Canadian Journal of Nursing Informatics

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This article was written on 05 Apr 2019, and is filled under Current Issue, Volume 14 2019, Volume 14 No 1.

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Healthcare Data as Content

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Nurse Developer Column

by Raymund John Ang, RN, MAN

Raymund is a medical-surgical RN with an interest in health informatics. He graduated with a BSN degree from the University of St. La Salle, and earned his Master of Arts in Nursing degree from the University of the Philippines Open University. He is currently the project lead of the Open Nursing Information System (Open-NIS) Project – with the aim of democratizing web application development for health professionals, especially nurses, using open source platforms, like WordPress.

COLUMN

Healthcare data

When nurses are first introduced to electronic medical records (EMR) in the hospital or clinical setting, they see a system for interdepartmental collaboration: a section for nurse’s notes or documentation, a module for physicians doing order entries, an area for pharmacy to track medications given to patients, or an interactive view of patient’s laboratory and diagnostic test results. The workflow of healthcare professionals using EMRs are generally data-driven, and based on the architecture or design implemented by the software vendor. But no matter which vendor developed the EMR, storage and manipulation of healthcare data is a crucial function that these systems address.

Data storage and manipulation are within the boundaries of database management systems. These systems allow, or restrict, the access of databases to certain applications based on privileges. EMRs may be complex healthcare systems, but the underlying philosophy is the same as with any other database-driven application. The application may be written in a particular programming language, like Java, C#, Python or PHP, but the purpose is still the same – gain access and manipulate the database while ensuring security and performance.

For nurses who are thinking of creating healthcare applications to improve nursing workflow, specifically web-based applications, learning programming might be a daunting task. Aside from becoming familiar with the syntax and data types, the nurse must also learn how to prepare the development environment suitable for programming in a particular language, plus the needed software dependencies to make the program run. For those who are really interested and passionate in learning programming, this may not be an issue. But for those nurses who want to create applications but do not want to go into the intricacies of learning a programming language and coding from scratch, these activities could be a push back.

A more suitable way of building web applications for nurses who do not have the time (or patience) to study programming is to use Content Management Systems or CMS as application development platforms. Barker (2016) described content management system as a software stack used to efficiently manage content saved in a repository through a multiuser approach. Content management systems, as the term implies, are systems designed to manage content using role access and capabilities without having to code from scratch. Instead of building the user interface, establishing database connection, user and role management, and content management itself from the ground up, nurses can set up a CMS, like WordPress on their computers and start developing applications based on their workflow requirements.

When developing applications with a CMS as application development platforms, the nurse should be aware how content is defined. For WordPress, content is defined as a “post”; for Joomla, it is defined as an “article”; and for Drupal, content is defined as a “node”. The manner by which content is specified by any CMS is important since this is how healthcare data will be stored in the application – as content. It is possible to use these CMSs as development platforms and not have to define data as content, but this will introduce incompatibilities with other plugins, modules or extensions designed for these CMSs. This will certainly limit the available options, and doing so would mean the nurse developer needs to learn how to program in code.

Among the three widely used CMS platforms, WordPress is, perhaps, the most popular and may be the easiest to configure and work with. For a nurse informaticist using WordPress as an application development platform, healthcare data is treated as a “post” and differentiated using “custom post types”. For example, in the application the nurse developer may want to build, patients are treated as posts with a post type of “patient”. The doctors are considered posts with a post type of “doctor”. Doctor’s orders are defined as posts with a post type of “orders”. Data attributes or properties, such as gender, birthdate, reason for admission can be stored as custom fields and saved either in an entity-attribute-value (EAV) model using the postmeta table or a normalized relational model using a separate table for each post type. Though this is not the only way of storing and defining data within WordPress, it is how content is defined, and attributes or properties extended and stored. Working within the WordPress ecosystem means the nurse is able to use most themes and plugins which are created with the default WordPress configuration in mind.

References

Barker, D. (2016). Web Content Management: Systems, Features, and Best Practices. Sebastopol, CA: O’Reilly Media, Inc.

Shivakumar, S. K. (2017). Enterprise Content and Search Management for Building Digital Platforms. New Jersey: John Wiley & Sons, Inc.


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