Thai nursing environment was the developed, spiffy tidy up collaborative software program called "Healthcare 2000" by the MOPH Nursing Division for the collection bear retrieval of nursing care data.

Although a preliminary Thai NMDS has been identified, challenges associated touch upon its development and implementation in jail the Thai national health dossier system remains.

 

Professional Outreach

The main purposes of TMI (Thai Medical Ip Society, 2003) are as follows:

To be the center for duplicate and distributing medical information.

To bring out means for the management advance medical information in administration playing field academic areas.

To exchange information attend to experience in medical informatics.

To establish those who practice medical informatics.

To provide suggestions and recommendations replace medical information sectors both contents and outside the MOPH.

To crowd together be involved in any advertising or political activities

 

The main activities of TMI are as follows:

Holding an annual conference

Supporting the sitting, training, and information sharing appearance the development of medical science in Thailand

Publishing and distributing join issues of documents per day as approved by the board

Being the center for the arrangement and ideas focused on class development of medical informatics

 

The TMI includes a clinical informatics public interest group, a NI unusual interest group, and the HIS/LIS Club.

The NI interest agency focuses on the classification slope nursing data and the step in nursing databases. The TNI supports the development of NI, especially nursing databases using blue blood the gentry ICNP.

The activities of TNI proposal as follows:

Holding a joint yearly meeting with the Nurses' Meet people of Thailand and the Restorative Informatics Society

Publishing and distributing university teacher newsletter every 4 months

Supporting cover up academic and research activities accent NI

Responding to the NI tradition needs of Thai nurses

 

Standards Development

The development of Thai nursing conventions is related to the system of the ICNP, although hold medicine the ICD 10 has been used in all disorder service facilities.

The HL7 has been employed in many hospitals as the standard interface adoration the Web-based hospital information systems.

 

TAIWAN

There were 610 hospitals and 175,000 healthcare professionals in Taiwan 2002, serving a population of 22.5 million. The healthcare professional includes 34.3% registered nurses and 17.7% licensed practicing nurses.

 

History of Nursing Informatics in Taiwan

The term NI was first used in Island in 1990.

Computers had antiquated used in nursing education thanks to the 1980s, and the affiliated nursing research into patient arrangement supported by National Science Legislature began in the 1990s. Even supposing a formal master's program wish on NI was not not in use until 2001, the elective courses in baccalaureate and master’s programs have started in the flail 1990s.

 

Nursing Information Systems in Taiwan

The pattern for long term attention information systems was similar, cage that almost 50% of far ahead term care institutes were plead for planning any investment in ideas systems and only 19% esoteric installed information systems.

 

Nursing Informatics Education

Computer-assisted instruction programs have been complex by the Ministry of Breeding for nursing vocational education programs since 1986.

The growth keep in good condition the internet has lead be required to the integration of distance nurture into nursing curricula. Online courses are available for baccalaureate programs in counseling, teaching principles move strategies, and long term care.

 

Nursing Informatics Research

NI research is do at its infancy in Formosa, with only around 40 archives published in domestic nursing reminiscences annals in the period 1994-2003.

Position first formal academic association opt for NI was set up tenuous 2004, when a NI in working condition group was organized within honourableness Taiwan Association of Medical Science, which had been established shut in 1991.

Standardized terminology such as hand over nursing diagnosis classification systems playing field the ICNP has been translated for clinical use, and tests of their reliability and believability have been proposed in Taiwan.

 

Nursing Informatics Practice

Computerized care plans sense now common in clinical do.

Moreover, decision support systems calculate test the integration of alexipharmic diagnoses and nursing diagnoses, champion expert systems implemented on PDAs for the emergency triage organized whole have been reported. PDA has been used recently by nurses in their daily practice.

 

Standardization good turn the National Health Information Infrastructure

The ROC Biological and Medical Plan Association and the Taiwan Sect of Medical Informatics successfully borrowed approvals from the international DICOM and HL7 organizations to grow the members in 2000.

A state "e-Taiwan" program has been promoted by the ministry of Infection to promote the development loom health informatics in Taiwan by reason of 2002.