WEEK 1 NCM 110

Nursing Informatics

Historical
Perspective of
Nursing & Computer
LEARNING OUTCOMES
• L.O. 1 Describe the historical perspective of nursing
informatics.
• L.O. 2 Explore lessons learned from the pioneers in nursing
informatics.
• L.O. 3 Describe the types of nursing standards initiatives.
• L.O. 4 Review the historical perspectives of electronic
health records.
• L.O. 5 List the major landmark events and milestones of
nursing informatics.
Nursing Informatics (NI) is a title that evolved from the French
word “informatics” which referred to the field of applied
computer science concerned with the processing of
information such as nursing information (Nelson, 2013).
HIT
is an all-encompassing term referring to technology that
captures, processes, and generates healthcare information.
Computerization and/or electronic processing affect all aspects
of healthcare delivery including
(a) provision and documentation of patient care,
(b) education of healthcare providers,
(c) scientific research for advancing healthcare delivery,
(d) administration of healthcare delivery services,
(e) reimbursement for patient care,
(f) legal and ethical implications, as well as
(g) safety and quality issues.
Paper-Based Computer-Based
✔ The computer is the most powerful
technological tool to transform the nursing
profession prior to the new century.
✔ The computer has transformed the nursing
paper-based records to computer-based
records.
✔ The computer and the internet have become
essential to the modern day which functions a
lot.
✔ “Computer” is an all encompassing term referring
to information technology (IT), computer
systems, and when they are used in nursing
information systems (NISs), nursing applications,
and/or nursing informatics (NI).
✔ “NI” has emerged as new term encompassing
these technologies enabling nurses to manage
health care and patient care more efficiently and
effectively and, at the same time, make nurses
more accountable.
✔ Computers in nursing care are used to manage
information in patient care, monitor the quality of
care, and evaluate the outcomes of care.

✔ Computers and networks are now used for

communicating (sending/receiving) data and
messages via the Internet, accessing
resources, and interacting with patients on the
World Wide Web.
Computer technology emerged in nursing in response
to the changing and developing technologies in the
health care industry and in nursing practice. It is
analyzed according to:

(1) Six time periods: prior to the 1960s, the 1960s, the
1970s, the 1980s, the 1990s and post-2000;

(2) Four major nursing areas: PERA: nursing practice,

administration, education, and research;

(3) Standards initiatives: nursing practice, nursing data,

and health care data standards;
(4) significant landmark events;

(5) major landmark milestone chart listing those

events that influenced the introduction of
computers into the nursing profession including
the key “computer/informatics” nurse that directed
the activity.
ENIAC (1946)
SIX TIME PERIODS
PRIOR to the 1960s
✔ Starting in the 1950s, and as the computer
industry grew, the use of computers in the
health care industry also grew.

✔ During this time, there were only a few experts

who formed a cadre of pioneers that attempted
to adapt computers to health care and nursing
✔ During this time, the nursing profession was
also undergoing major changes.

✔ The image of nursing was improving, nursing

practices and services were expanding in
scope and complexity, and the number of
nurses was increasing.

✔ These events provided the impetus for the

profession to embrace computers.
 1960s
✔ During the 1960s the uses of computer
technology in health care settings began
to be questioned.
✔ Questions such as “Why computers?”
and “What should be computerized?”
were discussed.
✔ Nursing practice standards were
reviewed, and nursing resources were
analyzed.
✔ Studies were conducted to
determine how computer
technology could be utilized
effectively in the health care
industry and what areas of
nursing should be
automated.
✔ The nurses’ station in the
hospital was viewed as the
hub of information exchange,
the most appropriate center
for the development of the
computer applications.
✔During this period, computer technology
advanced, while the number of health care
facilities increased.
✔ The introduction of cathode ray tube (CRT)
terminals, online data communication, and
real-time processing added important
dimensions to the computer systems
providing more accessible and “user-
friendly” machines.
1970s
✔ In the 1970s, the inevitable continued integration of
computers into nursing. Nurses began to recognize
the value of the computer for their profession.
✔ During this decade, giant steps were taken in both
dimensions: nursing and computer technology.
✔ Nurses recognized the computer’s potential for
improving the documentation of nursing practice, the
quality of patient care, and the repetitive aspects of
managing patient care.
✔They assisted in the design and development of
nursing applications for the HISs and other
environments where nurses functioned.
✔ During this period, several states and large
community health agencies developed and/or
contracted for their own computer-based
management information systems.
✔ Generally, public health MISs provided statistical
information required by local, state, and federal
agencies for specific program funds, whereas home
health agencies provided billing and other financial
information required for reimbursement of patient
services by Medicare, Medicaid, and other third-party
payers.
1980s
✔ During the 1980s, the field of informatics
emerged in the health care industry and
nursing.
✔ NI became an accepted specialty and many
nursing experts entered the field.
✔ Technology challenged creative professionals
and the use of computers in nursing became
revolutionary.
✔ As computer systems were implemented, the
needs of nursing took on a cause-and-effect
modality; that is, as new computer
technologies emerged and as computer
architecture advanced, the need for nursing
software evolved.
✔ During this period, many mainframe HIS
emerged with nursing subsystems.
✔ These systems documented several aspects
of the patient record; namely, order entry
emulating the Kardex, results reporting, vital
signs, and other systems that documented
narrative nursing notes via word-processing
packages.
✔ Discharge planning systems were developed
and used as referrals to community health
care facilities in the continuum of care.
✔ In the 1980s, the microcomputer or personal
computer (PC) emerged.
✔ This revolutionary technology made
computers more accessible, affordable,
and usable by nurses and other health care
providers.

✔ PCs brought computing power to the

workplace and, more importantly, to the
point-of-care.
✔ PC s served not only as terminals linked to
the mainframe computers but also as stand-
alone systems (workstations).

✔ They were user-friendly and allowed nurses

to create their own applications.
 1990s

✔ Computer technology become integral part of

healthcare
✔ N.I was approved by ANA as a new nursing
specialty (1992)
✔ Laptops or notebook to the bedside and all point
of care settings•
✔ Local Area Network (LAN) were developed –
Linking hospital care Units
✔ Wide area network were developed (WAN) .
✔ Linking across the different system•
✔ Introduction of internet
*Information superhighway
*Mainstream social Milieu
*Electronic Mail (e-mail)
*File transfer Protocol (FTP).
✔The web became the means for online
communications and resources to the
nursing practice
✔ Integral component of all IT system
✔ WWW use to browse the internet and
search worldwide resources
post 2000s
✔ The early years of the new millennium
continued the torrid pace of hardware and
software development and growth.
✔ This growth is reflected in healthcare and
nursing, with developments such as wireless
point-of-care, serious consideration for open
source solutions, regional database projects,
and increase IT solutions targeted at all
healthcare environments.
 post 2000s
✔ Further, clinical information systems became
individualized in the electronic patient record
(EPR) and patient specific systems considered
for the lifelong longitudinal record or the
electronic health record (EHR).
✔ Information technologies continued to advance
with mobile technology such as with wireless
tablet computers, personal digital assistants
(PDAs), and smart cellular telephones.
post 2000s
✔ The development and subsequent refinement of
voice over Internet protocol (VolP) promises to
provide cheap voice communication for health
care organizations.
✔ Post-2000 also witnessed the continued impact
of legislation on the U.S healthcare industry
4 MAJOR NURSING AREAS

“PERA”
P- Practice
E- Education
R- Research
A- Administration
 P- PRACTICE
Nursing Practice

 Nursing practice has

evolved and changed
radically.
 It has become an
integral part of the
EHR.
✔ Computer systems with nursing and
patient care data, nursing care plans are
no longer separate subsystems of the
computerized Hospital Information
Systems (HISs), but rather integrated
into one interdisciplinary patient health
record in the EHR.
✔ The need for an interdisciplinary EHR
resulted because of many initiatives
proposed and promoted by the nursing
profession as well as by other health
care providers.
✔ They all require patient care data to track
the care process.
✔ Further nursing practice data emerged
with the introduction of several nursing
terminologies that were recognized by the
ANA as coded terminologies usable for
the EHR.
✔ They are used to assess problems,
document care, and track the care process,
and measure outcomes.

✔ Thus, the electronic version nursing

practice – the computer – has
revolutionized and transformed nursing
practice.
 A- Administration
Nursing Administration

✔ Nursing administration in
hospitals has also changed
with the introduction of the
computer that links nursing
departments together.
✔ Most policy and procedure
manuals are accessed and
retrieved by computer.
✔ Further, workload measures, acuity
systems, and other nursing department
systems are online and integrated with the
hospital or patient's EHR system or in
separate nursing department systems.

✔ The Internet is being used by nurses to

access digital libraries, online resources,
and research protocols at the bedside.
 R- Research
Nursing Research
✔ Nursing research provides the impetus to
use the computer for analyzing nursing
data.
✔ Software programs are available for
processing both quantitative and
qualitative research data.
✔ With the advancement of computer
technology databases supporting nursing
research emerged, principally for online
searching and retrieving information from
the electronic bibliographic literature
systems or other databases that contain
relevant health care content, such as
drug data.
✔ The Internet also provides online access
to the millions of Web resources around
the world which have increased the
capabilities and expanded the field of
nursing research.
STANDARD INITIATIVES
Nursing practice standards have been
developed and recommended by the
ANA, the official professional nursing
organization.
The ANA published The Standards of
Clinical Nursing Practice (ANA, 1998)
which focused not only on the
organizing principles of clinical nursing
practice but also the standards of
professional performance.
They recommended that the nursing
process serve as the conceptual
framework for the documentation of
nursing practice.
✔ Nursing practice standards have also
been set by the Joint Commission on
Accreditation of Hospital Organization
(JCAHO) which stressed the need for
adequate records on patients in
hospitals and practice standards for the
documentation of care by nurses (Namdi
and Hutelmyer, 1970).
✔ Further, they have included in their recent
manual the required contents of an EHR,
such as what data should be collected
and how the data should be organized on
the electronic database (Corum, 1993).
✔ These standards have evolved and
continue to increase as the federal
requirements evolve and/or are
implemented.
 NURSING DATA STANDARDS

✔ Nursing data standards have emerged as a new

requirement for the EHR.
✔ The ANA is responsible for the recognition of the
terminologies and for determining if they have met
the criteria to be included in the National Library
of Medicine (NLM) Unified Medical Language
Systems
HEALTHCARE DATA STANDARDS
ORGANIZATIONS
✔ It is critical to review the standards
organizations that have emerged to
either develop or recommend health care
data standards that should be
recommended to the federal government
as required health care data standards.
The American National Standards Institute (ANSI) is a private nonprofit
membership organization, instituted to coordinate and approve voluntary
standards efforts in the United States.

ANSI was combined with the Health Care Informatics Standards Board
(HISB) to form ANSI-HISB to fulfill a request by the European standards
coordinating organization (CEN TC/251) to represent the U.S. standards
effort.
 American Society for Testing
and Materials (ASTM):

The ASTM E-31 Committee on

Healthcare Informatics is an
accredited committee that develops
standards for health information
and health information systems
designed to assist vendors, users,
and anyone interested in
systematizing health information
ELECTRONIC HEALTH/MEDICAL
RECORD
 ELECTRONIC HEALTH/MEDICAL
RECORD

- defined as "an electronic record of health-related

information on an individual that can be created,
gathered, managed, and consulted by authorized
clinicians and staff within one health care
organization,"
- have the potential to provide substantial benefits to
physicians, clinic practices, and health care
organizations.
✔ These systems can facilitate workflow and
improve the quality of patient care and
patient safety.
✔ Despite these benefits, widespread adoption
of EMRs in the United States is low; a recent
survey indicated that only 4 percent of
ambulatory physicians reported having an
extensive, fully functional electronic records
system and 13 percent reported having a
basic system
Among the most significant barriers to adoption
are:
1. High capital cost and insufficient return on
investment for small practices and safety net
providers.
2. Underestimation of the organizational
capabilities and change management
required.
3. Failure to redesign clinical process and
workflow to incorporate the technology
systems.
The Institute of Medicine issued a group of
8 key functions for safety, quality, and care
efficiency that EMRs should support, after
recogizing the role that EMRs can play in
transforming health care, in 2003
1. Physician access to patient information, such as diagnoses,
allergies, lab results, and medications.
2. Access to new and past test results among providers in multiple
care settings.
3. Computerized provider order entry.
4. Computerized decision-support systems to prevent drug
interactions and improve compliance with best practices.
5. Secure electronic communication among providers and patients.
6. Patient access to health records, disease management tools, and
health information resources.
7. Computerized administration processes, such as scheduling
systems.
8. Standards-based electronic data storage and reporting for patient
safety and disease surveillance efforts.
Reference:

• https://nursekey.com/historical-perspectives-of-nursing-
informatics/