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Week 6: Informatics and the Development of Standards
EBOOK: McGonigle, D. & Mastrian, K. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett.

Discuss the roles of federal, state, and local public health agencies in the development of standards for informatics in healthcare.

This week in discussion, we will explore informatics and the development of standards. How does the roles of federal, state and local public health agencies help in developing standards for informatics in healthcare. Why is it necessary to have standards of informatics for healthcare?

APA format
2-3 References (One from the book the rest can take what you want)

and the Foundation of

Dee McGonigle, PhD, RN, CNE, FAAN, ANEF
Director, Virtual Learning Experiences (VLE) and
Professor Graduate Program, Chamberlain College of
Nursing Member, Informatics and Technology Expert
Panel (ITEP) for the American Academy of Nursing

Kathleen Mastrian, PhD, RN
Associate Professor and Program Coordinator for
Nursing Pennsylvania State University, Shenango Sr.
Managing Editor, Online Journal of Nursing Informatics


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Library of Congress Cataloging-in-Publication Data
Names: McGonigle, Dee, editor. | Mastrian, Kathleen
Garver, editor.
Title: Nursing informatics and the foundation of
knowledge/[edited by]
Dee McGonigle, Kathleen Mastrian.
Description: Fourth edition. | Burlington, MA: Jones &
Bartlett Learning,
[2018] | Includes bibliographical references and index.
Identifiers: LCCN 2016043838 | ISBN 9781284121247
Subjects: | MESH: Nursing Informatics | Knowledge
Classification: LCC RT50.5 | NLM WY 26.5 | DDC

LC record available at

Printed in the United States of America
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The Pedagogy
Nursing Informatics and the Foundation of
Knowledge, Fourth Edition drives comprehension
through a variety of strategies geared toward meeting
the learning needs of students, while also generating
enthusiasm about the topic. This interactive approach
addresses diverse learning styles, making this the ideal
text to ensure mastery of key concepts. The
pedagogical aids that appear in most chapters include
the following:

Special Acknowledgments
We want to express our sincere appreciation to the
staff at Jones & Bartlett Learning, especially Amanda,
Christina, and Carolyn, for their continued
encouragement, assistance, and support during the
writing process and publication of our book.



1 Nursing Science and the Foundation of
Dee McGonigle and Kathleen Mastrian
Quality and Safety Education for Nurses

2 Introduction to Information, Information
Science, and Information Systems
Kathleen Mastrian and Dee McGonigle
Information Science
Information Processing
Information Science and the Foundation of
Introduction to Information Systems


3 Computer Science and the Foundation of
Knowledge Model
Dee McGonigle, Kathleen Mastrian, and
June Kaminski
The Computer as a Tool for Managing
Information and Generating Knowledge
What Is the Relationship of Computer Science
to Knowledge?
How Does the Computer Support Collaboration
and Information Exchange?
Cloud Computing
Looking to the Future
Working Wisdom
Application Scenario

4 Introduction to Cognitive Science and
Cognitive Informatics
Kathleen Mastrian and Dee McGonigle
Cognitive Science
Sources of Knowledge
Nature of Knowledge

How Knowledge and Wisdom Are Used in
Decision Making
Cognitive Informatics
Cognitive Informatics and Nursing Practice
What Is AI?

5 Ethical Applications of Informatics
Dee McGonigle, Kathleen Mastrian, and
Nedra Farcus
Ethical Issues and Social Media
Ethical Dilemmas and Morals
Ethical Decision Making
Theoretical Approaches to Healthcare Ethics
Applying Ethics to Informatics
Case Analysis Demonstration
New Frontiers in Ethical Issues


6 History and Evolution of Nursing

Kathleen Mastrian and Dee McGonigle
The Evolution of a Specialty
What Is Nursing Informatics?
The DIKW Paradigm
Capturing and Codifying the Work of Nursing
The Nurse as a Knowledge Worker
The Future

7 Nursing Informatics as a Specialty
Dee McGonigle, Kathleen Mastrian, Julie A.
Kenney, and Ida Androwich Introduction
Nursing Contributions to Healthcare
Scope and Standards
Nursing Informatics Roles
Specialty Education and Certification
Nursing Informatics Competencies
Rewards of NI Practice
NI Organizations and Journals
The Future of Nursing Informatics

8 Legislative Aspects of Nursing
Informatics: HITECH and HIPAA

Kathleen M. Gialanella, Kathleen Mastrian,
and Dee McGonigle Introduction
HIPAA Came First
Overview of the HITECH Act
How a National HIT Infrastructure Is Being
How the HITECH Act Changed HIPAA
Implications for Nursing Practice
Future Regulations


9 Systems Development Life Cycle: Nursing
Informatics and Organizational Decision
Dee McGonigle and Kathleen Mastrian
Waterfall Model
Rapid Prototyping or Rapid Application
Object-Oriented Systems Development
Dynamic System Development Method
Computer-Aided Software Engineering Tools

Open Source Software and Free/Open Source

10 Administrative Information Systems
Marianela Zytkowski, Susan Paschke,
Kathleen Mastrian, and Dee McGonigle
Types of Healthcare Organization Information
Communication Systems
Core Business Systems
Order Entry Systems
Patient Care Support Systems
Aggregating Patient and Organizational Data
Department Collaboration and Exchange of
Knowledge and Information

11 The Human–Technology Interface
Dee McGonigle, Kathleen Mastrian, and
Judith A. Effken Introduction
The Human–Technology Interface
The Human–Technology Interface Problem
Improving the Human–Technology Interface

A Framework for Evaluation
Future of the Human–Technology Interface

12 Electronic Security
Lisa Reeves Bertin, Kathleen Mastrian, and
Dee McGonigle Introduction
Securing Network Information
Authentication of Users
Threats to Security
Security Tools
Offsite Use of Portable Devices

13 Workflow and Beyond Meaningful Use
Dee McGonigle, Kathleen Mastrian, and
Denise Hammel-Jones Introduction
Workflow Analysis Purpose
Workflow and Technology
Workflow Analysis and Informatics Practice
Informatics as a Change Agent
Measuring the Results
Future Directions


14 The Electronic Health Record and
Clinical Informatics
Emily B. Barey, Kathleen Mastrian, and Dee
Setting the Stage
Components of Electronic Health Records
Advantages of Electronic Health Records
Standardized Terminology and the EHR
Ownership of Electronic Health Records
Flexibility and Expandability
Accountable Care Organizations and the EHR
The Future

15 Informatics Tools to Promote Patient
Safety and Quality Outcomes
Dee McGonigle and Kathleen Mastrian
What Is a Culture of Safety?
Strategies for Developing a Safety Culture
Informatics Technologies for Patient Safety
Role of the Nurse Informaticist


16 Patient Engagement and Connected
Kathleen Mastrian and Dee McGonigle
Consumer Demand for Information
Health Literacy and Health Initiatives
Healthcare Organization Approaches to
Promoting Health Literacy in School-Aged
Supporting Use of the Internet for Health
Future Directions for Engaging Patients

17 Using Informatics to Promote
Community/Population Health
Dee McGonigle, Kathleen Mastrian,
Margaret Ross Kraft, and Ida Androwich
Core Public Health Functions
Community Health Risk Assessment: Tools for
Acquiring Knowledge
Processing Knowledge and Information to
Support Epidemiology and Monitoring Disease

Applying Knowledge to Health Disaster
Planning and Preparation
Informatics Tools to Support Communication
and Dissemination
Using Feedback to Improve Responses and
Promote Readiness

18 Telenursing and Remote Access
Original contribution by Audrey Kinsella,
Kathleen Albright, Sheldon Prial, and
Schuyler F. Hoss; revised by Kathleen
Mastrian and Dee McGonigle Introduction
The Foundation of Knowledge Model and Home
Nursing Aspects of Telehealth
History of Telehealth
Driving Forces for Telehealth
Telehealth Care
Telehealth Patient Populations
Tools of Home Telehealth
Home Telehealth Software
Home Telehealth Practice and Protocols
Legal, Ethical, and Regulatory Issues

The Patient’s Role in Telehealth
Telehealth Research
Evolving Telehealth Models
Parting Thoughts for the Future and a View
Toward What the Future Holds


19 Nursing Informatics and Nursing
Heather E. McKinney, Sylvia DeSantis,
Kathleen Mastrian, and Dee McGonigle
Introduction: Nursing Education and the
Foundation of Knowledge Model
Knowledge Acquisition and Sharing
Evolution of Learning Management Systems
Delivery Modalities
Technology Tools Supporting Education
Internet-Based Tools
Promoting Active and Collaborative Learning
Knowledge Dissemination and Sharing
Exploring Information Fair Use and Copyright
The Future

20 Simulation, Game Mechanics, and Virtual
Worlds in Nursing Education
Dee McGonigle, Kathleen Mastrian, Brett
Bixler, and Nickolaus Miehl Introduction
Simulation in Nursing Informatics Education
Nursing Informatics Competencies in Nursing
A Case for Simulation in Nursing Informatics
Education and Nursing Education
Incorporating EHRs into the Learning
Challenges and Opportunities
The Future of Simulation in Nursing
Informatics Education
Game Mechanics and Virtual World Simulation
for Nursing Education
Game Mechanics and Educational Games
Virtual Worlds in Education
Choosing Among Simulations, Educational
Games, and Virtual Worlds
The Future of Simulations, Games, and Virtual
Worlds in Nursing Education


21 Nursing Research: Data Collection,
Processing, and Analysis
Heather E. McKinney, Sylvia DeSantis,
Kathleen Mastrian, and Dee McGonigle
Introduction: Nursing Research and the
Foundation of Knowledge Model
Knowledge Generation Through Nursing
Acquiring Previously Gained Knowledge
Through Internet and Library Holdings
Fair Use of Information and Sharing
Informatics Tools for Collecting Data and
Storage of Information
Tools for Processing Data and Data Analysis
The Future

22 Data Mining as a Research Tool
Dee McGonigle and Kathleen Mastrian
Introduction: Big Data, Data Mining, and
Knowledge Discovery
KDD and Research
Data Mining Concepts
Data Mining Techniques
Data Mining Models
Benefits of KDD
Data Mining and Electronic Health Records

Ethics of Data Mining

23 Translational Research: Generating
Evidence for Practice
Jennifer Bredemeyer, Ida Androwich, Dee
McGonigle, and Kathleen Mastrian
Clarification of Terms
History of Evidence-Based Practice
Bridging the Gap Between Research and
Barriers to and Facilitators of Evidence-Based
The Role of Informatics
Developing EBP Guidelines
Meta-Analysis and Generation of Knowledge
The Future

24 Bioinformatics, Biomedical Informatics,
and Computational Biology
Dee McGonigle and Kathleen Mastrian
Bioinformatics, Biomedical Informatics, and
Computational Biology Defined

Why Are Bioinformatics and Biomedical
Informatics So Important?
What Does the Future Hold?


25 The Art of Caring in Technology-Laden
Kathleen Mastrian and Dee McGonigle
Caring Theories
Strategies for Enhancing Caring Presence
Reflective Practice

26 Nursing Informatics and the Foundation
of Knowledge
Dee McGonigle and Kathleen Mastrian
Foundation of Knowledge Revisited
The Nature of Knowledge
Knowledge Use in Practice
Characteristics of Knowledge Workers
Knowledge Management in Organizations

Managing Knowledge Across Disciplines
The Learning Healthcare System




The idea for this text originated with the development
of nursing informatics (NI) classes, the publication of
articles related to technology-based education, and the
creation of the Online Journal of Nursing Informatics
(OJNI), which Dee McGonigle cofounded with Renee
Eggers. Like most nurse informaticists, we fell into the
specialty; our love affair with technology and gadgets
and our willingness to be the first to try new things
helped to hook us into the specialty of informatics. The
rapid evolution of technology and its transformation of
the ways of nursing prompted us to try to capture the
essence of NI in a text.

As we were developing the first edition, we realized
that we could not possibly know all there is to know
about informatics and the way in which it supports
nursing practice, education, administration, and
research. We also knew that our faculty roles
constrained our opportunities for exposure to changes
in this rapidly evolving field. Therefore, we developed a
tentative outline and a working model of the theoretical
framework for the text and invited participation from
informatics experts and specialists around the world.
We were pleased with the enthusiastic responses we
received from some of those invited contributors and a

few volunteers who heard about the text and asked to
participate in their particular area of expertise.

In the second edition, we invited the original
contributors to revise and update their chapters. Not
everyone chose to participate in the second edition, so
we revised several of the chapters using the original
work as a springboard. The revisions to the text were
guided by the contributors’ growing informatics
expertise and the reviews provided by textbook
adopters. In the revisions, we sought to do the

Expand the audience focus to include nursing
students from BS through DNP programs as well as
nurses thrust into informatics roles in clinical
Include, whenever possible, an attention-grabbing
case scenario as an introduction or an illustrative
case scenario demonstrating why the topic is
Include important research findings related to the
topic. Many chapters have research briefs
presented in text boxes to encourage the reader to
access current research.
Focus on cutting-edge innovations, meaningful use,
and patient safety as appropriate to each topic.
Include a paragraph describing what the future
holds for each topic.

New chapters that were added to the second edition
included those focusing on technology and patient
safety, system development life cycle, workflow
analysis, gaming, simulation, and bioinformatics.

In the third edition, we reviewed and updated all of the
chapters, reordered some chapters for better content
flow, eliminated duplicated content, split the education
and research content into two sections, integrated
social media content, and added two new chapters:
Data Mining as a Research Tool and The Art of Caring
in Technology-Laden Environments.

In this fourth edition, we reviewed and updated all of
the chapters based on technological advancements
and changes to the healthcare arena, including
reimbursement mechanisms for services. We have
pared this edition down to 26 chapters from the
previous edition’s 29; one chapter each was deleted
from Sections II, V, and VII. Section I includes
updates to the same five chapters on the building
blocks of nursing informatics, with extensive changes
to Chapter 3, Computer Science and the Foundation of
Knowledge Model. To improve flow, we combined
content. In Section II, the previous four chapters were
narrowed to three. New Chapters 6, History and
Evolution of Nursing Informatics and 7, Nursing
Informatics as a Specialty, were developed and
appropriate material from previous Chapters 6, 7, and
8 were assimilated. This section ends with an updated

Chapter 8, Legislative Aspects of Nursing Informatics:
HITECH and HIPAA (formerly Chapter 9). Section III
contains the same five chapters, although all were
updated and Chapter 13, Workflow and Beyond
Meaningful Use (formerly Chapter 14) now reflects the
payment models and reimbursement issues that we
are adjusting to after meaningful use has gone away.
Section IV contains the same five chapters with
updated content and some name changes to reflect the
current status of informatics and healthcare. Chapter
15 was renamed to Informatics Tools to Promote
Patient Safety and Quality Outcomes, and Chapter 16
has been changed to Patient Engagement and
Connected Health. Section V went from three chapters
to two chapters: Chapter 19 (formerly Chapter 20)
was updated, while the new Chapter 20, Simulation,
Game Mechanics, and Virtual Worlds in Nursing
Education, had content from former Chapters 21 and
22 integrated during its development. Section VI was
renamed to Research Applications of Nursing
Informatics. It still has the same four chapters, which
have been updated, but the first chapter in this section,
21, was renamed to reflect nursing research; its new
name is Nursing Research: Data Collection,
Processing, and Analysis. Section VII went from three
chapters to two chapters. Because emerging
technologies are discussed throughout the text, the
chapter focusing specifically on that was removed. The
two chapters that remain are Chapter 25, The Art of
Caring in Technology-Laden Environments, and the

new Chapter 26, Nursing Informatics and Knowledge
Management. In addition, the ancillary materials have
been updated and enhanced to include competency-
based self-assessments and mapping the content to
the current NI standards.

We believe that this text provides a comprehensive
elucidation of this exciting field. Its theoretical
underpinning is the Foundation of Knowledge model.
This model is introduced in its entirety in the first
chapter (Nursing Science and the Foundation of
Knowledge), which discusses nursing science and its
relationship to NI. We believe that humans are organic
information systems that are constantly acquiring,
processing, and generating information or knowledge
in both their professional and personal lives. It is their
high degree of knowledge that characterizes humans
as extremely intelligent, organic machines. Individuals
have the ability to manage knowledge—an ability that
is learned and honed from birth. We make our way
through life interacting with our environment and being
inundated with information and knowledge. We
experience our environment and learn by acquiring,
processing, generating, and disseminating knowledge.
As we interact in our environment, we acquire
knowledge that we must process. This processing
effort causes us to redefine and restructure our
knowledge base and generate new knowledge. We
then share (disseminate) this new knowledge and
receive feedback from others. The dissemination and

feedback initiate this cycle of knowledge over again, as
we acquire, process, generate, and disseminate the
knowledge gained from sharing and re-exploring our
own knowledge base. As others respond to our
knowledge dissemination and we acquire new
knowledge, we engage in rethinking and reflecting on
our knowledge, processing, generating, and then
disseminating anew.

The purpose of this text is to provide a set of practical
and powerful tools to ensure that the reader gains an
understanding of NI and moves from information
through knowledge to wisdom. Defining the demands
of nurses and providing tools to help them survive and
succeed in the Knowledge Era remains a major
challenge. Exposing nursing students and nurses to
the principles and tools used in NI helps to prepare
them to meet the challenge of practicing nursing in the
Knowledge Era while striving to improve patient care at
all levels.

The text provides a comprehensive framework that
embraces knowledge so that readers can develop their
knowledge repositories and the wisdom necessary to
act on and apply that knowledge. The text is divided
into seven sections.

Section I, Building Blocks of Nursing Informatics,
covers the building blocks of NI: nursing science,
information science, computer science, cognitive

science, and the ethical management of
Section II, Perspectives on Nursing Informatics,
provides readers with a look at various viewpoints
on NI and NI practice as described by experts in the
Section III, Nursing Informatics Administrative
Applications: Precare and Care Support, covers
important functions of administrative applications of
Section IV, Nursing Informatics Practice
Applications: Care Delivery, covers healthcare
delivery applications including electronic health
records (EHRs), clinical information systems,
telehealth, patient safety, patient and community
education, and care management.
Section V, Education Applications of Nursing
Informatics, presents subject matter on how
informatics supports nursing education.
Section VI, Research Applications of Nursing
Informatics, covers informatics tools to support
nursing research, including data mining and
Section VII, Imagining the Future of Nursing
Informatics, focuses on the future of NI,
emphasizes the need to preserve caring functions
in technology-laden environments, and reviews the
relationship of nursing informatics to organizational
knowledge management.

The introduction to each section explains the
relationship between the content of that section and the
Foundation of Knowledge model. This text places the
material within the context of knowledge acquisition,
processing, generation, and dissemination. It serves
both nursing students (BS to DNP/PhD) and
professionals who need to understand, use, and
evaluate NI knowledge. As nursing professors, our
major responsibility is to prepare the practitioners and
leaders in the field. Because NI permeates the entire
scope of nursing (practice, administration, education,
and research), nursing education curricula must
include NI. Our primary objective is to develop the most
comprehensive and user-friendly NI text on the market
to prepare nurses for current and future practice
challenges. In particular, this text provides a solid
groundwork from which to integrate NI into practice,
education, administration, and research.

Goals of this text are as follows:

Impart core NI principles that should be familiar to
every nurse and nursing student
Help the reader understand knowledge and how it
is acquired, processed, generated, and
Explore the changing role of NI professionals
Demonstrate the value of the NI discipline as an
attractive field of specialization

Meeting these goals will help nurses and nursing
students understand and use fundamental NI principles
so that they efficiently and effectively function as
current and future nursing professionals to enhance the
nursing profession and improve the quality of health
care. The overall vision, framework, and pedagogy of
this text offer benefits to readers by highlighting
established principles while drawing out new ones that
continue to emerge as nursing and technology evolve.

We are deeply grateful to the contributors who
provided this text with a richness and diversity of
content that we could not have captured alone. Joan
Humphrey provided social media content integrated
throughout the text. We especially wish to
acknowledge the superior work of Alicia Mastrian,
graphic designer of the Foundation of Knowledge
model, which serves as the theoretical framework on
which this text is anchored. We could never have
completed this project without the dedicated and
patient efforts of the Jones & Bartlett Learning staff,
especially Amanda Martin, Emma Huggard, and
Christina Freitas, all of whom fielded our questions and
concerns in a very professional, respectful, and timely

Dee acknowledges the undying love, support, patience,
and continued encouragement of her best friend and
husband, Craig, and her son, Craig, who has made her
so very proud. She sincerely thanks her cousins
Camille, Glenn, Mary Jane, and Sonny, and her dear
friends for their support and encouragement, especially

Kathy acknowledges the loving support of her family:
husband Chip; children Ben and Alicia; sisters Carol
and Sue; and parents Robert and Rosalie Garver. She
dedicates her work on this edition to her dad, Robert,
who died September 17, 2016. Kathy also
acknowledges those friends who understand the
importance of validation, especially Katie, Lisa, Kathy,
Maureen, Anne, Barbara, and Sally.

Authors’ Note
This text provides an overview of nursing informatics
from the perspective of diverse experts in the field, with
a focus on nursing informatics and the Foundation of
Knowledge model. We want our readers and students
to focus on the relationship of knowledge to informatics
and to embrace and maintain the caring functions of
nursing—messages all too often lost in the romance
with technology. We hope you enjoy the text!

Ida Androwich, PhD, RN, BC, FAAN
Loyola University Chicago
School of Nursing
Maywood, IL

Emily Barey, MSN, RN
Director of Nursing Informatics
Epic Systems Corporation
Madison, WI

Lisa Reeves Bertin, BS, EMBA
Pennsylvania State University
Sharon, PA

Brett Bixler, PhD
Pennsylvania State University
University Park, PA

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