Fifth Generation Computer (Future Computers ?

)
It is very difficult to define the fifth generation of the computer.

• Organic chips
• Decreasing cost of software
• Decreasing cost of hardware
• Artificial Intelligence
• Multi point input-output
• Large storage facility
• Auto decision
• High speed
• Under development in USA, Japan and UK
 Computer Aplications on Health Care Management
Systems 1950 to Present
Decade Computers Healthcare
1950s In 1952 after analyzing only 5% of the tallied In some institutions, automation of the financial and accounting
vote, the Univac I predicted that Eisenhower functions began in the mid 1950's. These systems were
would defeat Stevenson in the presidential transaction or process oriented systems
election (Shelly, & Cashman, 1980).
Remembering the 1948 election in which the
East Coast newspapers, based on a faulty
survey, erroneously predicted that Dewey was
the winner, CBS withheld the information until
it was confirmed by the actual vote. To this
point computers had been developing out of
the public's eye in university laboratories. This
incident brought the computer into the
mainstream, however the public's vision was
of "giant brains" which would out think
humans and eliminate their jobs.(World
Impact of the Integrated Circuit, 1995).
Decade Computers Healthcare
1956 Second generation computers, based on the
transistor are developed. These computers
are smaller, faster, more reliable and more
energy-efficient than first generation
computers. The second generation lasted
until 1963.

Decade Computers Healthcare

1958 The integrated circuit (IC) is developed by
Jack Kilby, an engineer with Texas
Instruments. The IC is the foundation of all
microchip technology (Texas Instruments,
1997).
Decade Computers Healthcare
1960s Douglas Engelbart, while working at Stanford A number of second generation computers are in use by
Research Institute invents the mouse. At that businesses, government and universities (Computers: History
time the device was ignored because and Development, 1997).
computers were so big and expensive that it Some health care institutions begin to include patient care
never occurred to anyone that a computer applications in their computer systems (Saba, Johnson, &
could be used by one individual. Later in his Simpson, 1994).
career he developed video-conferencing,
multiple-window screens and hypertext
(Inventor of the Mouse Wins $500,000 Prize,
1997). The mouse was first introduced to the
general public with the Macintosh computer,
but did not become standard in MS-DOS
products until the introduction of Windows™
in the late 1980's.
Decade Computers
1964 The third generation of computers were
introduced. What distinguished them from
the second generation was the use of the
integrated circuit. They had operating
systems which allowed them to run many
different programs at once by providing a
central program to monitor and coordinate
the computer's memory (Computers: History
and Development, 1997.)
Computers become smaller as more
components are squeezed onto the IC.
Healthcare
By the mid 1960's the abilities of computers had been
recognized by some health care institutions. In 1965 the US
Congress amended the Social Security Act to include Medicare
and Medicaid. To qualify for reimbursement, nurses were
required to provide data to document care delivered US
Department of Health and Human Services, 1983). This proved
to be a great impetus to the development of nursing
information systems.
By this time shared data-processing centers were providing
some hospitals with business and financial system processing
Ball, Hannah, 1988).
Decade Computers Healthcare
1965 Work begins on SNOP by the American College of Pathology to
systematize the language of pathology. Will eventually become
SNOMED
By the late 1960's some hospital information systems include
patient diagnoses and other patient information, and care
plans based on physician and nursing orders (Saba, Johnson, &
Simpson, 1994).
Decade Computers Healthcare
1969 The concept of a Uniform Minimum Health Data Set (UMHDS)
was formulated in an effort to develop national health data
standards and guidelines (Werley, Devine, & Zorn, 1998).
An ambulatory care system,
Computer Stored Ambulatory Record (COSTAR) system is
developed in the late 1960's at Massachusetts General Hospital
for the prepaid Harvard Community Health Plan. Patient care
data was computerized to meet providers' medical, financial,
and administrative needs (Saba & McCormick, 1986).
Bell Aerospace Company designs a health care system for the
Papagoe Indian Reservation in Tuscon, AZ. The centralized
database contained all the medical records. All health care
providers in this system with access to a computer terminal had
access to these records Saba & McCormick, 1986).
Decade Computers
1970s Fourth Generation Computers are seen. Intel
develops a chip that locates ALL the
components of a computer on a single chip.
This enabled the same microprocessor to be
programmed for many needs. Household
items such as microwave ovens, television
sets and automobiles with fuel injection were
able to incorporate microprocessors.
1971 - microprocessors lay the groundwork
for hobbyists to start building "home
computers," or microcomputers, as they are
first called.
Healthcare
Taking advantage of third generation computers, in 1968
development of
the PRoblem Oriented Medical Information System (PROMIS*)
was begun by Dr. Lawrence Weed at the University Medical
Center in Burlington, VT (McNeill, 1979). The importance of this
system lies in the fact that it was the first attempt to provide a
total, integrated system that included all aspects of health care
including patient treatment. It used as its framework
the problem-oriented medical record (POMR*). The system was
patient, not health care oriented. It was originally implemented
on a gynecology unit in 1971, then completely redeveloped for
use on a medical unit.
Decade Computers Healthcare
1972 The Uniform Hospital Discharge Set is adopted. (UHDS)

Decade Computers Healthcare

1973 The Division of Nursing, U. S. Public Health Service, Department
of Health, Education and Welfare funds the first invitational
conference on management information systems for public and
community health agencies under the auspices of the National
League for Nursing (NLN) (Saba & McCormick, 1986). This
conference was followed by five workshops held around the
country designed to teach community health nurses how to
implement computerized management systems in their
agencies. The participants were shown how systems could be
used for statistical reporting, cost analysis, and agency
administration.
The first meeting of the National Group for the Classification of
Nursing Diagnosis was held.
Decade Computers Healthcare
1976 SNOP enlarged to include medical terms and becomes known
as the Systematized Nomenclature of Medicine (SNOMED).
Development continued with the goal of using it in electronic
records.
Decade Computers Healthcare
1977 1977 - The first Apple II is delivered. Although weak by today's
standards, it had the ability to do color graphics and shipped
with a form of the Basic Programming language as part of the
computer. It used the Motorola 6502 chip. The original had 4 K
of RAM and an 8 bit bus.
Rockland County (NY) Health Department attempts to
computerize the patient progress methodology to develop a
patient care classification and nurse staffing system for local
community health nursing agencies. Funding and technological
limitations keep it from ever being functional (Saba &
McCormick, 1986).
Decade Computers Healthcare
1980s IBM realizes that they need to build a smaller,
stand alone computer. Bill Gates convinces
them to use a larger chip (16 bit) and more
RAM than originally planned (64 K instead of
16 K). He also convinces them to license the
Microsoft Operating System (the famous DOS,
rhymes with boss) as the operating system
and contracts to write software for this
machine.
Decade Computers Healthcare
1981 In 1981 IBM ships its first Personal Computer
(PC). It uses a 4.77-MHz Intel 8088 chip and
has 64 kilobytes RAM, one 5.25-inch floppy
diskette drive and PC-DOS 1.0 (Microsoft's
MS-DOS). Color graphics were extra. The
entrance of IBM into the PC market
legitimized the PC and established the
preeminence of the Intel 8086-family of chips
and the Microsoft MS-DOS operating
Decade Computers Healthcare
1982 The price of PCs drops as"clones" appear on The first International Medical Informatics Association Working
the scene. Although the term clone is used, Conference on the Impact of Computers on Nursing is held in
these computers were not an exact duplicate London, England. This was followed in 1985 by another
of the IBM PC. In computers, the term clone international nursing informatics conference in Calgary, Alberta,
means that a computer allows one to run the Canada. These are now held every three years.
same programs, or software. For the first 10
years after the introduction of the IBM PC
these clones were generally referred to as
being "IBM compatible." Later the term heard
more often was MS-DOS™ computers. Today
the terms used is generally a PC or Windows
Computers meaning they run an operating
system produced by Microsoft™.
Decade Computers Healthcare
1984 Apple Computer introduces the first 1984
Macintosh with 8-MHz 32-bit Motorola 68000
chip, built-in 9-inch B/W screen, graphics, a
400 KB 3.5-inch floppy disk drive, a mouse,
and 128 KB RAM. The Macintosh introduced
the graphical user interface (GUI) which was a
revolutionary change in the computing
environment. Instead of typing in a
command, or giving a combination of
keystrokes, users moved the mouse pointer
to the icon representing their choice and
clicked on their mouse. It quickly became
popular with users who found it easier to use
than the IBM PC type computers.
IBM ships the short-lived IBM PC Jr. It was an
attempt to reduce the cost of owning a
computer, but had too little power to satisfy
most potential computer owners.
Decade Computers
1985 Microsoft releases Windows 1.0. Although
gaining some converts, it was about five years
before it became popular.
The Intel 386 is introduced by Intel and the
first PCs based on the 386 chip are produced.
Healthcare
Middle to late 80's, Saba and the research staff of the Home
Health Care Classification Project at Georgetown University
develop a method for classifying home health Medicare
patients for the purpose of predicting resource requirements
and measuring outcomes (Saba, O'Hare, Zuckerman, Boondas,
& Oatway, 1991). Known as the Home Health Care Classification
it is still in use today.
Decade Computers
1986 The First Freenet, in Cleveland, OH comes on
line on July 16. It included access to nurses
and doctors for information on health related
questions (Zakon, 1996).
Healthcare
ANA House of Delegates adopts a resolution identifying the
need for nurses to use information systems to collect essential
data for clinical practice, management of nursing care and
nursing resources, education, administration, and research
(Milholland, 1997). They also recommended that the Nursing
Minimum Data set be tested and implemented at local,
regional and national levels.
Decade Computers Healthcare
1987 Apple Computer introduces the open ANA House of Delegates approved policies to promote the
architecture Macintosh featuring a plug-and- classification of nursing practice in the categories of
play architecture for expansion cards. assessment, diagnosis, interventions and outcomes
(Milholland, 1997).
Work begins on the Nursing Interventions Classifications by
nurse researchers at the University of Iowa. This system is in
use today, known by its acronym of NIC.

Decade Computers Healthcare

1988 Microsoft ships Windows 2.1 for PCs based 1988
on the 286 and 386 Intel chip.

Decade Computers Healthcare

1989 Intel announces the 25-MHz 486 ANA Steering Committee on Databases to Support Clinical
microprocessor at Spring Comdex in Chicago, Nursing Practice was first convened. Today this committee is
Illinois. known as the Committee for Nursing Practice Information
Infrastructure.
Decade Computers Healthcare
1990s 1990 - Intel introduces the 33-MHz 486 ANA House of Delegates directed ANA to pursue collaborative
microprocessor. efforts to develop essential minimum data elements for
Windows 3.0 is introduced by Microsoft. determining cost and quality of nursing care and to provide
leadership in developing uniform classification systems
(Milholland, 1997).
A shift from the retrospective, process oriented systems
towards patient-centered outcome-oriented systems.
Focus of automation in hospital information systems becomes
quality of patient care (Guide to Effective Health Care Clinical
Systems, 1996)
Decade Computers Healthcare
1991 Creative Labs introduces the Sound Blaster Increased clinician usage by developing better user interfaces is
Pro Deluxe, the first stereo PC sound card. a goal of information systems (Guide to Effective Health Care
Clinical Systems, 1996).

Decade Computers Healthcare

1992 Apple Computer chairman John Sculley coins
the term Personal Digital Assistant, referring
to handheld computers that typically operate
via a stylus on a LCD display.
ANA establishes nursing informatics as a nursing specialty
(Milholland,1997).
Cost becomes the major driver of computerization, surpassing
quality of care (Guide to Effective Health Care Clinical Systems,
1996).
Mosby publishes the first edition of the Nursing Outcomes
Classifications (NOC), a system still in use.
Work begins on the Patient Care Data Set at the University of
Virginia. Still in use.
Decade Computers Healthcare
1993 Apple Computer introduces a personal digital Controlling costs are still important, but the 1992 recession
assistant (PDA), the Newton MessagePad. It slows the budget growth for systems (Guide to Effective Health
runs on four AAA batteries. Care Clinical Systems, 1996).
Intel introduces the Pentium processor.
Decade Computers
1994 Microsoft releases Microsoft Windows 3.11.
Dr. Nicely reports his discovery of the
Pentium floating point bug to Intel, and his
report is made public on CompuServe.
Healthcare
Outcomes become a prominent focus for automation (Guide to
Effective Health Care Clinical Systems, 1996).
LOINC system initiated by the Regenstrief Institute and
developed by Regenstrief and the LOINC committee as a
response to the demand for electronic movement of clinical
data from laboratories that produce the data to hospitals,
physician's offices, and payers who use the data for clinical care
and management purposes. (LOINC background, n.d.) Is in use
today.
Decade Computers Healthcare
1995 Intel announces the Pentium Pro Keeping costs down still prevails, but focus now moves to
microprocessor, if numbered it would be a improving patient outcomes. Capturing data at the point of
686. The processor uses 5.5 million care becomes important (Guide to Effective Health Care Clinical
transistors. Systems, 1996).
To operationalize point of care data capture PDAs start to
appear in hospitals.

Decade Computers Healthcare

1996 Compaq Computer introduces the 180-MHz
Pentium Pro-based Prolinea.
Advanced Micro Devices begins shipping the
K5-PR100 microprocessor. It is a 100-MHz
Pentium-compatible plug-in replacement.
Price is US$84 each for 1000.
Managed care is driving increased computerization. There is
increased interest in patient-centered computing environments
(Guide to Effective Health Care Clinical Systems, 1996).
Health Insurance Portability and Accountability Act passed by
Congress. Also known as the Kennedy-Kassenbaum Bill
Decade Computers Healthcare
1997 The Nightingale Tracker, a portable communication system
utilizing a PDA that will allow nurses or students in the field to
be in touch with instructors in an office, under development
since 1994 goes into Beta Testing.

Decade Computers Healthcare

1999 SNOMED and the Read System are combined and become
SNOMED-RT. Is recognized by the ANA.
Decade Computers Healthcare
2000 The Health Insurance Portability and Accountability Act
(HIPAA), first passed by Congress in 1996 is getting the
attention of health care agencies. The final rules and
regulations are i being promulgated

Decade Computers Healthcare

2002 Rules for privacy provisions for HIPAA are finalized.
Software for PDAs that allow clinicians to easily access
reference material becomes popular.
SNOMED-CT is released.
National Alliance for Health Information Technology (Alliance),
a non-governmental group of senior healthcare leaders from
organizations associated with healthcare such as hospitals,
ambulatory care providers, health-systems payers, technology
vendors, and other healthcare stakeholders is established.

Decade Computers Healthcare

2003 Attention in PDAs turns to the portability aspect of this act.
Attention is given to standardization of documentation.
Decade Computers Healthcare
2004 President Bush establishes the position of National Coordinator
for Health Information Technology and the Office of the
National Coordinator for Health Information Technology (ONC)

Decade Computers Healthcare

2005 American Health Informatics Consortium (AHIC) established. It
was a federal advisory committee of public and private sector
Decade Computers leaders. Healthcare
Health Information Technology Standards Panel (HITSP) is
2005
established. They are responsible for designating standards that
will be used in the structure and transmission of healthcare
information, standards that will affect how nursing and others
document care, including the nursing and other healthcare
terminologies that will be acceptable

Decade Computers Healthcare

2007 Microsoft finally releases VISTA PDAs are being used more and more in the clinical area by all
healthcare professionals.