SEMINAR

ON
COMPUTERS IN NURSING

SUBMITTED TO: SUBMITTED BY:

MRS. FIONA G. RAJA

LECTURER IN NURSING MSC NURSING 1ST YEAR

MSAJ COLLEGE OF NURSING MSAJ COLLEGE OF NURSING

SUBMITTED ON:
 STUDENT PROFILE

COURSE: MSC NURSING 1ST YEAR

SUBJECT: ADVANCE NURSING PRACTICE

METHOD OF TEACHING: SEMINAR

TOPIC: COMPUTERS IN NURSING

EVALUATOR: MRS. FIONA

LECTURER IN NURSING

MSAJ COLLEGE OF NURSING

NAME OF THE STUDENT: G. RAJA

DATE OF SUBMISSION:
 INTRODUCTION

Computers are being included in hospitals and medical clinics throughout

the World. The Invention of computers started the revolution of Information
Technology (IT) in the world, bringing modern concepts into the world. In the
past few decades, offices, factories and business adopted computers to enhance
their performance. The next were the households to adopt the computers as
their new form of Entertainment. Today , computers, along with Internet
Technology are being introduced into the hospitals to enhance the performance
of medical facilities that are dispended. Modern health care delivery system has
become very complex in that there is need to obtain continuously updated
information about clients. Efficient information transmission can be achieved
with a unified data system rather than several loosely related data systems. A
unified health information system helps to bring relevant data in usable form
to the right user at the right time for the purpose for solving client care
problems. The development of electronic devices specially the computers has
given added impetus to problem solving activity. Problems which were difficult
to tackle earlier, can now be tackled with the aid of computers accurately and
rapidly.

HISTORY OF COMPUTERS
Computer technology has undergone significant changes from its
inception. Charles Babage is generally recognised as the first person to
propose the concept of modern computer. In 1833 this English
mathematician outlined in detail his plan for an “ Analytical Engine”. Dr.
Vannevar Bush of Massuchusetts Institute of Technology (MIT) built a
large scale electromechanical analog computer in 1925. The first large
scale electromechanical digital computer was developed by Dr. Howard
Aiken of Harvard University in 1944. The first electronic digital computer,
the ENIAC ( Electronic Numerical Integrater & calculator) was developed by
John Mauchly & J.P Eckert of the University of Pennsylvania in 1946. The
first stored programme electronic computer was EDSAC ( Electronic
Delayed Storage Automatic computer) was developed by M.V. Wilkes at
Cambridge University , England in 1949. The EDVAC ( Electronic Discrete
 The advances in computer technology are usually talked in terms of “
Generations”

THE FIRST GENERATION OF COMPUTER 1951- 1958

In 1951 the first generation computer - valve / vacuum tubes based
machines were used. In 1957 magnetic tubes were invented. These tapes
provided a much quicker & more reliable means of storing information on a
computer.

THE SECOND GENERATION OF COMPUTER 1959 – 1964

 This generation is smaller than the first. Began in 1959 with the
development of transistor (Electronic switching Device)
 Assembly language was developed. High level language such as FORTRAN
and COBOL were developed.
 In 1962 the first removable disc was developed for public use.

THE THIRD GENERATION OF COMPUTERS 1965 – 1970

 This new technology drastically reduced the size of a computer , by
replacing the circuit boards of transistors with chips as small as 1/8
of an inch.
 These silicon chips were a huge break through due to their small size
reliability and cost. IBM created the most significant advancement in
computing in this era.
 This led to the emergence of extremely powerful computers. Complex
systems like Airline reservation system were implemented during this
period.

FOURTH GENERATION COMPUTERS 1971

A Major technological advancement that characterizes the 4 th
generation is the tiny micro- processor. Currently the fastest is 750 MHZ.

FIFTH GENERATION OF COMPUTERS

 The world is moving towards the development of what one call “
Super Large Scale Integration” computers which in turn will
complement and improve on special miniaturization and cost
reduction.
  Development of artificial intelligence , to make decisions almost like
human beings, speech synthesizer , as well as the use of video
disks, optical disks and tapes for external storage media are
included in the fifth generation of computer innovation.

OBJECTIVES OF COMPUTERS IN HEALTH CARE INSTITUTIONS

 Improve efficiency at work
 Improve the services to the clients
 Provide better professional care to the clients
 Improve profitability
 Prevent losses due to errors and pilferage
 Provide the management with planning and control information
 Effective time management
 Enhance the image of the Establishment
COMPUTERISATION IN MEDICAL ESTABLISHMENTS
The philosopher says “ Change is eternal” . Nature , industry, technology
and needs keep changing. Health care institutions must keep pace with the
change constantly. With the invasion of internet and e- commerce in our lives
it has become essential for health care institutions to be upto date with the
latest technology.

Computerisation in medical establishment can be divided into two broad

areas

1. Administrative
2. Clinical

Administrative: Every health care institution will have a substantial

amount of administrative work - for which a computer is ideal.

The administrative applications include:

 Billing
 Inventory control
 Financial Accounting
  Correspondence
 Medical Records
Clinical

 The Clinical applications help the doctor in his or her professional

Work. For example the client’s Case sheet, generation of prescription,
Immunisation schedule, dosage calculations, antenatal follow ups and
ECG analysis.
 There is always overlap between the administrative and clinical
applications. The strength of a computerized system lies in its easy
accessibility and deployment for a variety of purposes without
duplication of effort.
 Besides the above said areas there are many areas in which
computers are of great help.

These include:

1. Professional writings & Presentations

2. Continuing medical education
3. E- mail & Internet Access
4. Research
5. Entertainment & Family Use
HOSPITAL INFORMATION SYSTEMS
DEFINITION
Hospital Information systems is “the dedicated use of a computer with
associated hardware, Software and terminals to collect, store, process, retrieve
and communicate relevant patient care and administrative information to
support primarily the professional specialty group providing direct patient care
within a hospital, its associated clinical departmental subsystems, and its
outpatient services”. Acc to ‘Collen’ 1983
HOSPITAL INFORMATION SYSTEM TRENDS
Hospitals have been slow in buying HISs or PCSs.
According to Dorenfest (1987) , they were because the systems being
offered did not meet their needs. The hospital executives wanted integrated
systems that could be updated simultaneously as the services were
 provided. In the fifth and sixth surveys of 3,000 + community hospitals
with patient care systems, Dorenfest found that of the approximately
5,500 community health hospitals in the country , only 2,241 (41.1%) had
patient care systems in 1991 and only 2,348 (43.6%) had systems in 1992.
This was lower than he had estimated in his study of 1987 , when he
predicted that 3,200 (58.1%) would have systems by 1990. The slow progress
reflected the reduced budgets and changes in hospital services from
inpatient to outpatient. Each of these patient care community hospitals
had a computer based patient care system with automated order entry
capability at the nurse’s station.

HOSPITAL INFORMATION SYSTEM TYPES

HISs vary widely, but most consist of various applications centering around
services, including nursing, provided to and received by patients. They are designed to
incorporate administrative, clinical, and special-purpose applications to satisfy
medical, nursing, and other departments in a hospital.

ADMINISTRATIVE APPLICATIONS

Administrative applications are those that support the administrative

functions of patient care. They generally include budgeting and payroll, cost
accounting, patient billing, inventory control, bed census, and medical records. They
also include the admission, discharge, and transfer (ADT) systems which control the
flow of patients in a hospital from admission to discharge. They are used to prepare
the midnight census and activity reports. ADT changes and generation of bed charges
provide the census, which is a key factor in planning hospital resources.

CLINICAL APPLICATION

Clinical applications generally include applications that focus on patient care

services during a hospitalization or an episode of care. They are essentially
short – term databases. They include order entry / results reporting, Vital signs,
shift report, nursing care plans, nurse’s notes, and other nursing documentation
activities. The order entry application generally includes all physician and nursing
orders, requested tests ( laboratory, radiological , etc) procedures, drugs, and other
services provided in the hospital. The results reporting applications produce
reports of the test results, evaluations and/or outcomes of the procedures,
outcomes of medications administered including medication profiles for the
patients and results of the other identified services.

Clinical Data Handling

Collecting and storage of clinical data will be one of the most important and
widespread use of computers in health care settings during the coming years.
The computerized data improve client care by providing more complete
information. Computerized data has other advantages such as : Produces easily
read, error – free transcript , readily accessible database, provides administrative
information and saves a lot of time from the routine paper work.

Managing Routine Documents

This include , Leave and fitness certificates, discharge summaries ,

correspondence to client and reference etc, which can be easily handled by a
computer.

Prescriptions, Drugs & Prescribing Information

 A computerized drug directory can give quickly the constituents, there
strengths, indications, contra- indications, drug interactions which will save
a lot of time in searching for these.
 Academic reference can easily be done on a computer than in a book
which saves time & energy.

Statistics & Research Material

The stored data in the computer can be used for multiple purpose &
can easily be presented in various ways to achieve different perspectives. This
may be the best source for studying diseases & response patterns & for
planning resources.

Diagnosis & Therapeutic Decision Support

A computer is ideally suited for decision making based on a set

Access to information. Ultrasound, CT Scan , MRI etc. are all computerized
diagnostic equipment , providing critical information to the consultant.
 In the struggle to become more effective & efficient, computers are of
great help. An expert system that uses Knowledge & inference procedures to
solve difficult problems can be developed and sized. An expert system is an
application of artificial intelligence. The user supplies input facts and the expert
system responds to these supplies as an intelligent assistant by giving advice
and suggesting possible course of action.

SPECIAL - PURPOSE APPLICATIONS

 Special – Purpose applications generally refer to the

services other than medical and nursing services that
are provided for patient care. Other special – purpose
systems include patient monitoring systems using
physiological monitoring equipment connected to a
patient database management system; patient classification
for nurse staffing systems and nurse scheduling and
personnel systems; and quality care and outcomes
applications that are not a part of the large integrated
patient care system.
 Newer systems include graphic and imaging capabilities
enhancements have added new dimensions to systems,
They are also forming the basis for diagnosing visual
conditions and will improve the decision making
application

CONFIGURATIONS

HISs can use several different computer system configurations , the most
common being stand alone large mainframe systems, which are on-line interactive
systems with real time processing. Other HISs run on minicomputer and
microcomputer systems that combine the various computer configurations, and
many of the newer systems are described as modular, local area network ,
point of service, and /or workstation systems. These different descriptions overlap
depending on the context in which they are used.
 COMPUTERISED MEDICAL RECORDS
It is one of the every important application of integrated
hospital information system.

 Software can be designed to capture medical records in a well standardised

format
 Legible and neat records can be created easily
 Archive of the records can be done for several years, cost effectively and
space effectively
 Confidentiality desired by the client can be much better
 Copies of records can be made available to the clients using a printer
 Indexing and retrieval is done easil.
When the client arrives, if the registration is done on the computer ,
the following steps are automatically performed:

 Client billing and receipts

 Future appointments if needed
 Generation of worksheet
 Individualized report format for each client
 Management reports including daily collection, testwise collection and reports
relating to referring physicians.
Maintaining computerized client records can have benefit such as:
 Report which includes previous results of the client, and may also have a
graphical representation of the values over a period of time can be very
useful for the referring physician
 Clients who visit the same health care institution for repeat tests, helps to
build up a large client base and also a good reputation for the centre.
COMPUTER – BASED PATIENT RECORD

 A computer - based patient record (CPR) is an electronic patient

record that resides in a system specifically designed to support users
by providing accessibility to complete and accurate data, alerts,
reminders, clinical decision support systems, links to medical knowledge
and other aids . ‘ Dick & Steen’ 1991
  The automated patient record, also referred to as the computer based
patient record (CPR) was determined to have many advantages over a
paper based record and has emerged as a new structure for the
traditional paper patient record. Such a record can 1, Improve health care
personnel’s ability to deliver health care

NURSING DOCUMENTATION IN HOSPITAL INFORMATION SYSTEM

HISs are being increasingly replaced by a constellation of delivery
network groups. Through the network groups, the currently closed proprietary
systems have the capability of being integrated at the network level into an
accessible, open system.

STANDARDS OF COMPUTERISED DOCUMENTATION

 Nursing documentation has been consistent with hospital standards, nurse

practice acts, and legal definitions of clinical nursing practice.

 Nurses should refer to the current standards governing computerized

documentation before its application

 The standards that govern nurse’s documentation of patient care have only
become more clearly articulated. Practice acts establish regulatory and
statutory rules, JCAHO and the American Nurses Association (ANA) set
standards required for hospital accreditation and professional practice, and
hospitals establish policies on which malpractice negligence rules are
supported..
ADVANTAGES OF DOCUMENTATION SYSTEMS
The most important benefits were:

 Increased time nurses spend with patient

 Access to information
 Improved quality of documentation
 Improved quality of patient care
 Increased nursing productivity
 Improved communication
 Improved hospital image
 Reduced error of omissions
  Support the nurses clinical decision making skills
 Analyze aggregated data from the care outcomes of many clients in
order to guide future nursing decisions
 Automate the retrieval of computer stored clinical information to
expand the capabilities of the quality assurance efforts
 Helps structure the care planning process
 Automate nursing care plan systems to automatically produce the
patient acuity/ classification report.
BASIC CATEGORIES OF NURSING DOCUMENTATION SYSTEMS
The documentation of patient care that falls within the capability of computers
includes the following categories:

 Care planning systems

 Direct patient care systems
 Discharge care planning systems
 Case management systems
Care Planning Systems
The care planning systems of today use the nursing process and are
based on nursing diagnostic schemes or patient problem. These systems
include assessment, diagnosis, intervention, and outcome components of care.
With the advent of the computer- based patient record, the nursing care
planning process can be automated. These systems enhance the quality of
information, reduce documentation, reduce errors, and increase communication
between nurses and other health care professionals within a hospital.

Direct Patient Care Systems

There are three components of direct patient care systems: those
resulting from processes of care delivery that are interdependent with medical
care, those that are independent, and those that are dependent on medical care.

The following reports could result from a direct patient care system :

 Admission assessment
 Nursing care plan, including nursing diagnosis or Kardex
  Daily nursing progress note, including documentation of every problem or
potential problem identified in the initial admission assessment and a
reassessment or analysis of new nursing diagnosis, nursing actions, and
evaluations
 Medical administration sheets, including regularly scheduled medications,
intravenous medications and blood administration
 Vital signs and other flow sheets, including intake and output, height and
weight and diet
 Nursing order summary sheets
 Automatic schedule summaries for special procedures and unit tests
 Transfer note and care plan
 Discharge care plan and summary
Discharge Care Planning Systems
The documentation of patient care usually begins with the admission
assessment and ends with the discharge care plan. Discharge care planning
systems provide for continuity of care from the home to the hospital and back
to the community, another care facility, an outpatient department or the home.
Case Management Systems

Case management systems include the concepts of the nursing process.

These systems provide further monitoring of the care process being completed,
integration of patient care with community and home health services, and
linking of patterns of care and associated costs. Care plans are an integral part
of operationalizing case management systems By using this method at the
management level , coverage is verified, benefits are identified, certification
requirements are verified, second opinion requirements are verified, and potential
billing problems are identified.

ROLE OF COMPUTERS IN MEDICAL AND NURSING EDUCATION & TRAINING

Computer technology is being widely used in the education sector. It has

tremendous potential in continuing medical education, especially in distance
learning programmes. Medical computer text books and journals are available in
four forms.
  Text - based books
 Pocket - size books on special digital diaries
 Multimedia books on CD- ROMs
 Specialised teaching software
There are lot of benefits in the administration of Medical, Dental, Nursing,
Paramedical courses.

Admission system: computerization will help in the admission system as

follows:
 Processing applications – Computers can help in coding the
applications and in processing the volume of data with speed and
accuracy
 Test development and evaluation _ With the help of computers one
can develop the tests for evaluation , item analysis, confidentiality of
the test and evaluation of test.

Training Programme: Computers can be used for planning the requirements

of the training programmes. Skills to be developed can be programmed so that
the students can workout their own pace and time schedules.

Better management of physical facilities : Computerisation help for effective

utilization of physical facilities such as conference room , seminar room

Effective use of clinical conferences With the help of internet,

Videoconferencing, and online chatting and multimedia worldwide latest
information with regard to diagnosis, treatment modalities and other therapeutic
measures can be made available for clinical conferences

Research & publication: Computerisation will help in research and

preparation of publications.

Academic Resource Management: Computerisation can help in the

management of academic resources, libraries, documentation, research studies,
publications and related records management

Professional Success and failure: Computerisation can help in storage of

information for longitudinal studies and help to predict the professional who
would be successful, committed and motivated.
BENEFITS OF HOSPITAL COMPUTERISATION

 Uses of Computers in Hospitals: [Medical Data]

Every day hospitals and clinics which are attached to it churn out enormous volumes
of data regarding patients, ailments, prescriptions, medications, medical billing details, etc.
Such medical records, are now a days recorded into medical billing software. Such
mammoth databases are known as Electronic Medical Records (EMR) and Electronic
Health Records (EHR). These databases are operated by a set of computers and servers,
and come in handy during medical alerts and emergencies. The concept of EHR is a bit
broader than the EMR, as the database is accessible from different clinics and hospitals.
Thus, a patient's medical history can be retrieved from any hospital by medical
practitioners.

 Uses of Computers in Hospitals: [Medical Imaging]

'Tests' are medical procedures where specified components of the human body are
scanned. A test can be as simple as a regular blood test or it can be a complex CT scan.
This process is often referred to as a medical imagery. In order to increase the precision of
such procedures, computers have been adopted and integrated into the testing equipment.
The Ultrasound and the MRI are the best examples where computers have been adopted,
in order to make the process faster and precise. Thus medical tests and tools have
become more advanced as a result of the use of computers.

 Uses of Computers in Hospitals: [Medical Examination]

Many systems are underway for the development of medical monitoring
which will help humans to properly monitor their own health. In many cases
doctors and surgeons also use sophisticated computer aided equipment to treat
their patients. Such systems and procedures include, bone scan procedure,
prenatal ultrasound imaging, blood glucose monitors, advanced endoscopy which
is used during surgery and blood pressure monitors. Basically these medical tests
and tools provide significant convenience to medical practitioners. You will find
that major laboratory equipment and heart rate monitors have already been
computerized in many hospitals.

 ADVANTAGES OF COMPUTERS IN HOSPITALS

There are significant advantages of using computers in hospitals. The
importance of computers in hospitals has also increased drastically due to the
fact that the procedures have to be speedy to cater to a larger population and the
medical services have to be more precise.
 To sum up, the advantages of computers in hospitals can be summarized as
follows:

 Precise 'tests' and medical examinations

 Faster medical alerts, which are more accurate time-wise
 Enhanced data about a patients medical history
 Precision in diagnosis
 Precision in billing
 Automated updating of medical history

Computers in health care are well accepted all over the world . Successful
computerization can yield many tangible benefits to healthcare system.

The Major Benefits Are:

 Effective and Efficient Administration :

The administrators are required to make more timely speedier
management of information by proper information , Duplication of efforts,
errors and delays are very much reduced improving the efficiency

 Informed Management Action :

Computerisation can help in planning, organizing, controlling and
evaluating . Computerisation will also help in utilization of professionals,
referrals of clients etc

 Quality Care and Client Satisfaction:

Computerisation will help to collect information on a continuing basis,
so that attention can be given to various factors which improve client’s
satisfaction and provide quality care.

 Better Client Service:

Administrative efficiency, effective medical audit, quality care all in turn
improves client

 Cost Control :
It is very important to control the cost in a health care set up, because
the resources are limited. With proper information and planning, pilferage
and wastage can be prevented.

Elimination of Revenue Losses:

Proper billing and follow up on payment due will help to reduce
revenue losses

 Management of Medical / Health Records :

 The Information need to be adequately stored, retrieved and analysis
carried out. This would also help in minimization of legal issues relating to
negligence and medical legal cases. Computerisation also will help in
maintaining confidential records.

 Better Utilization of facilities:

With computerization most of the information can be systematized and
appropriate , timely and economical information can be obtained. Timely
statistics help in better planning and direction to achieve optimal return on
investments.

 Information on New Drugs , Materials and Therapies:

With the help of internet and multimedia detailed information on
these can be obtained and the right choices and more rational decisions can
be made

 Material Management:
Materials and equipments are one of the cost consuming factors in a
health care institution. Computerisation would reduce the inventory, reduce the
pilferage , result in better utilization of equipment and better maintenance of
the equipment and overall efficiency of the institution

 Financial Planning and Resource Mobilization:

Computers will help in financial planning, budgeting , fund raising, and
mobilization of resources.

Theory Application

The Theory applied here is , “ General System Theory”.

INPUT THROUGHPUT OUTPUT

Nursing services Computerisation Effective

Should be in planning & Nursing

assessed for Organisation of Administrative

computer nursing services Service was

application achieved
SUMMARY
So far we discussed about the history of computers, computerization in
medical establishments, and in detail about the hospital information system, its
types and trends. Also discussed about the benefits of hospital computerization
and community health computer development projects and its special purpose
systems in community.

CONCLUSION
Hospital information systems encompass the application of IT in the
hospital setting. Most functions in the hospital can be computerized and this
applies to medical, nursing and administrative functions. An ideal HIS design
should be focused upon the linking of financial information system (FIS) and
management information system (MIS) to clinical information system (CIS) .
This would help to improve the hospital services in a time efficient and
cost effective manner. Computerization should also helps for beneficial effects
in community settings
 BIBLIOGRAPHY

 Virginia K. Saba , Kathleen A. Mc.Cormick ,“ Essentials of Computers

for Nurses” IInd edition (1986) published by

 Mc Grawhill, New York. (Pp 189- 204,354 -370, 430 -448)

 Stephanie’s “ Principles & Practice of Nursing” by Sr.Nancy IVth

edition (2005) Volume II, published by N.R. Brothers , Indore. (pp 483 – 490 )

 Naveen Thacker , Niranjan shendurnikar’s , “ Computers for Nurses” Ist

edition (2006) published by Jaypee brothers medical publishers (p) Ltd ,
New Delhi (pp 95- 113)

 Karanbir Sing , “ Computers for Nurses made Easy” Ist edition (2007)
Jaypee brothers Publication, Medical publishers, New Delhi (pp 164 – 167 )

 Annmarriner Tomey’s, “Guide to Nursing Management” (1998) 4th

edition published by Mosby year book (pp 7 – 11)

 BM Sakharkar’s , “ Principles of Hospital Administration & Planning ”

(2006) published by Jaypee brothers , Medical publishers , New Delhi. (pp
86- 94)

JOURNAL ABSTRACT

 Joshua Fogel’s, PhD, “ Internet Use and Advanced Practice Oncology

Nursing” (2002) published in Topics in Advanced Practice Nursing
eJournal.

 Lee’s PhD, “ Technology in Nursing Integration into Professional nursing

Paper” (2007) published in Topics in Advanced Practice Nursing eJournal
NET REFERENCE:

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