🧠 Health Informatics: Clinical Knowledge & Decision-Making

📌 Role of Knowledge Management in Improving Decision-Making in Clinical and Policy Contexts

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🔷 1. Introduction

In modern healthcare, clinical decisions and policy decisions must be based on accurate, timely, and evidence-based knowledge. Health informatics and knowledge management (KM) ensure that the right knowledge reaches the right people at the right time to improve safety, quality, and outcomes.

✅ “Health informatics transforms raw data into actionable knowledge — empowering smarter decisions at the bedside and the boardroom.”

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🔷 2. What is Clinical Knowledge in Health Informatics?

Clinical knowledge includes:

• Medical facts, guidelines, clinical protocols
• Insights from research, electronic health records (EHRs), and experience
• Risk factors, trends, and outcomes tracked through informatics tools

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🔷 3. What is Knowledge Management (KM)?

Knowledge Management is the process of:

• Collecting (data from EHRs, reports, studies)
• Organizing (using taxonomies, standards)
• Sharing (via digital platforms, dashboards, alerts)
• Applying (in clinical care, policies, and planning)

KM in health informatics ensures that data becomes meaningful knowledge, ready to support decision-making.

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🔷 4. Role of KM in Clinical Decision-Making

KM Contribution	Clinical Impact
📚 Access to guidelines & evidence	Supports evidence-based practice
🧠 Clinical Decision Support Systems (CDSS)	Provides alerts (e.g., drug interactions, vital sign warnings)
📊 EHR analytics	Helps track trends and patterns in patient health
💬 Tacit knowledge sharing	Improves decision-making through case discussions, team rounds
🧾 Protocol standardization	Reduces variability in care and improves safety

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🔷 5. Role of KM in Health Policy Decision-Making

KM Contribution	Policy-Level Impact
📈 Aggregated health data analysis	Informs national health planning (e.g., disease surveillance)
📊 Predictive modeling	Assists in resource allocation and crisis preparedness
📋 Evidence-informed policymaking	Leads to guidelines based on real-time research and outcomes
🌐 Global knowledge sharing	Promotes adoption of best practices and international standards

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🔷 6. Health Informatics Tools Supporting KM & Decision-Making

Tool	Function
📋 EHR systems	Store, retrieve, and analyze patient histories
💊 CDSS	Provides alerts and care recommendations
📚 Clinical databases (e.g., Cochrane, UpToDate)	Support clinicians with current research
📊 Dashboards and BI tools	Help policy-makers visualize trends and make strategic decisions
🧠 AI & NLP engines	Extract insights from unstructured data like clinician notes

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🔷 7. Benefits of Knowledge-Driven Decision-Making

Benefit	Clinical	Policy
✅ Accuracy	Safer diagnoses and treatments	Evidence-based regulations
✅ Speed	Rapid clinical responses	Quicker public health actions
✅ Efficiency	Less redundancy, better workflows	Smarter budgeting and planning
✅ Patient-Centeredness	Personalized care plans	People-focused health programs

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🔷 8. Challenges in KM Implementation

• 💻 Fragmented systems and data silos
• ❌ Lack of training in data interpretation
• 🔒 Privacy and data security issues
• ⏱️ Time constraints for busy clinicians
• 🧩 Difficulty translating complex data into actionable policy

Health informatics, empowered by effective knowledge management, plays a crucial role in making both clinical and policy decisions accurate, evidence-based, and patient-centered. It ensures that valuable knowledge is not lost, overlooked, or delayed — but transformed into timely action.

🌟 “Smart systems + shared knowledge = safe decisions, healthier people.”

🗂️ Standardized Languages Used in Health Informatics

✳️ Systematized Nomenclature of Medicine (SNOMED CT) and Beyond

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🔷 1. Introduction

In health informatics, standardized languages are essential to ensure that health data is understood, shared, and used consistently across different systems, providers, and locations. These languages transform medical terms into uniform, computable codes, enabling interoperability and data accuracy in Electronic Health Records (EHRs), decision support, and analytics.

✅ “Without a common language, systems can’t speak — and care can’t connect.”

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🔷 2. Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT)

🧠 What is SNOMED CT?

• SNOMED CT is the most comprehensive, multilingual clinical healthcare terminology in the world.
• Developed and maintained by SNOMED International.
• Contains hundreds of thousands of concepts covering diseases, symptoms, procedures, body structures, medications, organisms, and more.

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🔧 Purpose of SNOMED CT

• Enable consistent representation of clinical content in EHRs.
• Facilitate data exchange and integration across healthcare settings.
• Support decision support systems, research, and health statistics.
• Improve semantic interoperability — meaning data has the same meaning across systems.

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📋 Example:

Concept	SNOMED CT Code
Diabetes mellitus type 2	44054006
Blood pressure measurement	75367002
Shortness of breath	267036007

🗂️ These codes ensure that systems interpret the meaning exactly the same, no matter what language or platform is used.

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✅ Benefits of SNOMED CT

• ✅ Reduces ambiguity in clinical documentation
• ✅ Enhances data retrieval and analysis
• ✅ Enables safer, faster decision-making
• ✅ Facilitates global research and reporting
• ✅ Supports personalized care by linking data points logically

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🔷 3. Other Standardized Languages in Health Informatics

Standard	Purpose	Example
ICD (International Classification of Diseases)	Classifies diseases for mortality, morbidity, and billing	ICD-10 code I10 for hypertension
LOINC (Logical Observation Identifiers Names and Codes)	Standardizes lab tests and clinical observations	LOINC 4548-4 for blood glucose
RxNorm	Normalizes names for clinical drugs and their ingredients	Acetaminophen 500mg tablet
CPT (Current Procedural Terminology)	Used for billing and procedures (mainly in the US)	CPT 99213 for outpatient visits
UCUM (Unified Code for Units of Measure)	Ensures standardized representation of units	mg/dL, mmHg

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🔷 4. Role of Standardized Languages in Health Informatics

Application	Impact
🏥 EHR documentation	Ensures accurate and consistent entries
🔄 Interoperability	Enables systems to communicate and exchange information
💊 Medication safety	Avoids errors in prescriptions and allergies
📊 Data analysis and research	Enables population health monitoring and clinical studies
🌐 Global health reporting	Supports WHO, CDC, and national registries

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SNOMED CT and other standardized languages form the linguistic backbone of health informatics. They enable data to be accurate, computable, and sharable, which is critical for safe care, informed decisions, and effective health system management.

🌟 “Informatics is only as powerful as the language it speaks — and standardized terminologies give healthcare a universal voice.”

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📘 Standardized Languages Used in Health Informatics

🧩 Clinical Terms, SNOMED CT, and SNOMED CT to ICD-10-CM Mapping

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🔷 1. Introduction

In health informatics, standardized clinical terminologies ensure that medical data is consistently recorded, interpreted, and shared across healthcare systems. Two of the most widely used standards are:

• SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms)
• ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification)

A mapping between these two enhances interoperability, billing, coding, and clinical documentation.

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🔷 2. SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms)

✅ Overview:

• A comprehensive, multilingual clinical vocabulary used to represent diagnoses, symptoms, procedures, findings, and more.
• Designed for detailed clinical documentation in Electronic Health Records (EHRs).
• Maintained by SNOMED International.

🔹 Example:

Clinical Term	SNOMED CT Code
Asthma	195967001
Migraine	37796009

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🔷 3. ICD-10-CM (International Classification of Diseases – Clinical Modification)

✅ Overview:

• A coding system used primarily for morbidity reporting, billing, and administrative purposes.
• Maintained by WHO (core ICD-10) and NCHS (for ICD-10-CM in the US).
• Less detailed than SNOMED CT, but widely used for reimbursement and epidemiology.

🔹 Example:

Diagnosis	ICD-10-CM Code
Asthma, unspecified	J45.909
Migraine without aura	G43.0

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🔷 4. SNOMED CT to ICD-10-CM Mapping

🧭 Purpose of Mapping:

• Translates clinically rich SNOMED CT entries into standard ICD-10-CM codes for:
  • Billing and claims
  • Public health reporting
  • Statistical analysis

🔄 One-to-Many and Many-to-One Relationships:

• A single SNOMED CT concept may map to multiple ICD-10-CM codes depending on context.
• Some ICD-10-CM codes may correspond to broad categories that cover multiple SNOMED CT terms.

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🔹 Mapping Example:

Clinical Concept	SNOMED CT Code	Mapped ICD-10-CM Code
Essential Hypertension	59621000	I10
Type 2 Diabetes Mellitus	44054006	E11.9
Acute Appendicitis	74400008	K35.80

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🔷 5. Benefits of Using Standardized Terminologies and Mapping

Benefit	Explanation
🔄 Interoperability	Enables seamless data sharing across systems and countries
📝 Accurate Documentation	Enhances clarity and completeness in patient records
💰 Billing & Reimbursement	Automatically maps detailed clinical documentation to billing codes
📈 Epidemiological Reporting	Assists in population health tracking and surveillance
📊 Analytics & Research	Improves quality of health data for decision-making and study
✅ Clinical Decision Support	Supports alerts and guidelines based on coded data

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🔷 6. Challenges in Mapping

• ❗ Context sensitivity – Mapping may vary based on clinical context or severity
• 🧩 Granularity mismatch – SNOMED CT is often more specific than ICD-10-CM
• 🔄 Maintaining up-to-date maps – Both systems are updated regularly and need synchronized revisions
• ❌ One-to-many relationships – Some SNOMED terms may not have exact ICD matches

The use of standardized languages like SNOMED CT and ICD-10-CM — and the mapping between them — is essential to bridge the gap between clinical care and administrative requirements. This ensures that health information is accurate, sharable, and usable across systems, settings, and borders.

🌟 “Standardized clinical terminologies make healthcare data meaningful — and mapping connects the clinical world to the administrative one.”

📘 Standardized Nursing Terminologies

✳️ Focus on NANDA-I and NOC

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🔷 1. Introduction

Standardized nursing terminologies (SNTs) are systems of terms used to clearly and consistently describe nursing care. They ensure that nursing assessments, diagnoses, outcomes, and interventions are uniformly documented, communicated, and analyzed in health information systems (like Electronic Health Records – EHRs).

✅ “Standardized terminologies allow nursing care to be visible, measurable, and evidence-based.”

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🔷 2. What is NANDA-I?

(North American Nursing Diagnosis Association – International)

• NANDA-I provides standardized nursing diagnoses — statements that describe actual or potential health problems that nurses are licensed to treat.
• Each diagnosis follows a PES format:
  • P – Problem (nursing diagnosis)
  • E – Etiology (related factors)
  • S – Signs/Symptoms (defining characteristics)

🔹 Example:

• Diagnosis: Impaired physical mobility
• Code: 00085
• Related to: pain
• As evidenced by: difficulty turning in bed

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🔷 3. What is NOC?

(Nursing Outcomes Classification)

• NOC provides a standardized set of patient outcomes that reflect the effectiveness of nursing interventions.
• Each outcome includes:
  • A label (e.g., Mobility Level)
  • Indicators to measure progress
  • A 5-point Likert scale for rating

🔹 Example:

• Outcome: Mobility Level
• Code: 0208
• Indicators: Walks with assistance, turns in bed independently

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🔷 4. Relationship Between NANDA-I and NOC

NANDA-I (Diagnosis)	NOC (Outcome)
Impaired physical mobility	Improved mobility level
Ineffective breathing pattern	Respiratory status: Airway patency
Risk for infection	Infection severity, Infection status

This linkage allows care planning, intervention selection, and outcome evaluation to be clearly structured and documented.

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🔷 5. Benefits of Using NANDA-I and NOC

Benefit	Explanation
✅ Consistency	Ensures uniform documentation and care planning
✅ Visibility of Nursing	Makes nursing contributions measurable and trackable
✅ Supports EHRs	Facilitates integration into digital systems and care pathways
✅ Research & Quality Improvement	Enables analysis of outcomes linked to nursing care
✅ Improved Communication	Standardizes language among nursing teams and healthcare providers

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NANDA-I and NOC are essential components of standardized nursing terminologies. They enhance clinical reasoning, patient care documentation, and nursing accountability — and they are crucial for modern, evidence-based, and informatics-driven nursing practice.

🌟 “What gets named gets noticed; what gets measured gets improved.”

🗂️ Omaha System

📌 A Standardized Terminology for Community and Public Health Nursing

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🔷 1. Introduction

The Omaha System is a research-based, comprehensive standardized taxonomy used by nurses and other health professionals to document and evaluate client care, particularly in community, home health, and public health settings.

✅ “The Omaha System bridges clinical care with community practice—making health interventions measurable and meaningful.”

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🔷 2. Origin and Purpose

• Developed in the 1970s by the Visiting Nurse Association of Omaha, Nebraska, USA
• Recognized by the American Nurses Association (ANA) as a standardized nursing terminology
• Used in electronic health records (EHRs), quality improvement, case management, research, and outcomes monitoring

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🔷 3. Components of the Omaha System

The Omaha System has three integrated components, forming a complete framework:

🧩 A. Problem Classification Scheme (PCS)

– Used for assessment and care planning

Domains:

1. Environmental (e.g., income, residence)
2. Psychosocial (e.g., mental health, relationships)
3. Physiological (e.g., pain, circulation, nutrition)
4. Health-related behaviors (e.g., hygiene, medication regimen)

🧩 B. Intervention Scheme

– Describes nursing actions and services

4 Categories of Actions:

1. Teaching, Guidance, and Counseling
2. Treatments and Procedures
3. Case Management
4. Surveillance

Each intervention is linked to a target (e.g., pain management, health promotion).

🧩 C. Problem Rating Scale for Outcomes (PRSO)

– Used to evaluate client progress over time

3 Ratings (1–5 scale):

• Knowledge – What the client knows
• Behavior – What the client does
• Status – Condition of the client related to the problem

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🔷 4. Example of Omaha System in Use

Case: A community health nurse is caring for a diabetic patient living alone.

Problem	Health-related behavior: Diet
Intervention	Teaching on diabetic meal planning
Outcomes	Knowledge (3 → 5), Behavior (2 → 4), Status (2 → 4)

This example shows progress through education and follow-up.

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🔷 5. Benefits of the Omaha System

Benefit	Explanation
✅ Holistic View	Covers social, environmental, and behavioral factors
✅ Supports Continuity	Used across settings: home, community, public health
✅ Interdisciplinary Use	Can be used by nurses, social workers, therapists
✅ Outcome-Focused	Tracks knowledge, behavior, and status changes
✅ EHR Integration	Compatible with digital health record systems
✅ Quality Improvement	Supports data collection for audits, QI, and research

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🔷 6. Settings Where It’s Used

• 🏠 Home Health Care
• 🌍 Community/Public Health
• 🏥 Ambulatory & School Health
• 📊 Research & Evaluation Projects
• 🧑‍⚕️ Interdisciplinary Team Care

The Omaha System is a powerful tool for delivering, documenting, and evaluating care—especially in non-hospital settings. Its structured approach allows for individualized care planning, evidence-based interventions, and measurable outcomes, making it invaluable in both clinical and community practice.

🌟 “The Omaha System gives structure to compassion—making community care scientifically strong and humanly centered.”