Major Historical Perspectives of Nursing and
Midterm Exam Coverage
• Historical Perspectives of Nursing and the
Computer
• Electronic Health Records from a Hospital
Perspective
• Computer Hardware
• Computer Software
• Computer System
• Nursing Informatics and Healthcare Policy
• Role of Technology in Records and Medication
Use
• Nursing Minimum Data Sets
• Informatics Theory
Historical Perspective of
Nursing and the Computer
Computer
- it is a general term referring to Information
Technology (IT) and computer systems. In
nursing, it is synonymous to Nursing Information
Systems (NIS), nursing computer applications and
Nursing Informatics (NI).
- Computers are used to manage information in
patient care, monitor quality of nursing care and
evaluate care outcomes.
- Computers with networks are now used in
communicating data via the internet, accessing
resources and interacting with patients on the
World Wide Web (WWW).
Nursing Informatics
- refers to the integration, of nursing, its information
and information management with information
processing and information technology to support
the health of the people worldwide (International
Medical Informatics Association, 1998).
- a specialty that integrates nursing, computer and
information science to manage and communicate
data, information and knowledge in nursing
practice. It facilitates the integration of data,
information and knowledge to support patients,
nurses and other providers in their decision-
making in all roles and settings. This support is
accomplished through the use of information
structures, processes and information technology
(American Nurses Association, 2006).
Clinical Information Systems
- this can be used interchangeably with Electronic
Health Information Systems (EHR-S),
computerized patient record and electronic
medical record.
- refers to a set of components that form the
mechanism by which patient records are created,
used, stored and retrieved and usually located
within a healthcare provider setting. It includes
people, data, rules and procedures, processing
and storage devices, communication and support
facilities (Institute of Medicine, 1991).
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Computers
- Computer technology emerged in nursing in
response to the changing and developing
technologies in the healthcare industry and in
nursing practice. The major historical perspectives
of nursing and computers can be analyzed based
on the following themes:
o Six time periods (divided on time coverage prior
to 1960s to post 2000)
o Four major nursing areas (nursing practice,
administration, education and research)
o Standards initiatives (nursing practice, data,
healthcare data standards)
o Significant landmark events (chart)
• Six Time Periods
Six historical perspectives of nursing and computers are
as follows:
Prior to 1960s - Simple Beginnings
- The use of computers in both computer and
medical industry grew on early 1950s. There were
only few experts who formed a cadre of pioneers
that attempted to adapt computers to healthcare
and nursing. During this time, the image of nursing
profession is undergoing major changes:
improving nursing image, expansion of scope and
complexity of nursing practice and services and
the increasing number of new nurses. Initially,
computers were used in health care facilities for
basic business office transactions. Some
examples are punch cards to store data and card
readers for computer programs, sorting and
preparation of data for processing. They were
linked together and operated by paper tape and
used teletypewriters to print their output. As
computer technology advanced, healthcare
technologies improved.
1960s - Issues and NI Researches
- The use of computer technology in healthcare
settings began to be questioned. Areas of debate
are centered on the application of computers and
data that needs to be computerized. Nursing
standards were reviewed and resources were
analyzed. Studies were conducted to assess
computer technology and its effective utilization in
the healthcare industry. Nurses’ stations were
considered as “hub” of information exchange.
- The increasing number of healthcare facilities was
paralleled to the advancement in computer
technology. The introduction of new computer
technologies such as the Cathode Ray Tubes
(CRT) added more dimensions to computer
systems providing more accessible and user-
friendly machines.
- Hospital Information Systems (HISs) were
primarily developed to process financial
transactions but few emerged to document and
process healthcare activities.
 - Computer vendors were beginning to penetrate
the healthcare field but the progress was slow due
to limitations in technology, lack of standardization
and diversity in paper-based patient records.
1970s - Giant Leap for NI
- Nurses begin to recognize the value of the
computer for their profession. Giant steps were
taken in both nursing and computer technology.
Nurses assisted in the design of HISs and other
environment that lead to the development of
forerunning software as bases of today’s systems.
Computer applications for financial and
management functions of patient care systems
were perceived as cost-saving technologies.
Several states and large community health
agencies in the US developed and/or contracted
for their own computer-based Management
Information Systems (MISs) which provide
statistical and financial information required local
government and federal agencies for specific
program funds and reimbursement of patient
services such as Medicare, Medicaid and other
third-party payers.
1980s - Emergence of Informatics Field
- The field of Informatics emerged in the healthcare
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. The need for nursing
software evolved and nursing education identified
the need to update practice standards, determine
data standards, vocabularies and classification
schemes that could be coded for Computer-based
Patient Record Systems (CPRSs).
- Many mainframe HISs emerged with nursing
subsystems that documented several aspects of
the patient record including Kardex, results
reporting, vital signs and other system that
documented narrative nursing notes via word-
processing packages. Discharge planning
systems were also developed and used as
referrals to community healthcare facilities in the
continuum of care.
- The microcomputer, widely known as the
personal computer (PCs) emerged that made
computers more accessible, affordable and
usable by nurses. It served not only terminals
linked to mainframe PCs but also as stand-alone
systems or workstations.
1990s - Affirmation of Nursing Informatics as
Specialty Field
- Computer technology became an integral part of
healthcare settings, nursing practice and nursing
profession. Professional organizations identified
initiatives that addressed IT and informatics.
Policies and legislation were adopted promoting
computer technology in healthcare including
nursing.
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- The nursing profession became actively involved
in promoting NI. NI was approved by American
Nurses Association (ANA) as a new nursing
specialty.
- The need for computer-based nursing practice
standards, data standards, nursing minimum data
sets and national databases emerged concurrent
with the need for a unified nursing language
including nomenclatures, vocabularies,
taxonomies and classification schemes. Nurse
administrators demanded that HISs should
include nursing protocols and nurse educators
continued to require use of innovative
technologies for all levels and types of nursing and
patient education. Nurse researchers required
knowledge presentation, decision support, and
expert systems based on aggregated data.
- The 1990s bring about development of smaller
and faster computers – laptops and notebooks,
workstations, Local Area Network (LANs) and
Wide Area Networks (WANs). The internet made
it possible for the information and knowledge
databases to be integrated into bedside systems.
- The internet brought new cyberspace tools. By
1995, the internet introduces electronic mail (e-
mail), file transfer protocol (FTP), Gopher, Telnet
and WWW protocols. The Web became the
means for communicating online services and
resources.
Post 2000 - Rapid Growth and Development in NI
- Healthcare and nursing undergone developments
such as wireless point of care, open source
solutions, regional database projects and
increased IT solutions on healthcare environment.
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). Mobile computing devices
were also introduced such as Personal Digital
Assistants (PDAs), Tablet computers and smart
phones. The Voice over Internet Protocol (VoIP)
promises to provide cheap voice communication
for healthcare organizations. The prediction of
smart cards was realized in Europe (Germany).
- The internet has provided a means for
development of clinical applications. Critical care
units are monitored remotely by health providers.
Telenursing, a recognized specialty since the late
1990s, is increasing in popularity and providing
patient care in an efficient and expeditious fashion
- The Health Insurance Portability and
Accountability Act of 1996 (HIPAA) was
enacted post year 2000 to streamline health care
transactions and reduce cost. Standardized
transaction and code sets were implemented in
early 2004 to protect security and ensure privacy
and confidentiality of healthcare data. The
legislation recommended healthcare providers to
use Provider Identification Number (PIN).
 Four Major Nursing Areas
- The historical perspectives on nursing that shaped
the need for computers, information technologies
and informatics can be describe through focusing
on major areas in nursing
Nursing practice
- 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 HISs, but rather integrated into
one interdisciplinary patient health record in the
EHR. The need for an interdisciplinary EHR
resulted because of the many initiatives
proposed and promoted by the nursing
profession as well as by the 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
of nursing practice – the computer – has
revolutionized and transformed nursing practice.
- all about Nursing Care Plan
Nursing Administration
- Nursing administration in hospitals has also
changed with the introduction of the computer
that links nursing departments together. Most
hospital policies and procedure manuals are
accessed and retrieved by computers.
Furthermore, work load 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.
Nursing Education
- The computer has radically changed nursing
education. Most universities and schools of
nursing offer computer-enhanced courses,
online courses (open university), and/or distance
education. Campus wide computer systems are
available for students to communicate via e-
mail, transfer data files, access digital libraries,
and retrieve online resources of millions of
Internet sites. An email accounts is considered a
gateway to these possibilities.
- New educational strategies require different
methods of teaching. The advent of computers
in educational technology has greatly
revolutionized teaching methodologies and
strategies. Today, most faculty members use the
Internet to teach courses via the Web and
communicate with other students via email. The
students on the other hand have to be more
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active and assume more responsibility for their
education that can be enhanced through the use
of the Web. The WWW facilitates student-
centered instructional settings creating a
motivating and active learning environment.
Finally, time, distance and cost are no longer
barriers to educational programs.
Nursing Research
- Nursing research provides the impetus to use
the computer for analyzing computer 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 information systems or other
databases that contain relevant healthcare
content, such as drug data. The internet also
provides online access to millions of Web
resources around the world which have
increased the capabilities and expanded the
field of nursing research
Standard Initiatives
- The third significant historical perspective
concerns standard initiatives focusing on
nursing practice standards, nursing data
standards and healthcare data standards as well
as federal legislation that impact on the use of
the computer into nursing:
Nursing Practice Standards
- There are two professional organizations that
pioneered the setting of standards in the nursing
practice:
• American Nurses Association (ANA)
- is considered as the official nursing organization
that contributes in the development and
recommendation of standards of nursing
practice worldwide. In 1998, the ANA published
the Standards of Clinical Nursing Practice which
focused not only on the organizing principles of
clinical nursing practice but also the standards of
professional performance. They also
recommend that the nursing process serve as
the conceptual framework for the documentation
of nursing practice.d
• Joint Commission on Accreditation of
Hospital Organizations (JCAHO)
- focuses on the need for adequate records on
patients in hospitals and practice of standards
for the documentation of care by nurses. They
also recommended acuity systems to determine
resource use as well as required care plans for
documenting nursing care. JCAHO described
the required contents of an EHR (example:
collection and organization of electronic data)
though the publication of their recent manual.
- In the Philippines, standardization of the nursing
profession was instigated by the Philippine
 Nurses Association (PNA), as a member of the 1973 First Invitation conference on
International Council of Nurses, founded way Management Information Systems
back September 2, 1922 and the Board of (MIS) for public/ community health
Nursing which was empowered by the Republic agencies, held in Fairfax Virginia
Act 9173. 1977 First research: state-of-the-art
• Nursing Data Standards conference on Nursing Information
- Nursing data standards has emerged as a new Systems (NIS) held in Chicago
requirement for the EHR. There are 13 nursing 1979 First military conference on
terminologies that have been recognized by computers in nursing in Washington
ANA such as the Critical Care Classification DC
(CCC), Nursing Outcomes Classification (NOC) 1980 First workshop on computer usage
and Nursing Information Classification (NIC). in healthcare sponsored by the
- The ANA is the worldwide organization University of Akron Ohio
responsible for the recognition of the 1981 First national conference on
terminologies in nursing education. Other computer technology and nursing
held in Bethesda, MD
organizations that contribute to the
Nursing Information Systems
standardization of nursing data are as follows:
Journal first published
1982 First National Nursing Computer
American Society for Testing and Materials (ASTM)
Technology Conference, becoming
- The ASTM facilitates student-centered an annual event, held in Newark,
instructional settings creating a motivating and New Jersey
active learning environment First international meeting: Working
! High Level Seven (HL7) – Health Level Seven is Conference on Nursing Uses and
one of several American National Standards Computers in Nursing held in
Institute (ANSI) - accredited Standards Developing London
Organizations (SDOs) operating in the healthcare First workshop on computers in
arena. Most SDOs produce standards (sometimes nursing held in Boston
called specifications or protocols) for a particular 1984 First nursing computer journal is
healthcare domain such as pharmacy, medical published: Computers in Nursing
devices, imaging or insurance (claims processing) Counsel in Computer Applications in
transactions. Nursing (CCAN) formed in Kansan
! International Health Terminology Standards City
Development Organization (IHTSDO) – is a not- First Nursing Minimum Data Set
for-profit association that develops and promotes (NMDS) meeting
use of SNOMED CT to support safe and effective 1985 Council on Nursing Informatics
health information exchange. SNOMED CT is a formed in New York
clinical terminology and is considered to be the First invitational NMDS conference
most comprehensive, multilingual healthcare held
terminology in the world. Essentials of Computer Electives
! National Committee on Vital and Health initiated in graduate and
Statistics (NCVHS) – a statutory public advisory undergraduate programs at
body to the Secretary of Health and Human Georgetown University School of
Services (HHS) that has a 57 year history of nursing
advising HHS in the areas of health data, health American Nurses Association
statistics, privacy and national health information recognizes NANDA as the first
policy. The members are leaders and experts in taxonomy in nursing
their fields, and the NCVHS has a reputation for 1989 Graduate program in Nursing
open, collaborative processes and ability to deliver Informatics introduced at Maryland
timely, thoughtful, and practical recommendations. University in Baltimore and
University of Utah
Significant Landmark Events 1990 ANA Congress of Nursing Practice
- Shown in the following table are the highlights in recognizes Nursing Informatics as a
the history of nursing informatics: specialty area
YEAR EVENT 1991 International Classification of
1961 Healthcare Information and Nursing Practice (ICNP) was
Management Systems Society initiated
(HIMSS) is founded First Doctoral Specialty in Nursing
1965 Development of one of the first Informatics sponsored by Maryland
Hospital Information System (HIS) University
at El Camino Hospital in Mountain
View California

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 1992 American Nursing Informatics
Association is initiated at California,
has since become international
ANA recognizes taxonomies
ANA recognizes Nursing Informatics
as a specialty by delineating the
scope of practice
1993 Electronic Library goes online
1995 First International Nursing
Informatics, Teleconference held in
Melbourne, Australia, Auckland and
New Zealand
Credentialing in Nursing Informatics
initiated by American Nurses
Credentialing Center (ANCC)
1996 First Harriet Werley Award for best
nursing informatics paper
Online Journal of Nursing
Informatics (OJNI) first published
1997 Nursing Information and Data Set
Evaluation Center (NIDSEC)
standards and scoring guidelines
published to address documentation
of nursing care
1999 Nursing Vocabulary Summit
Conference Held
2001 Canadian Informatics Nurses
Association received emerging
group status from the Canadian
Nurses Association
2002 JCAHO identified clinical information
systems as a way to improve safety
and recommended that hospitals
adopt technologies
Online MSN in Nursing Informatics
offered by Duke University
2003 HIPAA deadline for electronic
transaction standards enacted in
October
President calls for widespread
adaptation of Electronic Health
Record (EHR) in 10 years
2004 The office of the National Health
Information Coordinator established
Electronic Health Records from
a Hospital Perspective
Electronic Health Records
- An electronic record composed of health
information regarding an individual patient that
exists as part of a complete system designed to
provide access to, and management of, such
information. The electronic health record (EHR)
is developed and managed by the health facility
or provider. The term Electronic Health Record
has largely replaced the older “Electronic
Medical Record.”
- It is much more than an electronic replacement
of existing paper systems. The EHR can start to
actively support clinical care by providing a wide
variety of information services. However, it is
hard to understand what information is really
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important to clinical care and what is simply
occasionally desirable.
- The EHR bring uncountable advantages in
primary health care detaching such as the faster
access to information, the updated information,
it allows having a clinical process with all the
patient clinical information and an easier access
to information (ex: allows the simultaneous
access from different locations).
- Recognizable efforts in the development of EHR
are distinguished by the Nicholas E. Davis
Awards of Excellence Program whose history
describes the improvement of EHR in different
settings.
Impacts of HER’s on Care
- Our world has been radically transformed by digital
technology – smart phones, tablets, and web-
enabled devices have transformed our daily lives
and the way we communicate. Medicine is an
information-rich enterprise.
- A greater and more seamless flow of information
within a digital health care infrastructure, created by
electronic health
The Nicholas E. Davies Awards of Excellence
Program
- The Computer-Based Patient Record Institute
(CPRI), founded in 1992, was an organization
representing all the stakeholders in healthcare,
focusing on the clinical applications of
information technology. It was among the first
nationally based organizations to initiate and
coordinate activities to facilitate and promote the
routine use of Computer-Based Patient Records
(CPRs) throughout healthcare.
- The CPRI group on CPR Systems Evaluation
developed the CPR project evaluation criteria in
1993 which became the basis in assessing
accomplishments of CPR projects and provided
the Foundation of Nicholas E. Davies Awards
Excellence Program.
- The Program was named after Dr. Nicholas E.
Davis, an Atlanta-based physician, president
elect of the American College of Physicians, and
member of Institute of Medicine (IOM)
committee in improving patient records. He was
killed in a plane crash just as the IOM report on
CPRs was being released.
- The HIMSS Nicholas E. Davies Awards of
Excellence recognize excellence in the
implementation and use of health information
technology, specifically EHRs, for healthcare
organizations, private practices and public
health systems.
- Nowadays the Nicholas E. Davies Awards
Excellence Program is managed by the
Healthcare Information Management Systems
Society, and has the following program
objectives: o Promote the vision of EHR systems
through concrete examples
o Understand and share documented value of EHR • Functionality - delivered by the EHR to meet
systems the organizational objectives and the needs of patients
o Provide visibility and recognition for high impact EHR and end-users
system • Technology - technical design and architecture
o Share successful EHR implementation strategies that enable the EHR to deliver the required functionality
and performance
o Encourages and recognizes excellence in the • Value - concrete return on investment as well
implementation of EMREHR systems Implementation as intrinsic value derived from the implementation of the
• Implementation EHR
• Strategy
• Planning Application and Assessment Process
All applications will undergo the following process:
• Project Management and Governance –
1. Applications scoring based on established objective
Strategy
criteria updated regularly reflecting EHR adoption
changes
The Healthcare Information Management Systems
2. Threshold application (11 pages) review to
Society (HIMSS)
determine if applicant meets initial screens
- The Healthcare Information and Management
3. If threshold is met, full application of 50 pages is
Systems Society (HIMSS) is the healthcare
submitted for evaluation
industry's membership organization exclusively
4. Sites visit for confirmation of application
focused on providing global leadership for the
optimal use of healthcare information technology
Nicholas E. Davies Excellence Awardees
(IT) and management systems for the
betterment of healthcare. Founded in 1961 with • Organizational Award
offices in Chicago, Washington D.C., - The first organizational award was given on 1995.
- Brussels, and other locations across the United There are 20 recognized institutions. The list of
States and Europe, HIMSS represents more awardees from 1995-2004 is tabulated below
than 20,000 individual members and over 300
corporate members that collectively represent YEAR ORGANIZATIONS
organizations employing millions of people. 1995 Intermountain Health
HIMSS frames and leads healthcare public Care, Salt Lake City, UT
policy and industry practices through its Columbia Presbyterian
advocacy, educational and professional Medical Center, NY
development initiatives designed to promote Department of Veterans
information and management systems' Affairs
contributions to ensuring quality patient care. 1996 Brigham and Women’s
HIMSS has the following mission and vision: Hospital, Boston, MA
o HIMMS Vision - Advancing the best use of 1997 Kaiser Permanente of
information and management systems for the OHIO, Cleverland, OH
betterment of health care North Mississippi Health
- Promote the vision of EMR systems through Services, Tupelo, MS
concrete examples Regenstreif Institute for
- Understand and share documented value of Health Care, IL
HER system 1998 Northwestern Memorial
- Provide visibility and recognition for the Hospital, Chicago, IL
o HIMMS Mission - To lead change in the healthcare Kaiser Permanente
information and management systems field through Northwest, Portland, OR
knowledge sharing, advocacy, collaboration, 1999 Kaiser Permanente, CO
innovation, and community affiliations Queens Medical Center
Honolulu, HI
The Four (4) Criteria 2000 Harvard Vanguard Medical
Associates, MA
- The four major criteria in the initial assessment VA Puget Sound
of awardees identified by the CPRI Workgroup
Healthcare System,
on CPR Systems are as follows: Washington
• Management – the organizational aspects of St. Vincent’s Hospital,
EHR implementation: Westchester Country, NY
o strategy 2001 University of Illinois at
o planning Chicago Medical Center,
o project management OH
The Ohio State Medical
o governance Center, Columbus OH
2003 Cincinnati Children’s
Hospital Medical Center
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 2004 Evanston Northwestern • Application of new technologies and
Healthcare Evaston, IL techniques.

• Primary Care Computer Hardware

- The first primary care award was given on 2003.
There are 7 recognized institutions. The list of 2003 • It is a machine
– 2004 awardees are as follows: • It is electronic
- • It is automatic
YEAR ORGANIZATIONS • It can manipulate data
2003 Cooper Pediatric, Duluth, • It has memory
GA • It has logic functions
Evans Medical Group,
Evans, GA
Roswell Pediatrics, Computers
Alpharetta, GA - A computer is defined as a machine that is capable
2004 Pennsylvania National of performing a sequence of arithmetic and logic
Electronics Disease operations and with the following characteristics:
Reporting System, - A computer system is capable of performing certain
Harrisburg, PA logical operation, provide new time dimension, has
South Dakota the ability to store and retrieve information, control
Department of Health error and check itself.
Electronic Vital Records - On the other hand, it has limitations. A computer is
and screening Systems, dependent on prepared instructions. It has no ability
Pierre SD to derive meaning from objects and cannot correct
Utah Statewide wrong instruction supporting the idea “GIGO” which
Immunization Information means “garbage in – garbage out”.
System, Salt Lake City, Components of a Computer System
UT • Hardware - It refers to the tangible parts of a
computer
Common Characteristics of Nicholas E. Davis • Software - Refers to any sequence of instruction
Excellence awardees that make it easier to communicate with computers.
- There are common characteristics noted in the It also pertains to the programs that govern the
previous Nicholas E. Davis Excellence Awardees. operation of a computer that make the hardware
• Considered the Electronic Health Record productive.
(EHR) as a key component in the strategic • Peopleware/ Personnel - Refer to the user or
vision. They understand that healthcare is an people who work with the computer so that it can be
information business. used to find solutions to problems; it indirectly refers
to the persons who use the information generated
• The EHR implementation strategic vision is
by the computer. In medical and nursing
defined by remarkably similar organizational informatics, it refers to the members of the
goals. healthcare team.
• Provision of adequate funding and appropriate
resources needed for the project to realize Classes of Computers
success. • Supercomputer –machines with the capacities
• Creation of governance of EHR System beyond large computer systems with the speed of
implementation 100 million instructions per second.
• Present short but concrete operational • Mainframes – the largest, fastest and most
planning. expensive type of computer for processing, storing
and retrieving data and can access billions of
• Organize a documentation system for value for characters of data.
the implementing organization • Microcomputers / Personal Computers – is a
• Allocation of cost-effective budget. digital computer system under the control of a
Differences of Nicholas E. Davis Excellence stored program that uses a microprocessor, a
Awardees programmable read only memory (ROM) and
- On the other hand, Nicholas E. Davis Excellence random-access memory (RAM).
awardees show differences that make one distinct • Handheld Computers/ PDAs - is a handy
from the other. computer which can be brought from one place to
• Variable years spent in EHR program another
development.
• Different external agenda and societal History of Computers
challenges. First Generation Computers
- Modern computing can probably be traced back to
the 'Harvard Mk I' and Colossus (both of 1943).

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 Colossus was an electronic computer built in Britain
at the end 1943 and designed to crack the German
coding system - Lorenz cipher. The 'Harvard Mk I'
was a more general purpose electro-mechanical
programmable computer built at Harvard University
with backing from IBM. These computers were
among the first of the 'first generation' computers.
- First generation computers were normally based
around wired circuits containing vacuum valves and
used punched cards as the main (non-volatile)
storage medium. Another general purpose
computer of this era was 'ENIAC' (Electronic
Numerical Integrator and Computer) which was
completed in 1946. It was typical of first generation
computers, it weighed 30 tonnes contained 18,000
electronic valves and consumed around 25KW of
electrical power. It was, however, capable of an
amazing 100,000 calculations a second.
Second Generation Computers
- The next major step in the history of computing was
the invention of the transistor in 1947. This replaced
the inefficient valves with a much smaller and more
reliable component. Transistorised computers are
normally referred to as 'Second Generation' and
dominated the late 1950s and early 1960s. Despite
using transistors and printed circuits these
computers were still bulky and strictly the domain of
Universities and governments.
Third Generation Computers
- The explosion in the use of computers began with
'Third Generation' computers. These relied Jack St.
Claire Kilby's invention - the integrated circuit or
microchip; the first integrated circuit was produced
in September 1958 but computers using them didn't
begin to appear until 1963. While large ‘mainframes'
such as the I.B.M. 360 increased storage and
processing capabilities further, the integrated circuit
allowed the development of Minicomputers that
began to bring computing into many smaller
businesses. Large scale integration of circuits led to
the development of very small processing units, an
early example of this is the processor used for
analyzing flight data in the US Navy's F14A
`TomCat' fighter jet. This processor was developed
by Steve Geller, Ray Holt and a team from
AiResearch and American Microsystems.
Fourth Generation Computers (Modern)
- On November 15th, 1971, Intel released the world's
first commercial microprocessor, the 4004. Fourth
generation computers were developed, using a
microprocessor to locate much of the computer's
processing abilities on a single (small) chip.
Coupled with one of Intel's inventions - the RAM
chip (Kilobits of memory on a single chip) - the
microprocessor allowed fourth generation
computers to be even smaller and faster than ever
before. The 4004 was only capable of 60,000
instructions per second, but later processors (such
as the 8086 that all of Intel's processors for the IBM
PC and compatibles are based) brought ever
increasing speed and power to the computers.
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Supercomputers of the era were immensely
powerful, like the Cray-1 which could calculate 150
million floating point operations per second. The
microprocessor allowed the development of
microcomputers, personal computers that were
small and cheap enough to be available to ordinary
people. The first personal computer was the MITS
Altair 8800, released at the end of 1974, but it was
followed by computers such as the Apple I and II,
Commodore PET and eventually the original IBM
PC in 1981.
- Although processing power and storage capacities
have increased beyond all recognition since the
1970s the underlying technology of LSI (large scale
integration) or VLSI (very large scale integration)
microchips has remained basically the same, so it
is widely regarded that most of today's computers
still belong to the fourth generation.
Basic Components
Central processing unit (CPU)
- The CPU controls the computer processes and
communicates with the other components of a
personal computer. A computer's CPU may be one
of the most complicated parts of the computer
because of its intricacies. If a computer is
experiencing CPU issues, a computer technician
may start by checking the fan and cleaning out any
dust or debris inside the machine. Another step a
computer technician may complete is verifying that
power supply cables work. A CPU will not function
properly unless it receives a signal from the power
supply.
Motherboard
- The motherboard provides the structure for all other
components and connects them, while also
providing a way to distribute power, deliver
information and connect to devices such as a printer
or mouse. It controls how data transfers and what
type of monitor or screen device to use, for
example. It houses the CPU, memory and
secondary storage devices such as hard drives.
- The first thing that a computer technician may do to
troubleshoot any motherboard issues is to take the
PC apart and inspect all the connections for
corrosion. They may also check the power supply
and make sure the computer is receiving electricity.
Random Access Memory (RAM)
- RAM is where data lives temporarily while it's being
actively used by programs, such as when a user
launches a computer application. A technician may
know how to identify the type of RAM in a computer,
how to replace it if it's defective and how to
diagnose problems with copying data from one
location in memory to another.
- A technician should have knowledge about the
different RAMs that are available and they may also
know what types of errors might affect a computer's
RAM operation. A technician may backup all
computer files before fixing RAM to avoid losing
critical programs and documents.
Video graphics array port
- A video graphics array (VGA) port is a video input
that is primarily used on PC monitors.
Troubleshooting a VGA port could include verifying
there isn't a loose connection, faulty cable or a
broken monitor. Another task a computer technician
may do is use compressed air to spray inside the
VGA port to ensure it's free of dust.
Power supply
- A power supply provides electricity to all
components of a computer system. Typically, it's a
power cord connected from the back of a PC tower
into an electricity socket. A technician may
troubleshoot the power supply by turning off the
computer, unplugging and detaching the power
supply cord or trying a new cord or outlet.
Cooling fan
- Cooling fans are a computer's system to decrease
overheating. Many computers have more than one
cooling fan to help users who run their computer
heavily, such as video streaming or gaming. A
computer technician may need to fix a computer's
cooling fan if a user notices their computer
overheating. They may check for any damage to the
blades and make sure that they are free from
debris. Replacing computer fans can be a common
troubleshooting solution for a technician.
Hard drive
- Hard drives are data storage devices used to store
files, programs or other information on a computer
system. They use magnetically coated discs called
hard disks that store digital representations of
information. If a hard drive fails, a computer
technician may suspect a corrupt hard drive. They
may use data recovery software to repair the
computer or may replace the hard drive.
Monitor
- A computer monitor is an electronic device that
displays what's what programs are running on your
computer so a user can see. Some computer
technicians may wear anti-static gloves when
handling computer monitors to avoid static
electricity. They may also troubleshoot monitor
issues by disconnecting it from the computer and
trying a new power cord.
9|Eli
Printer
- This is a machine that produces copies of text or
images on paper using ink. Popular printers include
laser or inkjet and computer technicians may be
skilled in troubleshooting issues across multiple
brands and varieties. Computer technicians may
service printers including verifying power is running
to the machine. They may also check to see if the
paper tray is full and ready for printing. Technicians
might replace or refill any ink cartridges and toner.
- If the physical printer components are operating
efficiently but the machine still isn't working, a
technician will then troubleshoot software
malfunctions that may occur in the communication
between the computer and the printer. This requires
more expertise to fix since it involves how the
systems interact with each other rather than
physical component failures on the printer itself.
Scanner
- A scanner is a device that digitally copies an image
or and makes it available as a file for access on a
computer. If a scanner malfunctions, a computer
technician may remove the cover and carefully
check if it has any damage. If there are no visible
issues, then they may check the power connection
cable. Similar to a printer, there is computer
software that connects the scanner to the computer,
so a technician will also verify that the software is
communicating to the scanner.
Computer mouse
- A computer mouse can have a wire or is wireless
and is an input device used to control a cursor on
the computer monitor. A wired computer mouse has
a cord that connects to a USB port on a computer
while a wireless mouse has no physical connection
with a computer system. Instead, a wireless mouse
communicates using an adapter that is usually
plugged into an available USB port and runs off its
own batteries using Bluetooth technology.
- Computer technicians may troubleshoot computer
mouse issues by ensuring it's connected properly if
it has a wire. If the mouse is wireless, a technician
can look to see if they need batteries and that the
wireless connection is working. Computer
technicians can clean both wired and wireless with
cloths to ensure there is no dust or debris on the
sensor on the bottom of a mouse. If there is, the
mouse may not operate correctly.
Definition of Computer Hardware
- The computer hardware is defined as all of the
physical components (objective) of the machine
itself. The basic hardware of the computer includes
the electronic circuits, microchips, processors and
 the motherboard itself encased in the Central
Processing Unit (CPU) box.
- In addition, hardware typically includes devices that
are peripheral to the main computer box such as
input and output device including keyboard, mouse,
printer, fax and storage components such as hard
drives. The group of required and optional hardware
items that are linked together to make up a
computer system is called configuration.
- Computer hardware advances during the late
1990s have made possible many changes to the
healthcare industry. The first operations to be
modified were special administrative functions such
as finance, payroll and nurse staffing and
scheduling reports. Later, the computer allowed
fantastic changes in the practice of radiology and
imaging, allowing noninvasive visualization of the
human body. Computers are now pervasive
throughout the healthcare industry.
Fundamentals of Computer Hardware
- The box of any computer contains a motherboard.
It is a thin, flat sheet made of a firm, non-conducting
material on which the internal components of the
computer are mounted. It has holes or perforation
through which components can be affixed. The
specific design of the components is called the
computer architecture.
Fundamentals of Computer Hardware
- A computer has four basic components, although
most have many add-on components. At its most
basic, a computer must consist of a CPU, input and
output controllers and storage media. Examples of
basic components are as follows:
• Central Processing Unit
- The Central Processing Unit (CPU) is considered
the brain of the computer that primarily consists of
the following:
• Arithmetic and Logic Unit
- Controls mathematical function such as addition
and subtraction and functions of the test logic
(Boolean) conditions [e.g. is value x greater, equal
to or more than the y value]
• Control Unit
- The control unit carries out the machine language
functions called fetch, execute, decode and store.
• Memory
- Memory includes the locations of the computer
internal or main working storage. It consists of
registers (small number of very high-speed memory
locations), RAM, ROM and cache (small memory
storage area holding recently accessed data).
Computer Power
10 | E l i
- Computers do not process information as words or
numbers. They handle information as byte that is
made up of 8 bits. The term bits and bytes refer to
how the machine stores information at the lowest,
or “closest to machine registers and memory”, level.
The following definitions and conversions are
necessary for the discussion:
• Bit – short for “binary digit” is a unit of data in
the binary number system. It means “two”, so a
bit can assume any of two positions. A bit is an
on (value of 1) and off (value of 0) switch.
• Byte – a group of 8 bits. Bits are grouped into
collection of eight (8), which then functions as a
unit. There are 255 different combinations of 0
and 1 in an 8-character (or 1-byte unit). Byte
conversion table is presented below:
FREQUENCY UNIT CONVERSION
1 Bit 1 Character
1 Byte 8 Bits
1000 Byte 1 Kilobyte
1000 Kilobyte 1 Megabyte
1000 Megabyte 1 Gigabyte
Computer Speed
- The basic operations of the CPU are called cycles
(fetch, decode, execute and store cycles). It takes
time to the computer to perform these functions.
The CPU speed is measured in cycles per second.
For example, the original IBM PC introduced in
1981 had a clock speed of 4.77 MHz (4.77 million
cycles per second). Nowadays, PC speeds are
timed in billion cycles per second or gigahertz
(GHz).
Terms:
➢ Computer - a machine that is capable of
performing a sequence of arithmetic and logic
operations
➢ Hardware - It refers to the tangible parts of a
computer
➢ Software - Refers to any sequence of
instruction that make it easier to communicate
with computers. It also pertains to the programs
that govern the operation of a computer that
make the hardware productive.
➢ Peopleware/ Personnel - Refer to the user or
people who work with the computer so that it
can be used to find solutions to problems; it
indirectly refers to the persons who use the
information generated by the computer. In
medical and nursing informatics, it refers to the
members of the healthcare team.
Computer Software
- Software is a general term for the various kinds of
programs used to operate computers and related
devices. Software can be thought of as the variable
part of a computer. Software requires hardware,
which is the physical substrate on which software
exists and runs, and hardware is useless without
software.
- The term software dates back to at least 1850. At
that time, it is referred to a type of garbage that
would decompose, and hardware referred to
garbage that would not decompose. The current
usage dates back to at least 1958, when John W.
Tukey, a highly influential statistician who held
posts at both Princeton University and Bell Labs,
used it in an article in the January 1958 issue of
American Mathematical Monthly. Titled the
Teaching of Concrete Mathematics, he described
software as the carefully planned interpretive
routines, compilers, and other aspects of
automotive programming.
Types of Software
- There are two basic types of software namely
system software and application software.
System Software
- System software is a program that manages and
supports the computer resources and operations of
a computer system while it executes various tasks
such as processing data and information,
controlling hardware components, and allowing
users to use application software.
- That is, systems software functions as a bridge
between computer system hardware and the
application software.
Basic Input and Output System (BIOS)
- The BIOS software has a number of different roles,
but its most important role is to load the operating
system. When you turn on your computer and the
microprocessor tries to execute its first instruction,
it has to get that instruction from somewhere. It
cannot get it from the operating system because the
operating system is located on a hard disk, and the
microprocessor cannot get to it without some
instructions that tell it how. The BIOS provides
those instructions.
Operating Systems
- Operating systems are the software component of
a computer system that is responsible for the
management and coordination of activities and the
sharing of the resources of the computer. The
operating system acts as a host for applications that
are run on the machine. As a host, one of the
purposes of an operating system is to handle the
details of the operation of the hardware. This
relieves application programs from having to
manage these details and makes it easier to write
applications. Almost all computers, including
handheld computers, desktop computers,
supercomputers, and even video game consoles,
use an operating system of some type. Common
examples are Microsoft Windows and Linux / Unix.
Disk Operating System (DOS)
- DOS is the medium through which the user and
external devices attached to the system
communicate with the system. DOS translate the
command issued by the user in the format that is
understandable by the computer and instruct
computer to work accordingly. It also translates the
11 | E l i
result and any error message in the format for the
user to understand.
Graphical User Interface (GUI)
- GUIs are computer program that enables a person
to communicate with a computer through the use of
symbols, visual metaphors, and pointing devices.
The GUI has replaced the arcane and difficult
textual interfaces of earlier computing with a
relatively intuitive system that has made computer
operation not only easier to learn but more pleasant
and natural. The GUI is now the standard computer
interface, and its components have themselves
become unmistakable cultural artifacts.
Utility Programs
- A program that performs a specific task related to
the management of computer functions, resources,
or files, as password protection, memory
management, virus protection, and file
compression. Common examples are Disk
Defragmenters, Application Launchers and Web
Browsers.
Application Software
- Programs that specify the information processing
activities required for the completion of specific
tasks of computer users. Examples
Classification of Application Software
Word Processing Software
- Writing tasks previously done on typewriters with
considerable effort can now be easily completed
with word-processing software. Writing tasks such
as keying in reports, letters, and tables, as well as
merging documents, can be performed easily.
Documents can be easily edited and formatted.
Revisions can be made by deleting (cutting),
inserting, moving (cutting and pasting), and copying
data. Documents can be stored (saved) and opened
again for revisions and/or printing. Many styles and
sizes of fonts are available to make the document
attractive.
Spreadsheet Software
- Spreadsheet software permits performance of an
almost endless variety of quantitative tasks such as
budgeting, keeping track of inventory, preparing
financial reports, or manipulating numbers in any
fashion, such as averaging each of ten
departmental monthly sales over a six-month
period. A spreadsheet contains cells, the
intersection of rows and columns. Each cell
contains a value keyed in by the user. Cells also
contain formulas with many capabilities, such as
adding, multiplying, dividing, subtracting,
averaging, or even counting. An outstanding feature
of the spreadsheets is its ability to recalculate
automatically. If one were preparing a budget, for
example, and wanted to change a variable such as
an increase in salary or a change in amount of car
payments, the formulas would automatically
recalculate the affected items and the totals.

Data Base Software
- A database contains a list of information items that
are similar in format and/or nature. An example is a
phone book that lists a name, address, and phone
number for each entry. Once stored in a database,
information can be retrieved in several ways, using
reports and queries. For example, all the names
listed for a given area code could be printed out and
used for a commercial mailing to that area.
Desktop Publishing Software
- This software permits the user to prepare
documents by using both word-processing devices
and graphics. Desktop publishing software uses
word-processing software, with all its ease of
entering and revising data, and supplements it with
sophisticated visual features that stem from
graphics software. For example, one can enhance
a printed message with virtually any kind of
illustration, such as drawings, paintings, and
photographs.
Presentation Software
- A speaker may use presentation software to
organize a slide show for an audience. Text,
graphics, sound, and movies can easily be included
in the presentation. An added feature is that the
slide show may be enhanced by inclusion of
handouts with two to six slides printed on a page.
The page may be organized to provide space for
notes to be written in by the audience as the
presentation ensues. An example of this is Power
Point. Preparation of the software is simplified by
the use of 'wizards' that walk the user through the
creation of the presentation.
Office Suite Software
- Office suite software puts together complete
programs of software. A typical suite package might
include word processing, spreadsheet, databases,
and presentation software. Depending on the jobs
that need to be done, the suite provides the tools to
make professional-looking documents.
- Application programs are written in a particular
programming language.
Common Software/Programs Utilized in the
Nursing Practice
- In most hospitals, software used by nurses includes
admission, discharge and transfer (ADT) systems
that help with patient tracking and medication
administration record (MAR) software. Increasingly,
hospitals have added charting software that
computerizes at least some parts of the nursing
record.
- Nurses also utilize common software for
communication purposes. Some examples are as
follows:
Chat Rooms
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- Chat rooms are like electronic conference calls.
Multiple users can send and receive messages at
the same time. Some chat rooms are public but
private chat rooms require password. Chat room
technology is synchronous, that is, users can
connect in real time even at huge distances.
Social Network
- Social network refers to any number of web
addresses designed to create online communities.
These communities can be focused around
common interests, goals, or simply away for people
to interact.
Electronic Bulletin Board
- Electronic bulletin board is an early form of
computer conferencing but still popular nowadays.
They may be called discussion boards or electronic
forums. Forums can be posted using administrative
or user defined categories. Electronic bulletin board
is asynchronous which means users can post
messages at the time of their convenience.
Listservs
- Listservs are considered the least powerful version
of the electronic bulletin board. The software
functions more like an electronic mailing list. When
a user post message to a board, it is merely emailed
to all members of the conference.
Programming Languages
- A programming language is a means of
communicating with the computer. The only
language a CPU can understand is binary or
machine language.
- A computer executes a sequence of instructions (a
program) in order to perform some task. In spite of
much written about computers being electronic
brains or having artificial intelligence, it is still
necessary for humans to convey this sequence of
instructions to the computer before the computer
can perform the task. The set of instructions and the
order in which they have to be performed is known
as an algorithm. The result of expressing the
algorithm in a programming language is called a
program. The process of writing the algorithm using
a programming language is called programming,
and the person doing this is the programmer.
Categories of Programming Languages
Machine Language
- Machine language belongs to low level
programming languages. They are the most basic
and can be understand directly by the computer and
consist of binary numbers 1 and 0.
Symbolic Language
- Symbolic language, on the other hand, use
convenient symbols or mnemonics.
Assembly Language
- Assembly language are intermediate languages
that are very close to machine language and do not
have the level of linguistic sophistication exhibited
 by other high-level languages but must still be
translated into machine language.
High Level Language
- High level languages are programming languages
that must first be translated into a machine
language before they can be understood and
processed by a computer. They use traditional
mathematical symbols. Also called Compiler
Languages, for these languages requires a special
program called a Compiler, which translates
programs written in particular languages into
machine language.
Common Programming Languages
Beginner’s All-Purpose Symbolic Instruction Code
(BASIC)
- BASIC is the first lingua franca of microcomputers,
often taught to beginning programmers because it
is easy to use and understand and because it
contains the same major concepts as many other
languages, it is thought to be more difficult.
Common Business Oriented Language (COBOL)
- It is a language that can be run on any computer
makes and models. It was designed for writing
business programs with minimum of time and effort
- COBOL is a compiled language, are split into four
divisions:
o Identification
o Environment
o Data
o Procedure
Formula Translation (FORTRAN)
- The first high-level computer language and the
progenitor of many key high-level concepts, such as
variables, expressions, statements, iterative and
conditional statements, separately compiled sub-
routines, and formatted input/output.
Pascal
- Pascal is a compiled, structured language, built
upon ALGOL, simplifies syntax while adding data
types and structures such as sub ranges,
enumerated data types, files, records, and sets
C – control
- C is considered by many to be more a machine-
independent assembly language than a high-level
language, its close association with the UNIX
operating system, its enormous popularity, and its
standardization by the American National
Standards Institute (ANSI) have made it perhaps
the closest thing to a standard programming
language in the microcomputer/workstation
marketplace
Computer Programming
- refers to the process of writing a computer program,
which is a series of instructions written in proper
13 | E l i
sequence to solve a specific problem. A program
encompasses the program instructions and is
generally written by a computer programmer.
- There are five major steps in writing any computer
program:
➢ Problem Definition – involves the identification
of the problem to be solved regarded as the
most crucial step in programming
➢ Program Design – where the process
designing takes place
➢ Writing the Code and Program
Documentation – includes structure and
narrative documentation
➢ Alpha Testing – also known as desk checking
where components are checked based on the
intended purpose and design
➢ Beta Testing and Program Documentation –
involves installation to actual user environment
that signals program implementation
Terms
➢ Software - a general term for the various kinds
of programs used to operate computers and
related devices. Software can be thought of as
the variable part of a computer. Software
requires hardware, which is the physical
substrate on which software exists and runs,
and hardware is useless without software.
➢ Programming language - a means of
communicating with the computer. The only
language a CPU can understand is binary or
machine language.
Computer System
- Every functioning computer is a system; that is, it is
a complex entity like the human body, consisting of
an organized set of interconnected components or
functions that function together as a unit to
accomplish results that one part alone could not.
- The term computer system is used to describe the
set of peripherals, computer box, and the software
that together perform computing functions to
achieve common goal.
- Health professionals use computer systems
consisting of multiple, interconnected computers
that function to facilitate the work of groups of
providers and their support people in a system
called a network. The greatest range of functionality
is realized when computers are connected to other
computers in a network.
- A system by its nature is not random. It is orderly
and predictable in its functioning. The use of
systems in computer is based on systems theory.
Systems Theory
- Systems theory provides the conceptual basis for
understanding complex entities that consist of
multiple interrelated parts working together to
achieve a desired result. The key concepts of
system theory are:
o Part
o Interaction
 o Interdependency
o Input
o Output
o Processing
o Feedback
o Control
The primary propositions of the theory are the following:
o A system takes an input on which to perform
processes
o The processes performed by a system on input
result in system output
o The processes in a system are subject to
control forces
o Feedback is the key mechanism of control in a
system
o A system’s parts interact in such a way that the
parts are interdependent with respect to the
system’s process
o Impingement on one part in a system will
produce effects on the system’s processes and
may produce distortions on other parts of the
system.
o Distortion in one part of a system may be a
symptom of a problem in another component
(secondary malfunction)
o Correlation of a malfunctioning part will correct
the system functioning only if the malfunction
was a primary malfunction and not a secondary
malfunction
o Effects on the system’s processing function will
affect the system’s output
A system is more than the sum of its parts. If the parts
of the system will function independently, the system no
longer exists:
o The functioning of the system is different than
the functioning of its separate parts
o The output of each separate parts, even if
combined, does not equal the output of the system
o When combined into a system, the component
parts form an entirely new entity
Elements of the System
Interdependent parts
- Without the interaction of the parts, the system
process could not occur. In computer systems, the
process involves mathematical, logical or data
transfer operations interacting among its
components.
Input
- Input is any feed from the system’s external
environment. Input in a computer system may serve
to initiate computer functioning, as when the
machine is turned on and the OS is loaded into
RAM.
Process
14 | E l i
- Process is the activity of the system. A system
perform process on its inputs to produce outputs or
some sort of results. Process in a computer system
can be seen in the example of a presentation
graphic system.
Output
- Output is any end product or waste produced as a
result of the system process. The output in a
presentation graphic system, for example, might be
an electronic file (softcopy) stored on D hard drive
or removable storage.
Control
- Control refers to any component or activity that
serves to prevent or correct problems or errors in a
system’s input, process, or output. A system must
function with rules and procedures. In computer
systems, variety of control facilities exists within the
OS.
Feedback
- is the output from one part of the system process
that serves as input to another part of the system
process. Feedback within system is typically used
as part of a system’s self-regulation function. In
computer system, feedback components are
important functions of the OS and utility programs.
Systems Classification
There are two types or classification of system:
Closed System
- defined as a system that exhibits several
characteristics. A closed system is clearly
differentiated from all other systems and factors in
its environment. Its boundaries are clearly defined
and rigid. It has sealed boundaries that separate it
from the rest of the environment. Access to the
closed system is highly restricted, because the only
inputs acceptable to the system are from another
part of itself.
- A closed system has to be self-sufficient, because
any input from the external environment is a threat
to the integrity of a closed system. It does not need
an internal source to help rid of its output or waste
products.
- An example of a closed system in nursing is the
chest tube drainage system. The components of the
system are dependent to each other to achieve the
common goal. If the integrity of the tubes will be
compromised, air (an external factor) will enter the
system and the desirable results will not be realized.
Open System
- a system that exhibits integration, fluid or fuzzy
boundaries and interaction with environments. They
need not be self-regulating although they might
exhibit that characteristic. An open system overlaps
other systems and may be a subsystem within a
larger system. It is sometimes difficult to identify the
boundaries of an open system because boundaries
 are permeable to external influences rather than
sealed against them.
- Intrauterine circulation of the fetus is an example of
an open system. Fetuses exhibit a certain degree of
circulatory independence but it needs interaction
with the permeable components of the maternal
blood for nourishment, respiration and excretion.
Similarly, adults have basic needs (air, water, food,
medication) coming from an outside source.
Information Systems
- is a set of people, procedures and resources that
collects, transforms and disseminates information
in an organization; a system that accepts data
resources as input and processes them into
information products as output; a system that uses
the resources of hardware, software and people to
perform input, processing, output, storage and
control activities (key pieces) that transform data
resources into information products; a purposefully
designed system that brings data, computers,
procedures, and people together to manage
information important to an organization's mission.
Types of Information Systems
Transaction Processing System (TPS)
- TPS records daily routine transactions such as
diagnostic exam requests from clients. TPS are vital
for the organization, as they gather all the input
necessary for other types of systems. TPS provide
the basic input to the company's database. A failure
in the TPS often means disaster for the
organization.
Knowledge Work System (KWS)
- KWS supports highly skilled knowledge workers in
the creation and integration of new knowledge into
the company. Computer Aided Design (CAD)
systems, for example, used by product designers
not only allow them to easily make modifications
without having to redraw the entire object (just like
word processors for documents), but also enable
them to test the product without having to build
physical prototypes.
Office Automation System (OAS)
- OAS support general hospital work for handling and
managing documents and facilitating
communication. Text and image processing
systems evolved from word processors to desktop
publishing, enabling the creation of professional
documents with graphics and special layout
features. Spreadsheets, presentation packages like
powerpoint, personal database systems and note-
taking systems (appointment book, notepad,
cardfile) are part of OAS.
Management Information System (MIS)
- MIS generates information for monitoring
performance (e.g. productivity information) and
maintaining coordination (e.g. between purchasing
and accounts payable). MIS extract process and
15 | E l i
summarize data from the TPS and provide periodic
(weekly, monthly, quarterly) reports to
administrators (e.g. hospital managers, nurse
managers).
Decision Support System (DSS)
- DSS supports analytical work in semi-structured or
unstructured situations. They enable managers to
answer "What if?" questions by providing powerful
models and tools (simulation, optimization) to
evaluate alternatives (e.g. evaluating alternative
care plans). DSS are user-friendly and highly
interactive. Although they use data from the TPS
and MIS, they also allow the inclusion of new data,
often from external sources, such as current share
prices or prices of competitors.
Executive Support System (ESS)
- provide a generalized computing and
communication environment to senior managers to
support strategic decisions. They draw data from
the MIS and allow communication with external
sources of information. But unlike DSS, they are not
designed to use analytical models for specific
problem solving. ESS is designed to facilitate senior
managers' access to information quickly and
effectively.
Physiologic Monitoring System
- monitor vital physiologic parameters so that
clinicians can be informed of changes in a patient's
condition. They typically consist of several distinct
components, including a central station, bedside
monitors, and ambulatory telemetry transmitters
and receivers.
Hospital Information Systems
- Hospital information systems (HIS) is a computer
system that is designed to manage all the hospital’s
medical and administrative information in order to
enable health professional perform their jobs
effectively and efficiently.
- Hospital information systems were first developed
in the 1960s and have been an essential part in
hospital information management and
administration. Early systems consisted of large
central computers connected to dumb terminals,
which are now being replaced by networked
microcomputers. The systems were used to
manage patient finance and hospital inventory. An
excellent example of HIS is the new Microsoft
Amalga.
Microsoft Amalga Hospital Information System
(HIS)
- the new version of Hospital 2000, is a state-of-the-
art, integrated hospital information system designed
to meet the needs of developing and emerging
markets. Amalga HIS delivers a complete, agile
hospital information system that is flexible,
affordable and intuitive. This scalable, integrated
HIS:
 o Manages all hospital functions with one
affordable, integrated solution
o Helps improve operational efficiency, care
quality and patient experience by providing staff
with a single, customized view of healthcare
information
o Helps improve care quality and the patient
experience by providing clinicians with a single,
customizable view of patient data across all
encounters to enable more informed decision-
making and faster throughput.
Program Modules of HIS
- HIS offers variety of administrative applications.
Clinical support programs are increasingly being
viewed as the critically important modules in an HIS.
- Semi clinical Modules
Order-Entry System
- Its main function is to monitor and sometimes
control the flow of patients in a hospital from
admission to discharge.
Order-Entry-Results Reporting Module (OE)
- OE is almost always available in all HIS. This
enables the staff to enter laboratory, pharmacy and
radiology orders, results and reports online.
Clinical Modules
Charting Systems
- Usually included are the medication reports,
admission assessment, shift assessment, special
assessments and some elements of the nursing
care plan. Charting systems are variable due to lack
of universally implemented standard nursing
language.
Point of Service Systems (POS)
- POS are special type of clinical system that uses
hand-held or bedside PC to ensure that the data are
entered at the point at which they are collected.
Placement of POS workstations is an issue among
healthcare institutions.
Laboratory, Pharmacy and Radiology Modules
- Shows laboratory, pharmacy and radiology data.
Some are equipped with warnings and standards
for comparison and critical assessment.
Network Systems
- A network is a set of interconnected computers that
through the hardware and software technology,
work cooperatively for the purpose of information
and application program interchange.
- The central concept of network science is
cooperation. All computers in a network must
function in an interdependent way. Moreover, it
must have software that can interpret the signals it
receives and a set of communication rules. The
rules are written into system software programs
called protocols or networking software.
16 | E l i
- Network systems are keys to the effective
functioning of most hospital computer systems.
Types of Network
➢ Local Area Network (LAN) - The computers are
geographically close together (that is, in the same
building).
➢ Wide Area Network (WAN) - The computers are
farther apart and are connected by telephone lines
or radio waves.
➢ Campus Area Network (CAN) - The computers
are within a limited geographic area, such as a
campus or military base.
➢ Metropolitan Area Network (MAN) - A data
network designed for a town or city.
➢ Home Area Networks (HAN) - A network
contained within a user's home that connects a
person's digital devices.
Terms
➢ Computer System - is used to describe the set of
peripherals, computer box, and the software that
together perform computing functions to achieve
common goal.
➢ Information Systems (IS) - a set of people,
procedures and resources that collects,
transforms and disseminates information in an
organization; a system that accepts data
resources as input and processes them into
information products as output; a system that uses
the resources of hardware, software and people to
perform input, processing, output, storage and
control activities (key pieces) that transform data
resources into information products; a
purposefully designed system that brings data,
computers, procedures, and people together to
manage information important to an organization's
mission.
➢ Hospital information systems (HIS) - a
computer system that is designed to manage all
the hospital’s medical and administrative
information in order to enable health professional
perform their jobs effectively and efficiently.
➢ Network - a set of interconnected computers that
through the hardware and software technology,
work cooperatively for the purpose of information
and application program interchange.
Nursing Informatics and
Healthcare Policy
Free Software and Open-Source Software
- The basic characteristic of Free Software, as
defined by its creator and leading advocate Richard
Stallman, is that the user is free to make decisions
on the use of the software code.
Free software is software that meets the following
criteria:
 • Users are free to use the program for any
purpose;
• Users are free to examine the software to see
how it works
• Users are free to distribute the program to
others;
• Users are free to improve the program
- Open Source, as defined by Bruce Perens in the
Open Source Initiative, is quite similar to Free
Software. The main underlying concept is that Open
Source does not just mean access to and free use
of the source code.
Open Software Criteria
o Freedom to redistribute
o Source code must be included
o Freedom to create derived works
o Integrity of the author's source code, i.e.
amended work must be distinguished from the
original version
o No discrimination against persons or groups
o No discrimination against fields of endeavor
o Distribution of license: i.e. redistribution of the
software shall include the license and must not
add further restrictions (such as non-disclosure
agreements)
o The license must not be specific to a product
o The license must not restrict other software
OSS/FS Windows-Based Applications
- Open-Source Software and Free Software exist to
common well-known applications. The following are
some of these familiar Window-based applications
and their category of usage. Universal Resource
Locator (URLs) and/or website addresses are
provided for the purpose of download by the
professor and typewritten in italics:
Mozilla Firefox (Web Browser)
- The premier free, open-source browser. Tabs, pop-
up blocking, themes, and extensions. Considered
by many to be the world's best browser
http://www.mozilla.com/en-US/firefox/
Miro (Video Player and Podcasting Tool)
- With beautiful interface. Plays any video type (much
more than windows media player). Subscribe to
video RSS, download, and watch all in one. Torrent
support. Search and download from YouTube and
others
http://www.getmiro.com/
Pidgin (Instant Messenger)
- Connect to multiple IM accounts simultaneously in
a single app, including: AOL IM, MSN, and Jabber.
http://pidgin.im/
Mozilla Thunderbird (Electronic Mail Client)
- Powerful spam filtering, solid interface, and all the
features needed by sophisticated nurses.
http://www.mozilla.com/en-US/thunderbird/
Cabos (Peer-to-Peer File Sharing)
Simple, easy to use file sharing program by Gnutella
network.
http://cabos.sourceforge.jp/
OpenOffice Org. (Office Suite)
- Big, full featured suite of tools for word processing
and spreadsheets. Compatible with and a free
17 | E l i
replacement for Microsoft Word documents. Also
supports Open Document Format.
http://www.openoffice.org/
GIMP (Photo Editor)
- Photo editing application that rivals Photoshop in
features
http://gimp-win.sourceforge.net/stable.html
OSS/FS Healthcare Applications
- It is suggested that in healthcare that the
development of OSS/FS could provide much more
needed competition to the current relatively closed
market of commercial, propriety software. OSS/FS
could also solve many of the problems that
healthcare information systems currently face.
Common OSS/FS applications are as follows:
openEHR
- The openEHR Foundation is an international, non-
profit organization that is working toward the
development of interoperable, lifelong EHRs.
http://www.openehr.org
Open EMR
- A free, open source medical clinic practice
management (PM) and HER application. It offers a
range of functions including Practice Management
features for patient scheduling and patient
demographics; online EMRs; prescription writing
capability with ability to email and print prescriptions
and ability to generate files for electronic billing.
(within the hospital lang bawal hospital-to-hospital)
http://www.openemr.net
FreeMEd
- FreeMED is the flagship product of the freeMED
Software Foundation as a result of many years of
work in developing OSS/FS electronic medical
record (EMR) and billing system, which focuses on
the needs of the healthcare team.
http://www.freemed.org
CARE2x
- One of the few OSS/FS projects to have been
originated by a surgery nurse, Elpidio Latorilla. It
aims to develop a practical, integrated healthcare
information system (HIS) and is designed to
integrate the different information systems into one
single efficient system.
http://www.care2x.com
Healthcare Specific OSS/FS Organizations
- The noble deed on development and exploration on
the use of OSS/FS in the healthcare field were
initiated by numerous organizations:
Open Source Health Care Alliance (OSHCA)
- The oldest of the organizations having been
formally established in Summer 2000 at a meeting
in Rome, Italy. It holds annual conferences and has
email discussion list open to anyone interested in
supporting the aims and work of the organization,
and is on current website upgrade.
 International Medical Informatics Association
(IMIA)
- Established in October 2002, that aims to work both
within IMIA and through encouraging joint work with
other OSS/FS organizations to explore issues
around the use of OSS/FS within healthcare and
health informatics.
Special Interest Group in Nursing Informatics
(IMIA-NI)
- The first nursing organization to establish a group
dealing with OSS/FS issues, established June
2003. The aims of IMIA-NI Working Group include
leading in informing the nursing profession
worldwide about the potentials of OSS/FS and
examining some claims, develop recommendation
and creative solution.
Data Processing
Data
- It refers to a collection of organized information,
usually the result of experience, observation or
experiment, other information within a computer
system, or a set of premises. This may consist of
numbers, words, or images, particularly as
measurements or observations of a set of variables.
Database
- A collection of information that is organized so that
it can easily be accessed, managed, and updated.
Information System
- A collection of methods, practices, algorithms and
methodologies that transforms data into information
and knowledge desired by, and useful for, individual
and group users in organizations and other
entities. This system can involve a combination of
work practices, information, people, and
technologies organized to accomplish goals in an
organization.
Database Management System
- Computer programs used to input, store, modify,
process and access data in a database. A DBM
software must be configured first to manage data
specific to the project. A functioning DBMS consists
of three interacting parts: data, configured DBM
software and query language used to access data.
Classification of Data
- There are two primary approaches in classifying
data:
• Conceptual Data Types – classification based
on how data will be used. These can also be
based on the source of the data. Examples:
Laboratories produces “lab data”; X-ray
department produces “image data”.
• Computer-Based Data Types – classification
based on computerized data type and can be
grouped into three:
o Alphanumeric – include letters and numbers
in any combination but cannot perform
numeric function. Examples: hospital number,
memo
o Numeric – data used to perform numeric
functions as adding, subtracting, multiplying
18 | E l i
and dividing. It can be long integer, currency or
scientific. Examples: date and time
o Logic – data that are limited to two options.
Examples: yes or no; true or false; 1 and 2; and
on and off
Types of Files
- Within a DBMS, there are two basic data types:
➢ Data Files – contain data that have been
captured and stored on a computer using a
software program. The extension of the file
identifies the software used to create file.
Example: Microsoft Word - .doc/.docx
extension; Microsoft PowerPoint ppt/.pptx
➢ Processing Files – executable program or set
of instructions that, when executed, causes a
computer to open or start a specific computer
program. Example: running a setup.exe file will
tell the computer to begin installing a program.
Classification of Files
Database Models
➢ One-to-one – single data element in relation to
singular data element. Example: individual
medication order
➢ One-to-many – a single data element related
to more than one data element. (more than one)
Example: Individual medication order with
multiple doses
➢ Many-to-many – multiple data elements
related to set of data element. Example:
healthcare providers to patients
Database Operations
➢ Input – entrance, update, modification of data
➢ Process – conversion of data in meaningful
operations
➢ Output – includes online and written report
Nursing Implications of Database Information
- The basic concepts of database are not unique and
have a great impact to nursing. The concept for
understanding such impact is presented in the Data
to Wisdom Continuum of Abbott and Goodwin.

Examples of DIKW
Data
- vital signs for an individual’s heart rate, respiration,
temperature, and blood pressure
Information
- serial set of vital signs taken over time, placed into
a context, and used for longitudinal comparison
Knowledge
- recognition of a pattern and identification of
interventions reflects information synthesis
(knowledge) based on nursing knowledge and
experience
Wisdom
- accuracy of the synthesis of information and
appropriate selection of interventions
- The continuum begins with the raw data. As data
are named, collected and organized, it becomes
information. By discovering the meaningful facts
and information and the relationship between facts,
knowledge base is built. By understanding
knowledge and implications, nurses are able to
manage a wide range of healthcare problems of
clients.
- Open-source software (OSS) - a type of
computer software in which source code is
released under a license in which the copyright
holder grants users the rights to study, change,
and distribute the software to anyone and for
any purpose
- The Internet – the Internet is a worldwide
network of interconnected computer networks
that operates using a standard set of
communications. In contrast to older
communications systems, the Internet was
purposely designed to be highly decentralized
(both with regard to physical infrastructure and
management) and independent of the
underlying physical media. Any
communications network that can carry two-
way digital data can also carry Internet traffic;
thus, Internet traffic flows through networks that
use conventional copper wire, coaxial cable,
optical fiber and radio waves.
- The Internet is named after the Internet
Protocol, the standard communications
protocol used by every computer on the
Internet. The Internet can powerfully leverage
19 | E l i
the nurses’ ability to find, manage, and share
information. Never before in human history has
such a valuable resource been available to
many people at such little cost.
Role of Technology in Records
and Medication Use
The Internet
- A worldwide network of interconnected
computer networks that operates using a
standard set of communications
- Decentralized and Independent
- Named after internet protocol (IP)
Brief History
- The conceptual foundation for the creation of
the Internet was significantly developed by
three individuals and a research conference,
each of which changed the way we thought
about technology by accurately predicting its
future.
➢ Vannevar Bush - wrote the first visionary
description of the potential uses for information
technology with his description of the "memex"
automated library system.
➢ Norbert Wiener - invented the field of Cybernetics,
inspiring future researchers to focus on the use of
technology to extend human capabilities.
➢ The 1956 Dartmouth Artificial Intelligence
Conference - crystallized the concept that
technology was improving at an exponential rate,
and provided the first serious consideration of the
consequences.
➢ Marshall McLuhan - made the idea of a global
village interconnected by an electronic nervous
system part of our popular culture.
- In 1957, the Soviet Union launched the first
satellite, Sputnik I, triggering US President
Dwight Eisenhower to create the ARPA agency
to regain the technological lead in the arms
race. ARPA appointed J.C.R. Licklider to head
the new IPTO organization with a mandate to
further the research of the SAGE program and
help protect the US against a space-based
nuclear attack. Licklider evangelized within the
IPTO about the potential benefits of a country-
wide communications network, influencing his
successors to hire Lawrence Roberts to
implement his vision.
- Roerts led the development of the network,
based on the new idea of packet switching
discovered by Paul Baran at RAND, and a few
years later by Donald Davies at the UK National
Physical Laboratory. A special computer called
an Interface Message Processor was
developed to realize the design, and the
ARPANET went live in early October, 1969.
The first communications were between
Leonard Kleinrock's research center at the
University of California at Los Angeles, and
 Douglas Engelbart's center at the Stanford
Research Institute.
- The first networking protocol used on the
ARPANET was the Network Control Program.
In 1983, it was replaced with the TCP/IP
protocol developed by Robert Kahn, Vinton
Cerf, and others, which quickly became the
most widely used network protocol in the world.
- Standardized protocols enable the internet to
function. It can be treated as the standard
language for the internet. Protocols determine
the following:
o Data transmission between two devices
o The type of error checking that will be
performed
o Data compression
o Signals and notifications
The main protocols on which the function of the
internet is dependent:
• Transmission Control Protocol (TCP) –
allows computers to connect to a network and
exchange data; carries the task of breaking
messages into small packets (datagrams).
• Internet Protocol (IP) – considered a lower
level protocol, which is responsible for making
decision on the packets and routing them.
Other protocols used on the internet are the
following:
➢ Hypertext Transmission Protocol (HTTP) –
which supports the World Wide Web (WWW)
➢ File Transmission Protocol (FTP) – permit
users to send all types of electronic files over
the Internet.
- Since the internet is composed of a vast
network of computers, proper identification of
computers and information sites must be made.
Anatomy of a Web Address
- Web addresses are also referred to as URLs
(Universal Resource Locators). It can identify a
specific machine, directory and file of that
machine. The professor will consider the
following example:
o HTTP – short for Hypertext Transfer Protocol
described as the transmission protocol,
introduces a web document or directory
o WWW – short for World Wide Web
o Directory – the directory or folder(s) in the web
server that contains a group of related web
pages within a website
o Domain Name – identifies the computer name,
web server name, web name or host name. The
Internet Domain Name System (DNS) permits
users to give globally unique names to
networks.
The top-level domains are tabulated below:
DOMAIN NAMES DESCRIPTION
.edu Educational site (usually a
University or a college)
.com Commercial business
site/computer
20 | E l i
.gov Government/non-military
site
.mil Military sites or agencies
.net Networks, internet service
providers, organizations
.org Non-profit organizations
and others
Web Navigation and Search Engines
- There are four directions and five basic
techniques in web navigation. Nurses must be
aware of these functions to ensure convenience
in exploring the web.
Directions:
o Back – go back to the previous page; press the
back button, right click window and select back or use
keyboard hotkey [alt+left arrow key]
o Forward – go forward to a new page after going
back; press the forward button, right click window and
select forward or use keyboard hotkey [alt+right arrow
key]
o Link – click a link and jump to a new page
o Jump – select a new page from external source
such as bookmarked sites
Techniques:
o Surfing - Jumping ahead of the browser if the link is
already loaded but the rest of the page is lagging
behind.
o Chains – After clicking several websites, a chain of
internet pages are created and explored backward
of forward
o Reload – refreshing the page to ensure that the
latest copy is loaded (e.g. tracking bid on sites such
as eBay)
o Stopping – Stopping the loading process of a site
anytime the user wants
o Restarting – Stopping the connection and clicking
the same link again
- With billions of web pages online, nurses could
spend a lifetime surfing the Web, following links
from one page to another. Amusing perhaps,
but not very efficient if one is seeking some
specific information. Searching the internet
requires part skill, part luck and a little bit of art.
Fortunately, a number of free online resources
help with the hunt. These are the search
engines such as Yahoo!, Google, and Ask.com.
Search engines are of two types:
o Directories – good at identifying general
information. A good example is the Yahoo®
Directory
o Indexes – identify text on the given criteria by
searching contents of websites through the use of
software and programs called robots and spiders
that analyze millions of webpages. Examples are
Google® and Yahoo Search®.
Electronic Mail (E-mail)
- One of the most popular uses for the internet
remains the ability to send and receive
 electronic mail or e-mail. The number of
healthcare providers with email address is
growing rapidly. Common providers are Yahoo
Mail®, Gmail® and Hotmail®.
Anatomy of an E-mail Address
- Internet works by connecting computers using
the same protocol. Therefore, all e-mail
addresses are using the same format.
➢ Name – the name of the owner of the address.
Users can devise their own name based on the
availability. Nurses must refer to their organizational
policies on how to make an email address in an
organization.
➢ Email Provider / Organizational Code – denotes
the email providers (Yahoo Mail®, Gmail®,
Hotmail® etc.) or Organizational Code in
conjunction with the organizational website
(@mugglenet, @microsoft, etc).
➢ Domain – corresponds to the high-level domain
names
Evaluating Quality Health Information on the
Internet
- The health summit working group has identified the
major criteria to evaluate an internet site. Not all
information in the internet is reliable so nurses must be
very particular on the type of addresses they are
acquiring health information from. The criteria identified
include the following:
o Credibility – source of information and
timeliness of the content
o Content – to help judge accuracy, examine the
hierarchy of events and presence of original
sources
o Disclosure – the purpose and moderator of the
site
o Links – the quality of links provided by the site
o Design – site accessibility and convenience of
use
o Interactivities – presence of feedback and
communication
o Caveats – achievement of site goals
- One of the major issues in internet use is the
availability of the connection. Nowadays,
wireless fidelity (WiFi) hotspots and internet
LAN stations are sprouting that enables mobile
computing and communication.
Mobile Computing in Nursing
- Mobile Computing in Nursing provides valuable
insights into how nurses are using mobile
computing solutions at the bedside and how
these solutions can best be used to solve
existing workflow inefficiencies.
- Mobile computing makes it easy to stay
connected no matter where you are. It's more
than that: Gamers enjoy peer-to-peer
interaction; photographers can send immediate
downloads and employees can telecommute
from different time zones.
- Tablet PCs are wireless devices that provide
the most promising trend in mobile computing.
21 | E l i
The slightest of them is the size and weight of a
spiral bound notebook.
Wireless Devices
- Wireless devices and devices with wires almost
perform the same functions but wireless
devices have many advantages over other
devices with wires. It facilitates people to work
in different places where they cannot take the
devices with wires attached to them. We are
using many electronic devices but the use of
wireless devices is making our life a bit easy. In
wireless devices the data is transferred in the
form of electromagnetic waves, which are the
main part of electromagnetic spectrum present
in the atmosphere. Communication through
wireless devices is known as wireless
communication.
- Science has invented many electronic devices
that are helping nurses a lot in their daily lives,
one of which is computer by which not a single
company in this world is workable but how great
it will be if this invention is wireless. The
wireless computer is known as Laptop which
has become part of a normal human being now
and any one can take it with him or her with all
their data stored in it. There are many other
wireless devices like USB, cell phones, PDAs
and radio etc. With the help of USB one can
transfer the data from one place to another by
taking that stick in his or her pocket. Cell
phones have also become the most used
wireless device by people in which the
communication is done by using radio
frequencies through different service provider
stations.
Nursing Minimum Data Sets
Incorporate Evidence and Policies in Nursing
Informatics
Components of Clinical Decision Support System
(CDSS)
- a tools nakakatulong to help with your patient
- Automated tools designed to support decision-
making activities and improve the decision
making process and decision outcomes similar
to Artificial Intelligence (AI). stimulation of
human
- A CDSS is designed to support healthcare
providers in making decisions about the
delivery and management of patient care
- They regard Clinical Decision Support System
as active knowledge systems which use two or
more items of patient data to generate case
specific advice. (Wyatt and Spiegelhalter)
Components
Integrated real-time patient database
- combines patient data from multiple sources
(e.g. lab, radiology, pharmacy data etc.). This is
needed to provide context for results
interpretation.
Data-driven mechanism
 - allows event triggers to go into effect and
activate alerts and reminders automatically.
Knowledge engineer
- translate the knowledge representation scheme
used in the system so clinical knowledge in the
system can be extracted and translated into
machine executable logic.
Time-driven mechanism
- permit automatic execution of programs at a
specific time to alert healthcare provider to
carry out a specific function or ensure that
action has been completed (e.g. medication
administration, time alerts)
Long-term clinical data repository
- data collected over time from a variety of
sources allowing a longitudinal patient record.
- naka stock na sya and pwedeng ma retrieve
yung mga years na data kapag kailangan
Key Functions
- Perreault and Metzger identified four (4) key
functions of CDSS in the healthcare field:
Administrative
- Supporting clinical coding and documentation,
authorization of procedures, and referrals.
Managing Clinical Complexity and Details
- Keeping patients on research and
chemotherapy protocols; tracking orders,
referrals follow-up and preventive care.
Cost Control
- Monitoring medication orders; avoiding
duplicate or unnecessary tests.
Decision Support
- Supporting clinical diagnosis and treatment
plan processes; and promoting use of best
practices, condition-specific guidelines, and
population-based management
Early Clinical Decision Support Systems
➢ Internist I - was a rule-based expert system
designed at the University of Pittsburgh in 1974 for
the diagnosis of complex diagnosis of complex
problems in general internal medicine. It uses
patient observations to deduce a list of compatible
disease states (based on a tree-structured
database that links diseases with symptoms).
➢ MYCIN - was a rule-based expert system designed
to diagnose and recommend treatment for certain
blood infections (antimicrobial selection for patients
with bacteremia or meningitis). It was later extended
to handle other infectious diseases. Clinical
knowledge in MYCIN is represented as a set of IF-
THEN rules with certainty factors attached to
diagnoses. It was a goal-directed system, using a
basic backward chaining reasoning strategy
(resulting in exhaustive depth-first search of the
rules base for relevant rules though with additional
heuristic support to control the search for a
proposed solution).
➢ CASNET - (Causal Associational Networks),
developed in the 1960s, was a general tool for
22 | E l i
building expert system for the diagnosis and
treatment of diseases. The most significant Expert
System application based on CASNET was
CASNET/Glaucoma for the diagnosis and
treatment of glaucoma.
➢ DxPlain - is a decision support system which uses
a set of clinical findings (signs, symptoms,
laboratory data) to produce a ranked list of
diagnoses which might explain (or be associated
with) the clinical manifestations. DXplain provides
justification for why each of these diseases might be
considered, suggests what further clinical
information would be useful to collect for each
disease, and lists what clinical manifestations, if
any, would be unusual or atypical for each of the
specific diseases
Myths Affecting Development of CDSS
- The healthcare industry challenged three basic
assumptions which strongly influenced the
development of decision support systems:
o “Diagnosis is the dominant decision-making issue in
medicine”
o "Clinicians will use knowledge-based systems if the
programs can be shown to function at the level of
experts"
o "Clinicians will use stand-alone decision-support
tools."
- By implication, these myths, which are
gradually being overcome, partly contributed to
the relative lack of success of DSS in clinical
care.
Policy Issue #1: Nursing Informatics as a Specialty
- In 1992, the American Nurses Association (ANA)
recognized nursing informatics (NI) as a specialty.
Attempts in 1989 to be recognized as a specialty
failed, but political forces within ANA supported the
request when it was repeated in 1992.
- The term NI first appeared in the literature in 1980s.
It has constantly evolved molded by the maturation
of the field and influenced by health policy. NI
practice differentiates itself from other areas of
nursing practice but emphasizes its interaction with
informatics discipline such as mathematics,
statistics, linguistics, engineering, computer
science and health informatics.
- NI supports national efforts, such as those outlined
by the Pew Health professions and Institute of
Medicine to increase interdisciplinary education.
- To become a specialty, it was necessary for NI to
show that educational programs are available to
prepare nurses to practice in the field. The field of
NI has slowly expanded since 1992. It will be
interesting to see how the current focus on IT
impacts the growth of NI as a specialty
Policy Issue #2: Nursing Informatics Practice
- Nursing has experienced a number of shortages in
recent history. The healthcare industry is headed for
a major crisis in the nursing workforce. At the same
time, the aging of baby boomers will cause
increased demand for hospital services.
- In 2002, the American Academy of Nursing (AAN)
Commission on Workforce launched a multiphase
project to develop IT that will help support nurses in
 their day-to-day work, thereby reducing demand on
their jobs. Given the average age of nurses are
45.2, technology devices would enable some
nurses to stay in their careers longer.
- On the other hand, patient safety is also a concern
for nurse informaticist. Proposals to increase patient
safety with the use of IT have been made by a
variety of groups. California law 1875, for example,
passed in 2003, applies pressure to hospital to
install IT to help healthcare providers reduce errors.
- The Health Insurance Portability and Accountability
Act (HIPAA) was passed in 1996 and is intended to
improve the public and private healthcare programs
by establishing standards to facilitate the efficient
transmission of electronic health information.
Policy Issue #3: TeleHealth and Nursing
Informatics
- Telehealth is defined as the use of electronic
communication networks to transmit data or
information that focuses on health promotion,
disease prevention, diagnosis, consultation,
education, and/or therapy. In one of its many
forms telehealth has been practiced ever since the
advent of the telephone. Telehealth in patient care
covers many areas, but can be divided into two
distinct parts, the technology and the
provider/client relationship. On the technology
side are many different technologies including
advanced image and audio capabilities that range
from high resolution still images to sophisticated
interactive teleconferencing systems. Technology
is now available that allows a virtual simulation of
tissues and blood flow. Use of the Internet to
transmit the feel of a lesion, or even muscles and
bones, prior to surgery will happen soon.
- As part of its participation in the national dialogue
on telemedicine/telehealth, ANA on August 29,
1996, submitted preliminary comments to a Joint
Working Group (JWG) convened by the Health
Resources and Services Administration (HRSA)
of the U.S. Department of Health and Human
Services. ANA continues to develop a more
detailed and comprehensive analysis of the broad
range of issues relevant to the continued growth
and development of telehealth. There have been
various proposals made to amend the current
state-based system to adapt to the increasing
demands of telehealth. Of these, California State
Senate Bill 1665 has advanced the farthest. It
addresses some of the issues related to telehealth
-- for instance, by allowing for consultation
services from an out-of-state practitioner -- but
leaves open many other issues related to
provision of care other than consultation, including
primary health services.
Informatics Theory
Standardizing Healthcare Data and Terminologies
in Nursing Informatics Practice
- Data standards as applied to healthcare include
methods, protocols, terminologies and
specifications for the collection, exchange,
storage and retrieval of information associated
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with the healthcare applications including medical
records, medications, radiological images,
payment and reimbursement, medical devices,
monitoring systems and administrative process.
Categories of Standards
• Syntax
- Refers to structure of communication; the
equivalent of rules in spelling and grammar
• Semantics
- Convey the meaning of communication; the
equivalent of dictionary and thesaurus
Healthcare standards are categorized into six (6):
• Data Exchange / Messaging Standards
- these allow transactions to flow consistently
between systems or organizations because they
contain instructions for format, data, elements,
and structure. Common standards includes HL
and for administrative data such as patient
demographics or encounters; DICOM for
radiology images and NCPDP for electronic
prescriptions.
• Terminology Standards
- these vocabularies provide specific codes for
clinical concepts such as diseases, problem list,
allergies, medications, and diagnoses that might
have varying textual descriptions in a paper chart
or a transcription. Examples of terminologies are
LOINC for lab results; SNOMED for clinical terms;
and ICD for medical diagnoses.
• Document Standards
- these indicate what type of information is included
in a document and where it can be found. A
common standard in paper medical records in the
SOAP (Subjective, Objective, Assessment, Plan)
format. The CCR (Continuity of Care Record)
provides a standard format for inter-provider
communication, including patient identifying
information, medical history, current medications,
allergies, and a care plan recommendation.
• Conceptual Standards
- these allow data to be transported across systems
without losing meaning and context. For example,
the HL7 RIM (Reference Information Model)
provides a framework for describing clinical data
and the context surrounding it.
• Application Standards
- these determine the way business rules are
implemented and software systems interact.
Examples including sign-on, which
simultaneously logs a user into multiple
applications within the same environment; and
standards for providing a comprehensive way of
viewing information across multiple, non-
integrated database.
• Architecture Standards
- these define the process involving in data storage
and distribution. The Centers for Disease
Control’s Public Health Information Networks/
National Electronic Disease Surveillance System
is an example. An emerging functional
architecture is the national electronic health
 record proposed by the Institute of Medicine and • Residence
HL7, commissioned by the HHS. - Service Elements
Impact of Clinical Data Standards • Unique facility or agency number elements
- The comprehensive patient record • Unique patient health record number
accommodates the patients’ movement among all • Unique number of principle RN
locations where care is provided: inpatient, • Episode encounter date
outpatient, and clinic settings. This allows the • Discharge or termination date
healthcare organization to conduct outcome • Disposition of patient
analysis with comparable data. Instead of
• Expected payer for this bill
conducting manual chart reviews and relying on
- In 1991 the American Nurses Association (ANA)
individual interpretation of narrative notes, the
created a committee to review nursing languages
system provides semantically consistent data that
and to recognize those that had met the
can be analyzed.
committee’s own criteria as potentially useful to
- unintended benefits. The improved charting has
support nursing practice. Since that time, the ANA
led to better charge capture, since changes are a
criteria have evolved with the growing knowledge
function of documentation and not a separate
of terminology standards in health informatics.
activity. And, by bringing various regions together
Standardized terminologies are bulleted below:
to plan and design the system, staff have come to
NANDA
see each other as internal consultants who share
- (diagnoses from the North American Nursing
best practices on policies and procedures, patient
Diagnosis Association). While ICD-9-CM codes
education programs, and preparation for
describe a disease or injury, NANDA nursing
accreditation visits. A planned single medication
diagnoses describe a patient's reactions to the
list per patient will cover inpatient and outpatient
disease and to treatment.
environments; it is expected to improve case
NIC
management, prevent adverse drug interactions,
- (Nursing Interventions Classification) is a
and enhance patient satisfaction.
standardized language for treatments that nurses
Organizations on Standardizing Healthcare Data
perform. NIC was developed at the University of
- the standards development involves technical
Iowa and information is published by Mosby,
committee that defines methods, and groups
There is a section of that University's Nursing Web
organized around the communities of interest.
site devoted to NIC and NOC.
Representing stakeholders in these development
NOC
projects are clinicians, researchers,
- (Nursing Outcomes Classification). Also
bioinformaticist, chief information officers,
developed at the University of Iowa. It goes
database administrators, information systems
beyond the work of NIC toward classification of
analyst, and project managers. In addition, special
outcomes useful in clinical nursing.
interest entities in public health, patient safety,
Omaha System
and electronic health records work to ensure that
- the Omaha System of nursing classifications was
the standards are relevant to practice in those
developed by the Omaha Visiting Nurse
areas.
Association. It covers some of the same ground
Nursing Minimum Data Set
as the NANDA nursing diagnoses, and
- a classification system which allows for the
incorporates the Nursing Minimum Data Set
standardized collection of essential nursing data.
(NMDS).
The collected data are meant to provide an
Saba’s Home Healthcare
accurate description of the nursing process used
- the Home Health Care Classification of Nursing
when providing nursing care.
Diagnoses and Interventions (HHCC), developed
- The American Nurses Association Steering
at Georgetown University, focuses on community
Committee on Databases to Support Clinical
health.
Practice (ANASCD) is involved in developing the
UMLS Metathesaurus
NMDS. This set is described as "the minimum
- The National Library of Medicine UMLS
data elements necessary for defining the cost and
Metathesaurus includes terms from NANDA, NIC,
quality of nursing care." Elements of the NMDS
NOC, HHCC, and others.
include the following:
Clinical Care Classification
• Nursing Care Elements - The Clinical Care Classification (CCC) System is
• Nursing Diagnosis a standardized, coded nursing terminology that
• Nursing Intervention identifies the discrete elements of nursing
• Nursing Outcome practice. CCC provides a unique framework and
Intensity of Nursing Care coding structure for capturing the essence of
- Patient Demographic Elements patient care in all health care settings.
• Personal identification Perioperative Nursing Data Set (PNDS)
• Date of Birth - Describes perioperative nursing practice with a
• Sex sub-set of terms that specifically describe
• Race and ethnicity perioperative nursing diagnoses, nursing

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 interventions, and patient outcomes in surgical
settings from pre-admission until discharge.
SNOMED CT
- (Systematized Nomenclature of Medicine-Clinical
Terms) is considered to be the most
comprehensive, multilingual clinical healthcare
terminology in the world.
PCDS
- The Patient Care Data Set (version 4.0, 1998)
contains a data dictionary and sets of terms and
codes representing specific values of Patient
Problems (363 terms), Patient Care Goals (311
terms), and Patient Care Orders (1357 terms). It
was recognized in 1998 by the American Nurses
Association (ANA) as one of the vocabularies to
be considered for use by nurses, and is included
in the National Library of Medicine's
Metathesaurus.
International Classification for Nursing Practice
- The ICNP is a combinatorial terminology for
nursing practice developed by the international
nursing community under the sponsorship of the
International Council of Nurses (ICN).
Nursing Management Minimum Data Set
- Data variables categorized into environment,
nurse resources, and financial resources that are
needed to inform the decision making process of
nurse executives related to leading and managing
nursing services delivery and care coordination.
Concept-Oriented Terminology in Nursing
Informatics
optimized for the management of terminology
definitions. It encompasses:
o Schemata – incorporate domain-specific
knowledge about the typical constellation of
entities, attributes and events in the real world
and reflect plausible combinations of concepts.
Example: “pain” can be combined with “acute”
to make “acute pain”.
o Type Definitions – are obligatory conditions
that state only the essential properties of the
concept. Example: a nursing activity must have
a recipient, an action and a target.
• Representation Language – terminology models
may be formulated and elucidated in an ontology
language. Ontology language represents classes
and their properties. In this way, ontology
languages are able to support, though explicit
semantics, the formal definition of concepts in terms
of their relationships with another concept.
• Computer-Based Tools – a representation
language may be implemented using description
logic within a software system or by a suite of
software tools.
YESSSSSS!!! Tapos na tayo guyssss magmi midterm
nalang. Aral maigiiiii at wag kakalimutan basahin ang mga
module din sa canvas kapit paaaa, kakayanin pa after nito
finals na langgg. Goodluck sa midterm hhehehe.
LabaRNNNNNN dash 6 :>>>
- Eli <3

it is important for nurses to understand the

-
definitions of and relationship among things in the
world (objects), his thoughts about things in the
world (concepts) and the labels nurses use to
represent and communicate thoughts about
things in the world (terms).
Terminologies
• Concept – thought or reference; unit of
knowledge created by a unique combination of
characteristics (an abstraction of a property of
an object or of a set of objects.)
• Objects – the referent; anything perceivable or
conceivable.
• Term – the symbol; verbal designation of a
general concept corresponds to two or more
objects which form a group by reason of
common properties.
Components of Advanced Terminology Systems
• Terminology Model – concept-based
representation of domain-specific terms that is

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