``Brief History of Nursing Informatics in

Canada ``
"Registered nurses need to be able to
demonstrate their unique contribution to the
health of Canadians within Canada's rapidly
evolving health care system. Basic, essential
nursing information is required by nurses,
employers, researchers, educators, policy
makers, and clients so that informed decisions
can
be
made
about nursing's role in the changing health care
system,"

- Canadian Nurses' Association, 1993:

Policy Statement on Health Information:
Nursing Components,

The CNA wrote this policy statement to highlight the

importance of developing the nursing data components
that will be included in our emerging national health
information system.

The CNA has also spearheaded an initiative, the

National Nursing Informatics Project, to begin to develop
a national consensus on definition, competencies, and
educational strategies and priorities.

The use of technology in nursing is not new, in fact

nurses have become proficient in utilizing and adapting
complex technology into caring nursing practice for
decades, at least since the time of Florence Nightingale
in the United Kingdom and even earlier, when Jeanne
Mance (1606-1673) founded the first hospital in
Montreal,Canada in 1642.

Various forms of machinery such as ventilators and

physiological monitors were first used in intensive and
critical care settings, and are now currently used in
adapted form in less acute areas, even in home care.

Nursing has evolved significantly over the past few

decades, with many of the changes being driven by
advances in information and communication technology
(ICT).

ICT has permeated all aspects of society, including

health care and affects all members of the
interdisciplinary health team.

Since nurses are the largest group of health care

providers, discipline-specific competencies in the use of
ICT and other technologies are imperative.

Nurses in Canada have made an enormous contribution

to all aspects of Canadian society. Their involvements
have influenced the wider social, economic and political
history of Canada, as well as the history and politics of
health care. Nursing history provides the public with
valuable perspectives on emerging technologies, health
care reform and gender issues in Canadian history
(Canadian Nurses Association, 2004, p. 2).

Nursing informatics began to evolve as nurses

participated in the early initiatives in hospital information
system adoption in various health agencies across the
nation. As these systems improved, specialized nursing
components and even free-standing nursing information
systems began to sprout up.

Early systems were primarily imported from other

countries, especially the USA.

By the late 1980s, most hospitals had at least a

rudimentary information system that required nurses to
enter common data such as admission profiles and
basic care requirements like diet, medications, and
treatments into a computer as part of their routine duties.

The National Nursing Informatics

Project

In 1998, the Canadian Nurses Association

spearheaded another initiative, the National
Nursing Informatics Project, to begin to develop a
national consensus on definition, competencies,
and educational strategies and priorities in nursing
informatics development.

The first phase of the project was the development

of a Discussion paper in 1999, and the collection of
feedback on key issues related to nursing
informatics competencies development from
Canadian nurses.

Nursing Minimum Data Set

The Nursing Minimum Data Set was the first major

Canadian Nurses Association informatics initiative
beginning in 1990. This was in response to the
strong conviction that nursing data must be
included in the centralized national health data
system being planned by the Canadian Institute of
Health Information (CIHI)

Raising Canadian Nursing

Awareness

The Canadian Nurses Association released a

number of other supportive documents in 2001.
A key one was published in the September Nursing
Now Bulletin, entitled: What is Nursing Informatics
and why is it so important? This publication was a
critical overview of the essential characteristics of
the emerging field of nursing informatics in
Canada.
It also introduced a definition of nursing
informatics, formulated by the National Nursing
Informatics Project working group.

The CIHI helped introduce the Strategic Plan for Health

Information Management in British Columbia in 1996
that provides guidelines for holistic assessment and
processing of information.

In 1999, a second edition of these guidelines was

produced, which incorporated issues related to the
advancement of health information and technology.

In 2002, an updated version Privacy and Confidentiality

of Health Information at CIHI: Principles and policies for
the protection of health information

In March 2000, the CIHI published an updated version of

the Roadmap Initiative a national vision and four-year
action plan to modernize Canada's health information
system.

Led by CIHI, this Initiative is a collaborative effort with

Statistics Canada, Health Canada and many other
groups at the national, regional and local levels.

the Canadian Organization for the Advancement of

Computers in Health or COACH, founded in 1975, has
actively initiated professional protocols for using
computer systems in Canadian health care.

In 2001, COACH, as Canada's Health Informatics

Association, launched the Patron Program.

In February 1999 the Canadian Federal government

published the timely document, Strengthening Health
Care for Canadians, outlining new initiatives and funding
to promote health care technology and informatics
initiatives.

The Canadian Nursing

Informatics Association

In 2001, a new group, the Canadian Nursing

Informatics Association (CNIA) received
emerging group status from the CNA and affiliate
status in 2003.

The CNIA now has full associate status with the

CNA.

The CNIA has a website and the executive board

encourages new members, including student
members.

Canadian Nursing Informatics

Association(CNIA)
exists to help nurses across Canada to
learn, share, research, and create
informatics-related projects and
experiences that can help to boost the
competencies, theory, and practice of
informatics on a national level.

Canadian Nursing Informatics

Association

Mission

~To be the voice for Nursing Informatics in

Canada. The CNIA is the culmination of
efforts to catalyze the emergence of a new
national association of nurse
informaticians.

Goals
To provide nursing leadership for the
development of Nursing/Health informatics
in Canada.
To establish national networking
opportunities for nurse informaticians.
To facilitate informatics educational
opportunities for all nurses in Canada.

 To engage in international nursing

informatics initiatives.
To act as a nursing advisory group in
matters of nursing and health informatics.
To expand awareness of Nursing
Informatics to all nurses and the
healthcare community.

Nursing Informatics

In 2009, IMIA-NI redefined nursing

informatics as " Nursing Informatics science
and practice integrates nursing, its
information and knowledge and their
management with information and
communication technologies to promote the
health of people, families and communities
world wide" at NI 2009 and encouraged all of
its members, including CNIA to use this
definition.

Health informatics

Health Informatics projects in Canada

are implemented provincially, with
different provinces creating different
systems.

A national, federally-funded, not-for-profit

organization called Canada Health
Infoway was created in 2001 to foster the
development and adoption of electronic
health records across Canada. As of
December 31, 2008 there were 276 EHR
projects under way in Canadian hospitals,
other health-care facilities, pharmacies
and laboratories, with an investment value
of $1.5-billion from Canada Health
Infoway.

Provincial and territorial programs

include the following:

eHealth Ontario was created as an

Ontario provincial government agency
in September 2008. It has been
plagued by delays and its CEO was
fired over a multimillion-dollar
contracts scandal in 2009.

Alberta Netcare was created in 2003 by

the Government of Alberta. Today the
netCARE portal is used daily by
thousands of clinicians. It provides access
to demographic data,
prescribed/dispensed drugs, known
allergies/intolerances, immunizations,
laboratory test results, diagnostic imaging
reports, the diabetes registry and other
medical reports.

netCARE interface capabilities are

being included in electronic medical
record products which are being
funded by the provincial government.

Canadian Institute for Health

Information (CIHI)
CIHI plans to establish an expert working
group to review many of the issues
relating to nursing workload measurement
systems and to make recommendations
regarding future developments and
implementation efforts.

Classification Standard for

Health Interventions
CIHI completed the development of a new
Canadian Classification for Health
Interventions (CCI) that is currently being
implemented in a number of provinces.

 The classification contains a

comprehensive list of diagnostic,
therapeutic, support and surgical
interventions, allowing for the standardized
collection of health interventions,
regardless of the service provider or
service setting.

Classification Standard for

Health Conditions
To accompany the CCI, CIHI also
enhanced the new version of the
International Statistical Classification of
Diseases and Related Health Problems,
Tenth Revision for Canadian use (ICD-10CA).

Nurses provided input to the development

of both the CCI and ICD-10-CA.CIHI plans
to maintain both classifications on an
ongoing basis to ensure their continued
relevancy and utility to the field.

Client Outcomes
Ontario Nursing and Health Outcomes
Project has done significant work in
identifying client outcomes that are
sensitive to nursing.

 The client outcomes that have been

identified to date include: functional status,
self-care, symptom control (dyspnea,
nausea, fatigue, pain), patient satisfaction
with nursing care, adverse occurrences
such as nosocomial infections, patient falls
and decubitus ulcers.

 Future plans include developing pilot

projects in acute, long-term and
community care.

Privacy, confidentiality and

security of health information
Nurses have identified the protection of
personal health information as a critical
issue in the context of rapidly evolving
health information technologies.

 Individuals and organizations responsible

for the development of systems designed
to collect, process, store, and share health
information have a responsibility to ensure
that these systems are secure in order to
maintain the integrity and confidentiality of
personal information.

The Code of Ethics for Registered

Nurses (CNA, 1997)
states that nurses safeguard the trust of
clients that information learned in the
context of a professional relationship is
shared outside the health care team only
with the clients permission or as legally
required. Finally, security refers to the
procedures and technologies that are used
to restrict access to, and maintain the
integrity of health information.