NURSING INFORMATICS TECHNOLOGY (Part 1) Six Time Period

1. Prior to 1960s
a. Computers were first developed in the late 1930s to early 1940s
“Computers are incredibly fast, accurate and stupid.
b. Use in the healthcare industry occurred in the 1950s and 1960s
Human beings are incredibly slow, inaccurate and brilliant. c. Computers were initially used in healthcare facilities for basic office
Together they are powerful beyond imagination” administrative and financial accounting functions.
- Albert Einstein d. Punch Card – A piece of stiff paper that contain digital information
represented by holes in predefined position
e. Card Reader – Read data from a card shape storage medium
Historical Perspective of Nursing and Computers 2. 1960s
Why Do We Need to Study NI? a. Computer technology in healthcare settings were being explored
• In the 21st Century, information is doubling every 5 years, if not tripling in b. Questions arise:
quantity and quality i. Why Computers?
• Technology facilitates the creative process in nurses, the daily work of nursing ii. What should be computerized?
professionals is being strongly influenced by informatics, with particular c. Nursing practice standards were reviewed, and nursing resources
attention to the accuracy and communication of patient data and care were analyzed
• As technology advances, healthcare organizations and providers are able to d. Hospital Information Systems were developed primarily to process
collect, analyze and leverage data more effectively, influencing the way care financial transactions and serve as billing and accounting systems
is delivered e. Vendors of computer systems were beginning to enter the health
care field
f. The nurses’ stations in the hospitals were viewed as the hub of
What is Nursing Informatics (NI)?
information exchange
• Derived from the French word “informatics” which referred to the field of g. Introduction of Cathode Ray Tube (CRT), online data
applied computer science concerned with information processing (in this communications and real time processing
case, nursing information) 3. 1970s
• 2001— American Nurses Association (ANA) defined Nursing Informatics as: a. Hospitals began developing computer-based information systems
o “A specialty that integrates nursing science, computer science, and i. Physician order entry and results reports
information science to manage and communicate data, ii. Pharmacy reports
information, and knowledge in nursing practice. Nursing informatics iii. Laboratory reports
facilitates the integration of data, information, and knowledge to iv. Radiology reports
support patients, nurses, and other providers in their decision-making v. Information for financial and managerial purposes
in all roles and settings. This support is accomplished through the use vi. Physiologic monitoring systems in the intensive care units
of information structures, information processes, and information vii. Started to include care planning, decision support, and
technology.” interdisciplinary problem lists.
b. Hospital Information Systems further advanced
Relationships and Interrelationships of Computer Literacy, Information Literacy and c. Computer–based Management Information System (MIS) in public
Nursing Informatics health was developed for statistical purposes.
• Nursing Science 4. 1980s
o A branch of science that deals with the principles and applications of a. Nursing Informatics (NI) emerged
nursing and related services b. Nursing profession need to update its practice standards and
• Computer Science determine its data standards, vocabularies, and classification
o Is the study of computers and computational systems schemes that could be used for the Computer-based Patient Record
• Information Science Systems (CPRS)
o Is a field primarily concerned with the analysis, collection, c. Microcomputers / Personal Computers emerged to bring computing
classification, manipulation, storage, retrieval, movement, power to workplace. Mostly served as stand-alone system.
dissemination, and protection of information. d. Many mainframe healthcare information systems emerged with
nursing subsystems:
i. Order Entry (like Kardex)
4 Major Historical Perspectives of Nursing and Computers ii. Results reporting
1. Six Time Period iii. Vital signs
2. Four Major Nursing Areas iv. Narrative nursing notes
3. Standard Initiatives v. Discharge planning system
4. Significant Landmark Events

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 5. 1990s Computers in Nursing Research
a. Computer technology become an integral part of healthcare • Computerized current literature searching on a specific problem and its
settings, nursing practice and the profession related concepts
b. NI was approved by ANA as a new nursing specialty • Search literature for instruments that have already been established or to
c. Demand for NI specialty increased greatly design and test instruments that need to be developed for past study
d. Laptops and notebooks were utilized at bedside and all point-of-care • Create form for the collection of data such as informed consent,
settings demographic data, and recording forms
e. Local Area Network (LAN) were developed in hospitals and Wide • Speeds completion or research projects
Area Network (WAN) were used to link care across healthcare
facilities
f. Internet is widely used and helped information and knowledge Computers in Nursing Administration
databases to be integrated into bedside systems • Administrators can use employee databases to communicate with employees,
g. Web became the means to communicate online services and examine staffing patterns, staff scheduling, and create budget programs
resources to the nursing community • Client records to be searched for trends, number of cases, most expensive
6. Post 2000 cases, and client outcomes
a. Developed of wireless point-of-care system with focus on open • Computer controlled heating, air conditioning, ventilation, and alarm systems
source system
b. Clinical Information System (CIS) became the individualized in the Standard Initiatives
Electronic Patient Record (EPR) and patient specific systems
1. Nursing Practice Standards
considered for lifelong longitudinal record for the Electronic Health
• The ANA is considered as the official nursing organization that
Record (EHR)
contributes in the development and recommendation of standards
c. Mobile technology advances:
of nursing practice worldwide. ANA published:
i. Wireless tablet computers
i. Nursing: Scope and Standards of Practice (ANA, 2008)
ii. Personal Digital Assistants (PDAs)
ii. Nursing Informatics: Scope and Standards of Practice (ANA,
iii. Smartphones
2010)
iv. Voice Over Internet Protocol (VOIP)
2. Nursing Education Standards
v. Health Smartcards
• The National League for Nursing (NLN) has been the primary
d. Telenursing became popular
professional organization that accredits undergraduate nursing
i. Remote monitoring of ICU patients and community patients
programs.
i. The NLN’s Nursing Forum on Computers in Healthcare and
Major Areas of Nursing Nursing (NFCHN) was formed in 1985.
• Nursing Practice • The American Association of Colleges of Nursing (AACN), which also
• Nursing Education accredits nursing education programs
• Nursing Research i. Revised the Essentials for Doctoral Education for Advanced
• Nursing Administration Nursing Practice (AACN, 2006) and
ii. The Essentials of Baccalaureate Education for Professional
Nursing Practice (AACN, 2011)
Computers in Nursing Practice 3. 3. Nursing Content Standards
• Point-of-Care systems and Clinical Information Systems • 1893 - Standardization of healthcare data began
o Work lists to remind staff of planned nursing interventions i. List of International Causes of Death for the reporting of
o Computer generated client documentation morbidity cases worldwide - (World Health Organization,
• Bedside Data Entry 1992)
o Records clients assessments, medication administration, progress • 1955 - Virginia Henderson published her 14 Daily Patterns of Living as
notes, care plan updating, client acuity and accrued charges the list of activities and conditions that became the beginning of
• Electronic Medical Record (EMR) and Computer-Based Patient Record (CPR) nursing practice standards
o Provides easy retrieval of specific data such as trends in vital signs, • 1959 - standardization of nursing began
immunization records, current problems i. Florence Nightingale’s six Cannons in her “Notes on Nursing”
• 1970 - ANA accepted the Nursing Process as the professional
Computers in Nursing Education standards for nursing practice
• 1973 - standardization of nursing content— data elements
• Computerized record keeping
• Currently, the ANA has “recognized” 12 nursing terminologies. They
• Computerized assisted Instructions
ANA selected six of the ANA “recognized” nursing languages for
• Interactive Video Technology
inclusion in the:
• Distance learning
i. National Library of Medicine’s (NLM)
• Testing (NCLEX)
• Student and course record management
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 ii. Metathesaurus of the Unified Medical Language System
(UMLS)
iii. Systematized Nomenclature of Medicine—Clinical Terms
(SNOMED-CT)
• 2002 - SNOMED-CT became the International Health Terminology
Standards Development Organization (IHTSDO)
Major Events for Nursing Informatics Community
A. Conferences and Workshops
▪ American Medical Informatics Association (AMIA) Annual Symposium
▪ Healthcare Information and Management and Systems Society
(HIMSS) Annual Conference and Exhibition
▪ Annual Summer Institute in Nursing Informatics (SINI) at University of
Maryland, Baltimore, MD
▪ Annual Rutgers State University of New Jersey College of Nursing:
Nursing and Computer Technology Conference
▪ Annual American Academy of Nursing
▪ Sigma Theta Tau International: Bi-Annual Conference
▪ Nursing Informatics Special Interest Group of the International
Medical Informatics Association (IMIA/NI-SIG): Tri-Annual Conference
▪ International Medical Informatics Association (IMIA): Triennial
Congress
B. Professional Councils and/or Committees
▪ American Nurses Association (ANA) - Nursing Informatics Database
Steering Committee
▪ National League for Nursing (NLN) - Educational Technology and
Information Management Advisory Council (ETIMC)
▪ American Academy of Nursing (AAN) - Expert Panel of Nursing
Informatics
C. Credentialing/Certification/Fellowship
▪ American Nurses Association (ANA); American Nurses Credentialing
Center (ANCC) - Informatics Nursing Certification
▪ Healthcare Information and Management and Systems Society
(HIMSS) - Certified Professional in Healthcare Information
Management and Systems (CPHIMS)
Landmark Events in Computers and Nursing, and Nursing Informatics
• For full list, please refer to: “Essentials of Nursing Informatics” 6th Ed. by: Virginia
K. Saba and Kathleen A. McCormick. Table 1.2, pages: 12-20.
Nursing Informatics in the Philippines: History and Present Educational Situation
• 1996 – Philippine Medical Informatics Society (PMIS) was established and had a
strong influence in the development of health informatics in the Philippines
• 1998 – faculty members of the University of the Philippines began formal
education and training in medical informatics and information science.
• 1999 – Standards of Health Information of the Philippines 1999 (SHIP99) was
established. It was headed by National Institute of Health of the UP Manila with
the collaboration of Philippine Nurses Association
• 2005-2006 – Health Informatics was offered by UP- Manila College of Medicine
(major in medical informatics) and College of Arts and Sciences (major in
bioinformatics)
• 2008 – Commission on Higher Education (CHED) Memorandum 5 Series of 2008
defined Nursing Informatics course in the undergraduate curriculum
• 2009 – This was later revised and included as Health Informatics course in CHED
Memorandum Order 14 Series of 2009 First Implementation of the integration of
Nursing Informatics in the undergraduate curriculum was on the summer of
2010
• Problems:
o The contents of the curriculum was adapted from international
materials which does not match the local needs
o Lack of certification and credentialing programs in post-graduate
levels are also absent with the scarcity of local nursing informatics
experts
o This new field has yet to gain acceptance and recognition in the
nursing community as a sub-specialty
• Resolutions:
o Need to standardize the contents of the course being implemented
by nursing schools.
o Theoretical concepts and practical applications should be aligned so
that it may be applicable to the Philippine setting
Computer Hardware
What Is A Computer?
• A computer is an electronic device, operating under the control of instructions
(software) stored in its own memory unit, that can accept data (input),
manipulate data (process), and produce information (output) from the
processing.
• Generally, the term is used to describe a collection of devices that function
together as a system.
Classes of Computers
1. Analog Computer
• Operates on continuous physical or electrical signal.
2. Digital Computer
• Operates on discreet discontinuous numerical digits using the binary
numbering system
3. Hybrid Computer
• Contains features of both the analog and the digital computer
• Hybrid Machines are generally used in scientific applications or in
controlling industrial processes
Types of Computers
1. Supercomputers
• Largest type of computer specially designed for scientific
applications requiring gigantic amount of data calculations
2. Mainframe Computers
• Use by large organizations such an banks to control the entire
business operation
3. Microcomputers / Personal Computers (PCs)
• Computers that process specific applications
• Often used as stand-alone computers or in a network
4. Handheld Computers
• Small computers. Have almost the same functionality and processing
capabilities as the standard microcomputers
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Basic Components of a Computer 3. Firmware: Set of instructions programmed on a hardware device. It
1. Hardware provides the necessary instructions for how the device communicates
• Refers to the physical components of a computer with the other computer hardware.
2. Software 4. Translator: Translates high-level languages to low-level machine
• Software is a set of instructions or programs used to operate codes
computers and execute specific tasks.
i. System Software Application Software
ii. Application Software • Application software is a collection of one or more programs used to solve a
iii. Utility Software specific task
• It can be called an application or simply an app
Computer Primary Hardware Components • Generally, software used in banking industry, airline/railway reservation,
1. Motherboard generation of telephone or electricity bills etc. all fall under application
• The main electronic component of the computer wherein every software.
other physical component of a computer is attached • Few examples of application software are:
2. Input devices o Word processing software
• Use to input data and issue commands o Spreadsheet software
3. Central Processing Unit (CPU) o Database software
• Interprets instructions to the computer, performs the logical and o Education software
arithmetic processing operations, and causes the input and output o Entertainment software
operations to occur. It is considered the “brain” of the computer.
4. Memory Utility Software
• Utilizes integrated circuits and are used by operating systems, • Utility software ensures optimum functionality of devices and applications.
software, and hardware. • Utility programs help the users in disk formatting, data compression, data
i. Random Access Memory or RAM is the main memory of the
backup, scanning for viruses etc.
computer. It stores data including numbers, letters of the • Few examples of utility software are:
alphabet, graphics and sound. Any information stored in o Anti-virus
RAM is lost when the computer is turned off. o Registry cleaners
ii. Read Only Memory or ROM is memory that is etched on a
o Disk defragmenters
chip that has start-up directions for your computer. It is o Data backup utility
permanent memory. o Disk cleaners
5. Output devices
• Converts information into human-readable form. It can be text,
graphics, tactile, audio, and video. Software Useful to Nurses
6. Storage devices 1. NCSBN Learning Extension
• Devices which are capable of holding information either temporarily • Medication Flashcards
or permanently • This simple app downloads a medication library to your phone. Great
for students preparing for exams or nurses who need a quick
reference point.
Computer Software
2. NCLEX RN Mastery
• Computer software is a program that enables a computer to perform a • Study Aid
specific task. • Hundreds of practice questions and sample quizzes. When you give a
• Software can be categorized into three types: wrong answer, the app gives you a detailed reason why
1. System Software 3. PEPID
2. Application Software • Drug and Clinical Resource
3. Utility Software • This app provides detailed information for all elements of patient
care. Students gain a credible and complete resource guide for
System Software coursework, lab exercises, and clinical practice.
• System software is a collection of one or more programs used to control and 4. Epocrates
coordinate the hardware and other application software • Clinical Care Assistant
• Systems software can be categorized under the following: • This app streamlines searches for information on prescription drugs,
1. Operating System (OS): Harnesses communication between drug interactions, and a directory of providers. Nursing students can
hardware, system programs, and other applications. (i.e. Windows 10, prevent mistakes on exams, and most importantly, provide proper
IOS, Android, Linux) treatment when they begin practicing
2. Device driver: Enables device communication with the OS and other
programs
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 5. Medscape
• Informational Resource
• Published by WebMD, this free app provides access to a medical
directory, continuing education, medical news, and a clinical
reference library. The news aspect of this app helps students stay up
to date in the industry
6. WebMD
• Healthcare app you need to check symptoms; learn about
conditions and drugs; research treatments and diagnoses; find
doctors and specialists in your area; get Rx discounts available at
your local pharmacy; and set medication reminders.
7. Med Mnemonics
• This app provides over 1,500 acronyms, rhymes, and memory tricks to
help nurses quickly learn numerous medical conditions, symptoms,
and other medical terminology
8. Taber’s Medical Dictionary
• The mobile app includes photos, videos, audio pronunciations, and
functionality to save favorite entries. This dictionary has 65,000
definitions to help nursing students study for tests
9. Nursing Central
• Comprehensive Reference Resource
• The app includes access to Davis’s Drug Guide, Taber’s Medical
Dictionary, Diseases and Disorders, and MEDLINE Search and
Journals, among other databases
10. NurseGrid
• The app lets you schedule across all worksites, view who’s on your
shift, message other nurses
Software Licensing: Proprietary and Free and Open-Source Licenses
• All software applications require a software license in order to run
• A software license is a legal instrument that governs how the software can be
used and distributed
• 4 Software Licenses Categories:
1. Proprietary Software (PS)
2. Free Software (FS)
3. Open-Source Software (OSS)
4. Freeware
Proprietary Software
• Proprietary software consists of software that is licensed by the copyright
holder under very specific conditions
• In general, you can use the software, but you are not allowed to modify the
software or distribute it to others
• The original source code for the software is not available, which means you
can't see the actual code written by the programmers
• Also referred to as closed-source software
• This is done on purpose to protect the intellectual property invested in software
development
Free Software
• The word 'free' in 'free software' emphasizes freedom, not price
• Free software is the software that grants the user the freedom to share, study,
and modify
• It allows you to do anything you want with it, even improving the version and
profiting from it
• Here are 4 of the most popular type of licenses that define free software:
1. The MIT (Massachusetts Institute of Technology) License: This is a
permissive license that places limited restrictions on software reuse.
2. The GNU General Public License v2: This copyleft license gives users
the freedom to run, study, and make improvements to the software.
3. The Apache License v2: This is a permissive license that mandates
preservation of the copyright notice and disclaimer.
4. The BSD Licenses: They are a set of non-copyleft licenses that gives
minimal restrictions on the use and redistribution of the software.
• A popular example of a free software is the Linux operating system
Open-Source Software
• The term open source was introduced in the late 1990s in response to the
limitations of free software.
• It emphasizes on the practical benefits of “free software”: supporting
collaboration on software development projects
• It provides a valuable way to engage with potential software users and
developers, and convince them to create and improve source code by
participating in an engaged community
Freeware
• Freeware refers to a software that you can use without incurring any costs
• Unlike open source software and free software, freeware offers minimal
freedom to the end user
• Often shared without including its source code
• Skype and Adobe Acrobat Reader is an example of freeware
• Most developers usually market freeware as:
1. Freemium
▪ Refers to a program that is offered at no cost, but money
(premium) is paid for extra, more capable features
2. Shareware
▪ Refers to a program that is initially available without any
costs attached, and users are encouraged to distribute
copies. However, that cost-free period usually lasts for a
certain period; thereafter, a user is required to pay for
continued use
OSS / FS Healthcare Applications
1. ClearHealth (www.clear-health.com)
2. Indivo (indivohealth.org)
3. SMART Platforms Project (smartplatforms.org)
4. GNUMed (gnumed.de)
5. OpenMRS (openmrs.org)
6. District Health Information System (sourceforge.net/projects/dhis/)
7. OpenEHR (www.openehr.org)
8. Tolven (www.tolvenhealth.com)
9. European Projects and Initiatives
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