OVERVIEW

Nursing Informatics

- Evolved from the French word “informatics”

- Referred to the field of applied computer science

- Concerned with the processing of information such as nursing information

Computers

- First introduced into healthcare facilities in the 1960s

- For the processing of basic administrative tasks

- The computer is an essential tool in HITsystems

Health Information Technology (HIT)

- HIT is an all-encompassing term

- Refers to technology that:

a. Captures health information

b. Processes health information

c. Generates health information

- Computerization affects all aspects of healthcare delivery including:

a. Provision and documentation of patient care

b. Education of healthcare providers

c. Scientific research for advancing healthcare delivery

d. Administration of healthcare delivery services

e. Reimbursement for patient care

f. Legal and ethical implications

g. Safety and quality issues

- A shift toward
a. Integrating multiple technologies and telecommunication devices

b. Invisible storage devices such as cloud storage

c. User-friendly, menu-driven, touchscreen manipulation methods

- Computers in nursing are used for

a. Managing patient care information

b. Monitoring quality

c. Evaluating outcomes

d. Communicating data and messaged via the Internet

e. Accessing resources

f. Interacting with patients on the Web

g. Documenting and processing real-time plans of care

h. Supporting nursing research

i. Testing new systems

j. Designing new knowledge databases

k. Developing data warehouses

l. Advancing the role of nursing in the healthcare industry and nursing science

MAJOR HISTORICAL PERSPECTIVES OF NURSING AND

COMPUTERS
SEVEN TIME PERIODS

1. Prior to the 1960s

a. Developed in the late 1930s and early 1940s

b. Use in healthcare did not begin until the 1950s and 1960s

c. A few experts formed a cadre to adapt computers to healthcare and nursing

d. Computers in healthcare were used for administrative and accounting functions

e. Punch cards

2. 1960s

a. Use of computer technology began to be explored

b. Studies were conducted to determine how computer technology could be utilized

c. The nurses’ station was viewed as the most appropriate center for the development of computer
applications

d. The mid-1960s presented nurses with new opportunities for computer use

e. Increased time devoted to documentation and a rise in medication errors prompted the
investigation of emerging computer-based information systems

3. 1970s

a. During the late 1960s through the 1970s, hospitals began developing computer-based information
systems which initially focused on (1) Physician order entry (2) Results reporting (3) Pharmacy (4)
Laboratory (5) Radiology reports (6) Information for financial and managerial purposes (7)
Physiologic monitoring systems in the intensive care units

b. A few systems started to include (1) Care planning (2) Decision support (3) Interdisciplinary
problem lists

c. Nurses were often involved in implementing systems

d. Interest in computers and nursing began to emerge in public and home health and education

e. In the 1970s, conferences helped public and home health nurses (1) Understand the importance of
nursing data and their relationship to new Medicare and Medicaid legislation (2) Provide information
on the usefulness of computers for capturing and aggregating home health and public health
information

f. Hospitals and public health agencies embarked on investigating computers and nursing

g. The opportunity to improve education using computer technology also began

h. Early nursing networks helped to expand nursing awareness of computers and the impact HIT
could have on practice

i. The Clinical Center at the National Institutes of Health implemented the Technicon Medical
Information System (TDS) computer system

j. TDS one of the earliest clinical information systems (called Eclipsys & Allscripts)

k. TDS was the first system to include nursing practice protocols

4. 1980s

a. The field of nursing informatics exploded and became visible in the healthcare and nursing

b. The nursing profession needed to update its practice standards and determine its data standards,
vocabularies, and classification schemes that could be used for the computerbased patient record
systems

c. Many mainframe healthcare information systems (HISs) emerged with nursing subsystems

d. These systems documented several aspects of the patient record

e. The microcomputer or personal computer (PC) emerged during this period

f. The first Nursing Special Interest Group on Computers met for the first time during SCAMC
(Symposium on Computer Applications in Medical Care) in 1981

g. In 1985, the ANA approved the formation of the Council on Computer Applications in Nursing
(CCAN)

h. CCAN became a very powerful force in integrating computer applications into the nursing
profession

i. The first edition of this book published in 1986

5. 1990s

a. Advances in relational databases, client-server architectures, and new programming methods

b. Better application development at lower costs

c. Legislative activity in the mid-1990s paved the way for electronic health records through the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 (public-law 104-19)

d. The complexity of technology, workflow analysis, and regulations shaped new roles in nursing

e. In 1992, the ANA recognized nursing informatics as a new nursing specialty separate Scope of
Nursing Informatics Practice Standards, and also established a specific credentialing examination for
it

f. The demand for nursing informatics (NI) expertise increased

g. The ANA developed the Nursing Information and Data Set Evaluation Standards (NIDSEC) to
evaluate and recognize nursing technology rapidly changed in the 1990s (1) PCs became smaller (2)
Computer notebooks became affordable (3) Computers were linked through networks (4) The
Internet became mainstream (5) The World Wide Web (WWW) increased access to information
h. The purpose of Information systems was to guide the development and selection of nursing
systems that included standardized nursing terminologies integrated throughout the system

6. 2000s

a. More healthcare information became digitalized and newer technologies emerged

b. In 2004 an Executive Order 13335 (1) Established the Office of the National Coordinator (ONC) for
Healthcare Information Technology (HIT) (2) Issued a recommendation calling for all healthcare
providers to adopt interoperable electronic health records (EHRs) by 2014/2015

c. Wireless, point of care, regional database projects, and increased IT solutions proliferated

d. The use of bar coding and radio-frequency identification (RFID) emerged as a useful technology

e. Smaller mobile devices with wireless or Internet access increased access to information for nurses
within hospitals and in the community

f. The development and refinement of voice over Internet protocol (VoIP) provided voice cost-
effective communication

g. The Internet provided a means for development of clinical applications

h. The nursing informatics research agenda promoted the integration of nursing care data in HIT
systems that would also generate data for analysis, reuse, and aggregation

7. 2010s

a. The impact of the Nursing Minimum Data Set (NMDS) demonstrated that continued consensus and
effort was needed to bring to fruition the vision and implementation of minimum nursing data into
clinical practice

b. A new nursing informatics research agenda for 2008–2018 emerged as critical for this specialty

c. The new agenda is built on one originally developed and published by the National Institute for
Nursing Research (NINR) in 1993

d. During 2010, the ONC convened two national committees: (1) National Committee on Health Policy
(2) National Committee on Health Standards which outlined and designed the focus for the
“Meaningful Use” (MU) legislation

e. Meaningful Use was designed to be implemented in at least three stages

f. Consists of the regulations which built onto each other with the ultimate goal of implementing a
complete an interoperable EHR and/or HIT system in all US hospitals

g. In 2011/2012 MU Stage 1 was initiated focusing primarily on the Computerized Physician Order
Entry (CPOE) initiative for physicians
h. In 2012/2013 MU Stage 2 was introduced focusing primarily on the implementation of Quality
Indicators

i. The Quality Indicators are used to guide hospitals in patient safety and if not implemented used as
indicators subject to financial penalties

j. It is anticipated that MU Stage 3 will be implemented in 2014/2015

k. The Center for Medicare and Medicaid Services (CMS) plans to increase reimbursement for the
implementation of “MU” regulations in their HIT and/or EHR systems through 2015

l. CMS may even penalize eligible providers and facilities who do not meet the proposed MU criteria

m. As the MU requirements increase they will impact on the role of the NI experts in hospitals

n. MU requirements ultimately on the roles of all nurses in the inpatient facilities, making NI an
integral component of all professional nursing services 

Consumer-centric Healthcare System

1. There is a shift to a consumer-centric healthcare system due to escalating costs

2. Consumers are encouraged to be active partners in their care

3. A variety of technologies have evolved to enable consumers to have access to their health
information

4. Consumers can choose whether to share this across healthcare providers and settings

5. Personal health records multiplied as either stand-alone systems or those tethered to EHRs

6. Consumers are more literate regarding healthcare information literacy and expect to become more
involved in managing their own health

LANDMARK EVENTS IN NURSING AND COMPUTERS

Major Milestones

1. Computers were introduced into the nursing profession over 40 years ago

2. Major milestones of nursing are interwoven with the advancement of computer and information
technologies

3. The increased need for nursing data, development of nursing applications, and changes, making
the nursing profession an autonomous discipline

4. There are currently several key events in which the NI community participates

a. Conferences
b. Symposia

c. Institutes

d. Workshops

5. Key events provide:

a. An opportunity for nursing informatics novices and experts to network and share their experiences

b. Key events provide the latest information, newest exhibits, and demonstrations

HISTORY OF NURSING INFORMATICS IN THE PHILIPPINES

Origins

- Since 1998, several faculty members of the University of the Philippines began formal education and
training. Dr. Herman Tolentino took a post-doctoral fellowship in medical informatics at the University
of Washington.

- Dr. Alvin Marcelo followed a year later for his training at the National Library of Medicine.

- Dr. Cito Maramba went to Coventry for his Masters in Information Sciences at the University of
Warwick.

- They were later followed by other physicians such as Dr. Micheal Muin and Dr. Ryan Bañez.

- By the year 2003, a Master of Science in Health Informatics was proposed to be offered by UP-
Manila College of Medicine (major in medical informatics) and the College of Arts and Science (major
in bioinformatics) and was later approved to be offered starting academic year 2005-2006.

- In 1999, a study group was formed headed by the National Institute of Health of the University of
the Philippines Manila. This group identified international standards for health information and their
adaptability in the Philippines. The document is referred to as the "Standards of Health Information in
the Philippines, 1999 version" or "SHIP99". Representatives from various sectors collaborated on this
project including the Philippine Nurses Association (PNA) in the person of Ms. Evelyn Protacio.

- The Philippine Medical Informatics Society (PMIS) and its founders had strong influence in the
development of health informatics in the Philippines. The PMIA was officially registered under the
Securities and Exchange Commission in 1996 by its board composed of eleven physicians. The
organization was headed by Dr. Alvin Marcelo

CHED as a Catalyst

- The nursing community was still yet to follow its international counterparts in the adoption of
information, communication and technology in nursing practice in the Philippines.
- Despite the inclusion of Informatics course in the undergraduate curriculum which focused on basic
desktop applications, the need for genuine nursing informatics course had not yet been realized

- In 2008, Nursing Informatics course in the undergraduate curriculum was defined by the
Commission on Higher Education (CHED) Memorandum Order 5 Series of 2008. This was later
revised and included as Health Informatics course in CHED Memorandum Order 14 Series of 2009.
This was first implemented in the summer of 2010.

Organization

- Early in 2009, Mr. Kristian R. Sumabat and Ms. Mia Alcantara Santiago, both nurses and graduate
students of Master of Science in Health Informatics at the University of the Philippines, Manila began
drafting plans to create a nursing informatics organization. In February 2010, they began recruiting
other nursing informatics specialists and practitioners to organize a group which later became as the
Philippine Nursing Informatics Association.

Issues and Challenges

- Like many other disciplines, nursing informatics face many challenges while in its infancy stage.

- The inclusion of informatics as an integral part of the undergraduate curriculum has been one of the
most influential factors for the increased awareness and interest in this field of nursing.

- However, the contents of the curriculum was adapted from international materials which does not
match the local needs.

- A community-centered approach to the use of information, communication and technology in

nursing practice must be adapted to ensure the impact of the program in the local healthcare system.
¡ Lack of certification and credentialing programs in post-graduate levels are also absent with the
scarcity of local nursing informatics experts. ¡ This new field has yet to gain acceptance and
recognition in the nursing community as a sub-specialty

Future Direction

- Development of training, certification and credentialing programs are in the pipeline for the
Philippine Nursing Informatics Association. ¡ Future partnerships with local and international nursing
and health informatics organizations have started as well. ¡ Other programs are expected to be slowly
delivered with PNIA's CORE X strategic platform which stands for Competency, Organization,
Recognition, Experience and Expertise.

- It is also a major thrust to support the use of health information standards in the Philippines and to
have nursing informatics specialists in every hospital in the country
NURSING STANDARDS INITIATIVES
Nursing Practice Standards

 Nursing practice standards have been developed and recommended by the ANA
 Nursing Scope and Standards of Practice that focused

a. On the organizing principles of clinical nursing practice

b. The standards of professional performance

 Nursing Informatics Scope and Standards of Practice builds on

a. Clinical practice standards

b. Outlines further the importance for implementing standardized content to support nursing practice
by specialists in nursing informatics

Nursing Education Standards

1. Since the NLN’s Nursing Forum on Computers in Healthcare and Nursing was formed in 1985, it
has supported the integration of computer technology in the nursing curriculum

2. The American Association of Colleges of Nursing (AACN), revised The Essentials for Doctoral
Education for Advanced Nursing Practice and The Essentials of Baccalaureate Education for
Professional Nursing Practice to require the use of computers and informatics for both baccalaureate
and graduate education

Nursing Content Standards

1. The nursing process data elements in EHRs are essential for the exchange of nursing information
across information systems and settings

2. Standardization of healthcare data began in 1893 with the List of International Causes of Death for
the reporting of morbidity cases worldwide

3. The standardization of nursing began with Florence Nightingale’s six cannons in her “Notes on
Nursing”

4. In 1955, Virginia Henderson published her 14 Daily Patterns of Living as the list of activities and
conditions that became the beginning of nursing practice standards in the United States

5. In 1970, the ANA accepted the Nursing Process as the professional standards for nursing practice
and which was followed by the standardization of nursing content-data elements in 1973

6. Currently, the ANA has recognized 12 nursing terminologies

7. The ANA selected six of the ANA recognized nursing languages for inclusion in the NLM’s
Metathesaurus of the Unified Medical Language System (UMLS) and for inclusion in the Systematized
Nomenclature of Medicine—Clinical Terms (SNOMED-CT)
8. There are a large number of standards organizations that impact healthcare data content as well
as healthcare technology systems

Confidentiality and Security Standards

1. Increasing access through the electronic capture and exchange of information raised concerns
about the privacy and security of personal healthcare information (PHI)

2. Provisions for strengthening the original HIPAA legislation were included in the 2009 HITECH Act

Electronic Health Records from a Historical Perspective

The Institute of Medicine (IOM)

 In 1989, the Institute of Medicine (IOM) convened a committee and asked the question, “Why is
healthcare still predominantly using paper-based records when so many new computer-based
information technologies are emerging?”
 Two major conclusions resulted from the committee’s deliberations.

a. First, computerized patient record (CPR) is an essential technology for healthcare and is an integral
tool for all professionals

b. Second, the committee after hearing from numerous stakeholders recognized that there was no
national coordination or champion for CPRs

The Computer-Based Patient Record Institute

 Created in 1992
 Given the mission to initiate and coordinate the urgently needed activities to develop, deploy, and
routinely use CPRs to achieve improved outcomes in healthcare quality, cost, and access
 Developed the CPR Project Evaluation Criteria in 1993 modeled after the Baldridge Award

a. These criteria formed the basis of a self-assessment that could be used by organizations and
outside reviewers to measure and evaluate the accomplishments of CPR projects

b. The four major areas of the initial criteria (1) Management (2) Functionality (3) Technology (4)
Impact

c. Provided a framework through which to view an implementation of computerized records

d. The criteria which provided the foundation for the Nicholas E. Davies Award of Excellence Program

 The Davies Program evolved through multiple revisions

 Under HIMSS management, the Davies Award of Excellence is offered in four categories

a. Enterprise (formerly Organizational or Acute Care), first offered in 1995

b. Ambulatory Care, started in 2003

c. Public Health, initiated in 2004 d. Community Health Organizations (CHO), first presented in 2008

THEORIES, MODELS AND FRAMEWORKS SUPPORTING NURSING

INFORMATICS
THEORIES SUPPORTING NURSING INFORMATICS

- Nursing theories are about nursing practice—a nurse’s interactions or relationships with individuals,
groups, or communities (also known as patients or clients) focused on applying the nursing process.

- Novice to Expert. Patricia Benner and other nurse educators adapted this model to explain how
nursing students and professional nurses acquired nursing skills.

- Computer science is the study of algorithms for solving computation problems.

- Information science focuses on the gathering, manipulation, classification, storage, and retrieval of
recorded knowledge.

- Communication theory uses these core concepts and additional principles developed since then to
analyze information transfer and the effectiveness and efficiency of communications.

- Cognitive Science is the study of the mind—of how we think and it looks at our
mental activities and processes.

- Systems theory relates to the properties of systems as a whole, focuses on the organization and
interdependence of relationships within a system.

- The study of behavior—the processes driving actions—is the focus of the Behavioral and Social
sciences.

- Change processes entail not only structures and ways of doing tasks, but also the performance,
expectations, and perceptions of all involved parties.

- Learning is a process of acquiring knowledge, skills, attitudes, or values through study, experience,
or teaching.

- Organizational Behavior where organizations are examined, using the methods drawn from
economics, sociology, political science, anthropology, and psychology.

- Management science uses mathematics and other analytical methods to help make better decisions,
generally in a business context.

- Group dynamics is a social science field that focuses on the nature of groups

 
MODELS IN NURSING INFORMATICS

- Models are representations of some aspect of the real world.

- The foundations of nursing informatics are the core phenomena and nursing-informatics models.

- Core phenomena are data, information, knowledge, and wisdom and the transformations that each
of these undergo.

- It is important to remember that different models reflect different viewpoints and are not
necessarily competitive, that is, there is no one “right” model.

1. GRAVES AND CORCORAN’s Model

- Proponent: Graves and Corcoran (1989)

- Their model placed data, information, and knowledge in sequential boxes with one-way arrows
pointing from data to information to knowledge.

- The model is a direct depiction of their definition of nursing informatics.

2. SCHWIRIAN’S MODEL

- Proponent: Patricia Schwirian (1986)

- A model of nursing informatics intended to stimulate and guide systematic research in this
discipline.

- Four elements are: (1) Raw material (nursing-related information) (2) Technology (a computing
system comprised of hardware and software) (3) Users surrounded by context (nurses, students) (4)
Goal (or objective) toward which the preceding elements are directed

3. TURLEY’S MODEL

- Proponent: James P. Turley (1996)

- In which the core components of informatics (cognitive science, information science, and computer
science) are depicted as intersecting circles.

- Nursing science is a larger circle that completely encompasses the intersecting circles. ¡ Nursing
informatics is the intersection between the discipline-specific science (nursing) and the area of
informatics.

4. MCGONIGLE AND MASTRIAN’S FOUNDATION OF KNOWLEDGE MODEL

- Proponent: Dee McGonigle and Kathleen Mastrian

- The base of this model shows data and information distributed randomly.

- From this base, transparent cones grow upward and intersect.

- The upward cones represent acquisition, generation, and dissemination of knowledge. ¡ Knowledge
processing is represented by the intersections of these three cones.

- Circling and connecting all of the cones is feedback.

5. TECHNOLOGICAL COMPETENCY AS CARING IN NURSING: A MODEL FOR PRACTICE

- Proponent: Rozzano C. Locsin, PhD, RN, FAAN
- A conceptual model that presents the link between technology and caring in nursing as coexisting
harmoniously. (Locsin, 1995)

6. DIKW MODEL

Data, Information, Knowledge and Wisdom

 Data - Discrete entities that are described objectively without interpretation

 Information - Data that is interpreted organized or structured
 Knowledge - Information that has been synthesized so that interrelationships are identified
and formalized
 Wisdom - Knowledge applied in a practical way or translated into actions. Result in decisions
that guide practice.

FRAMEWORKS IN NURSING INFORMATICS

- Nursing frameworks were proposed to illustrate dynamic interactions occurring between nurses,
computers, and enabling elements that optimize a user’s ability to process information via computers.

- There were still limitations identified in the early models because they did not: a. Explicitly make the
patient part of the model b. Define the context c. Or include all elements of nursing’s metaparadigm
(PHEN)

1. Judith A. Effken, PhD (2003) proposed the Informatics Research Organizing Model which
emphasized all elements of nursing’s metaparadigm including the system, nurse, patient, and
health
2. Gregory L. Alexander (2007) proposed the Nurse—Patient Trajectory Framework.

3.  Alexander’s framework utilizes

a. Nursing process theory

b. Human factors
c. Nursing and patient trajectories as components of a framework that can be used to evaluate
patient care systems

d. The midrange framework specifically emphasizes the use of human factors approaches to link
patient care processes, nurse and patient trajectories, and nursing and patient outcomes

e. In this discussion, the framework has been modified to explore HCI in the context of nurse and
patient trajectories as technology is integrated into nurse-led systems

f. Examples of HCI design and research using this model will be used to achieve the objectives

RELATED CONCEPTS
NURSING

• Nursing is the protection, promotion and optimization of health and abilities, prevention of illness
and injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and populations.

• It is dynamic a profession.

• Nurses must possess the technical skills to manage equipment and perform procedures,
interpersonal skills to interact appropriately with people, and cognitive skills to observe, recognize
and collect data, analyze and interpret data and reach a reasonable conclusion that forms the basis
of a decision

INFORMATICS
❖ Came from the French word informatique which means computer science.

❖ It denotes the application of computer science and information science to the management and
processing of data, information and knowledge in the named discipline.

TECHNOLOGY
❖ Came from the Greek teknolohiga which means systematic treatment.

❖ It is a scientific method achieving a practical purpose.

❖ Things that are invented to make life simple

COMPUTER SCIENCE

It is the study of the theoretical foundations of information and computation and of practical
techniques for their implementation and application in computer systems.
INFORMATION SCIENCE
It is an interdisciplinary science primarily concerned with the analysis, collection, classification,
manipulation, storage, retrieval and dissemination of information.

COGNITIVE SCIENCE
It is the process of human thinking, understanding and remembering.

HEALTH INFORMATICS
The intersection of information science, computer science and health care
It deals with the resources, devices, and methods required to optimize the acquisition, storage,
retrieval and use of information in health and biomedicine

MEDICAL INFORMATICS
It refers to the application of informatics to all of health care disciplines as well as to the practice of
medicine.

NURSING INFORMATICS
❖ a specialty that integrates nursing science, computer science and information science to manage
and communicate data, information, knowledge, and wisdom in nursing practice. 
LESSON 1: HISTORICAL PERSPECTIVE OF NURSING INFORMATICS
Overview
Nursing Informatics
 Evolved from the French word “informatics"
 Referred to the field of applied computer science
 Concerned with the processing of information such as nursing information
Computers

 First introduced into healthcare facilities in the 1960s

 For the processing of basic administrative tasks
 The computer is an essential tool in HIT systems
Health Information Technology (HIT)
1. HIT is an all-encompassing term
2. Refers to technology that:

 Captures health information

 Processes health information
 Generates health information
3. Computerization affects all aspects of healthcare delivery including:

 Provision and documentation of patient care

 Education of healthcare providers
 Scientific research for advancing healthcare delivery
 Administration of healthcare delivery services
 Reimbursement for patient care
 Legal and ethical implications
 Safety and quality issues
4. A shift toward:

 Integrating multiple technologies and telecommunication devices

 Invisible storage devices such as cloud storage
 User-friendly, menu-driven, touchscreen manipulation methods
5. Computers in nursing are used for:

 Managing patient care information

 Monitoring quality
 Evaluating outcomes
 Communicating data and messaged via the Internet
 Accessing resources
 Interacting with patients on the Web
 Documenting and processing real-time plans of care
 Supporting nursing research
 Testing new systems
 Designing new knowledge databases
 Developing data warehouses
 Advancing the role of nursing in the healthcare industry and nursing science

LESSON 2: MAJOR HISTORICAL PERSPECTIVE OF NURSING AND COMPUTERS- SEVEN TIME PERIODS
SEVEN TIME PERIODS
1. Prior to the 1960s

 Developed in the late 1930s and early 1940s 

  Use in healthcare did not begin until the 1950s and 1960s 
 A few experts formed a cadre to adapt computers to healthcare and nursing 
 Computers in healthcare were used for administrative and accounting functions
2. 1960s

 Use of computer technology began to be explored 

 Studies were conducted to determine how computer technology could be utilized 
 The nurses’ station was viewed as the most appropriate center for the development of computer
applications 
 The mid-1960s presented nurses with new opportunities for computer use 
 Increased time devoted to documentation and a rise in medication errors prompted the investigation of
emerging computer-based information systems
3. 1970s

 During the late 1960s through the 1970s, hospitals began developing computer-based information
systems which initially focused on (1) Physician order entry (2) Results reporting (3) Pharmacy (4)
Laboratory (5) Radiology reports (6) Information for financial and managerial purposes (7) Physiologic
monitoring systems in the intensive care units 
 A few systems started to include (1) Care planning (2) Decision support (3) Interdisciplinary problem
lists Nurses were often involved in implementing systems 
 Interest in computers and nursing began to emerge in public and home health and education 
 In the 1970s, conferences helped public and home health nurses (1) Understand the importance of
nursing data and their relationship to new Medicare and Medicaid legislation (2) Provide information on
the usefulness of computers for capturing and aggregating home health and public health information 
 Hospitals and public health agencies embarked on investigating computers and nursing 
 The opportunity to improve education using computer technology also began 
 Early nursing networks helped to expand nursing awareness of computers and the impact HIT could
have on practice 
 The Clinical Center at the National Institutes of Health implemented the Technicon Medical Information
System (TDS) computer system 
 TDS one of the earliest clinical information systems (called Eclipsys & Allscripts) 
 TDS was the first system to include nursing practice protocols
4. 1980s

 The field of nursing informatics exploded and became visible in the healthcare and nursing 
 The nursing profession needed to update its practice standards and determine its data standards,
vocabularies, and classification schemes that could be used for the computer- based patient record
systems 
 Many mainframe healthcare information systems (HISs) emerged with nursing subsystems 
 These systems documented several aspects of the patient record 
 The microcomputer or personal computer (PC) emerged during this period 
 The first Nursing Special Interest Group on Computers met for the first time during SCAMC
(Symposium on Computer Applications in Medical Care) in 1981 
 In 1985, the ANA approved the formation of the Council on Computer Applications in Nursing (CCAN) 
 CCAN became a very powerful force in integrating computer applications into the nursing profession 
 The first edition of this book published in 1986
5. 1990s

 Advances in relational databases, client-server architectures, and new programming methods 

 Better application development at lower costs 
 Legislative activity in the mid-1990s paved the way for electronic health records through the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 (public-law 104-19) 
 The complexity of technology, workflow analysis, and regulations shaped new roles in nursing 
  In 1992, the ANA recognized nursing informatics as a new nursing specialty separate Scope of Nursing
Informatics Practice Standards, and also established a specific credentialing examination for it 
 The demand for nursing informatics (NI) expertise increased 
 The ANA developed the Nursing Information and Data Set Evaluation Standards (NIDSEC) to evaluate
and recognize nursing technology rapidly changed in the 1990s (1) PCs became smaller (2) Computer
notebooks became affordable (3) Computers were linked through networks (4) The Internet became
mainstream (5) The World Wide Web (WWW) increased access to information 
 The purpose of Information systems was to guide the development and selection of nursing systems
that included standardized nursing terminologies integrated throughout the system
6. 2000s

 More healthcare information became digitalized and newer technologies emerged 

 In 2004 an Executive Order 13335 (1) Established the Office of the National Coordinator (ONC) for
Healthcare Information Technology (HIT) (2) Issued a recommendation calling for all healthcare
providers to adopt interoperable electronic health records (EHRs) by 2014/2015 
 Wireless, point of care, regional database projects, and increased IT solutions proliferated 
 The use of bar coding and radio-frequency identification (RFID) emerged as a useful technology 
 Smaller mobile devices with wireless or Internet access increased access to information for nurses
within hospitals and in the community 
 The development and refinement of voice over Internet protocol (VoIP) provided voice cost-effective
communication 
 The Internet provided a means for development of clinical applications 
 The nursing informatics research agenda promoted the integration of nursing care data in HIT systems
that would also generate data for analysis, reuse, and aggregation
7. 2010s

 The impact of the Nursing Minimum Data Set (NMDS) demonstrated that continued consensus and
effort was needed to bring to fruition the vision and implementation of minimum nursing data into
clinical practice 
 A new nursing informatics research agenda for 2008–2018 emerged as critical for this specialty 
 The new agenda is built on one originally developed and published by the National Institute for Nursing
Research (NINR) in 1993 
 During 2010, the ONC convened two national committees: (1) National Committee on Health Policy (2)
National Committee on Health Standards which outlined and designed the focus for the “Meaningful
Use” (MU) legislation 
 Meaningful Use was designed to be implemented in at least three stages 
 Consists of the regulations which built onto each other with the ultimate goal of implementing a
complete an interoperable EHR and/or HIT system in all US hospitals 
 In 2011/2012 MU Stage 1 was initiated focusing primarily on the Computerized Physician Order Entry
(CPOE) initiative for physicians 
 In 2012/2013 MU Stage 2 was introduced focusing primarily on the implementation of Quality
Indicators 
 The Quality Indicators are used to guide hospitals in patient safety and if not implemented used as
indicators subject to financial penalties
 It is anticipated that MU Stage 3 will be implemented in 2014/2015
 The Center for Medicare and Medicaid Services (CMS) plans to increase reimbursement for the
implementation of “MU” regulations in their HIT and/or EHR systems through 2015
 CMS may even penalize eligible providers and facilities who do not meet the proposed MU criteria
 As the MU requirements increase they will impact on the role of the NI experts in hospitals
 MU requirements ultimately on the roles of all nurses in the inpatient facilities, making NI an integral
component of all professional nursing services
LESSON 3: NURSING INFORMATICS PIONEER
History Project
1. In 1995, Saba initiated a history of NI at the National Library of Medicine, which consisted of the collection
of archival documents from the NI pioneers

2. The history project was initiated based on a recommendation by Dr. Morris Collen

3. In 2001, that the Nursing Informatics Working Group (NIWG) of the American Medical Informatics
Association (AMIA) became involved

4. The NI History Committee was established to take on this project

5. The committee solicited archival material from the known NI pioneers for a History of Nursing Informatics to
be housed in the NLM as part of its History Collection

6. In 2004, the rich stories of pioneers in nursing informatics were captured through a project sponsored by
the AMIA-NIWG

7. Pioneers were defined as those who “opened up” a new area in nursing informatics and provided a
sustained contribution to the specialty

8. Through multiple contacts and review of the literature, 145 pioneers and contributors were identified as
having shaped nursing informatics since the 1950s

9. Each identified pioneer was contacted to submit their nonpublished documents and/or historical materials to
the NLM to be indexed and archived for the Nursing Informatics History Collection

10. The catalogued document descriptions can be searched

online: www.nlm.nih.gov/hmd/manuscripts/accessions.html

11. A convenience sample of pioneers was interviewed over a 4-year period at various nursing informatics
meetings

12. Videotaped stories from 33 pioneers were recorded

13. The 33 videotaped stories are available on the AMIA website: www.amia.org/niwg-history-page

14. The website also provides “use cases” for ideas about how to use the information for teaching and
learning more about the pioneers

15. These resources are particularly useful for courses in informatics, leadership, and research

16. They also are useful for nurses in the workforce who want to learn more about nursing informatics history

17. The early pioneers came from a variety of backgrounds as nursing education in nursing informatics didn’t
exist in the 1960s

18. Almost all of the pioneers were educated as nurses, though a few were not

19. The pioneers had a vision that technology could make nursing practice better

20. The nursing pioneers influenced the evolution of informatics as a specialty from granular-level data
through health policy and funding
LESSON 4: NURSING STANDARDS INITIATIVES

Nursing Practice Standards

 Nursing practice standards have been developed and recommended by the ANA
 Nursing Scope and Standards of Practice that focused

a. On the organizing principles of clinical nursing practice

b. The standards of professional performance

 Nursing Informatics Scope and Standards of Practice builds on

a. Clinical practice standards

b. Outlines further the importance for implementing standardized content to support nursing practice by
specialists in nursing informatics

Nursing Education Standards

1. Since the NLN’s Nursing Forum on Computers in Healthcare and Nursing was formed in 1985, it has
supported the integration of computer technology in the nursing curriculum

2. The American Association of Colleges of Nursing (AACN), revised The Essentials for Doctoral Education for
Advanced Nursing Practice and The Essentials of Baccalaureate Education for Professional Nursing Practice to
require the use of computers and informatics for both baccalaureate and graduate education

Nursing Content Standards

1. The nursing process data elements in EHRs are essential for the exchange of nursing information across
information systems and settings

2. Standardization of healthcare data began in 1893 with the List of International Causes of Death for the
reporting of morbidity cases worldwide

3. The standardization of nursing began with Florence Nightingale’s six cannons in her “Notes on Nursing”

4. In 1955, Virginia Henderson published her 14 Daily Patterns of Living as the list of activities and conditions
that became the beginning of nursing practice standards in the United States

5. In 1970, the ANA accepted the Nursing Process as the professional standards for nursing practice and which
was followed by the standardization of nursing content-data elements in 1973

6. Currently, the ANA has recognized 12 nursing terminologies

7. The ANA selected six of the ANA recognized nursing languages for inclusion in the NLM’s Metathesaurus of
the Unified Medical Language System (UMLS) and for inclusion in the Systematized Nomenclature of Medicine
—Clinical Terms (SNOMED-CT)

8. There are a large number of standards organizations that impact healthcare data content as well as
healthcare technology systems

Confidentiality and Security Standards

1. Increasing access through the electronic capture and exchange of information raised concerns about the
privacy and security of personal healthcare information (PHI)

2. Provisions for strengthening the original HIPAA legislation were included in the 2009 HITECH Act

Electronic Health Records from a Historical Perspective

The Institute of Medicine (IOM)

 In 1989, the Institute of Medicine (IOM) convened a committee and asked the question, “Why is
healthcare still predominantly using paper-based records when so many new computer-based
information technologies are emerging?”
 Two major conclusions resulted from the committee’s deliberations.

a. First, computerized patient record (CPR) is an essential technology for healthcare and is an integral tool for
all professionals

b. Second, the committee after hearing from numerous stakeholders recognized that there was no national
coordination or champion for CPRs

The Computer-Based Patient Record Institute

 Created in 1992
 Given the mission to initiate and coordinate the urgently needed activities to develop, deploy, and
routinely use CPRs to achieve improved outcomes in healthcare quality, cost, and access
 Developed the CPR Project Evaluation Criteria in 1993 modeled after the Baldridge Award

a. These criteria formed the basis of a self-assessment that could be used by organizations and outside
reviewers to measure and evaluate the accomplishments of CPR projects

b. The four major areas of the initial criteria (1) Management (2) Functionality (3) Technology (4) Impact

c. Provided a framework through which to view an implementation of computerized records

d. The criteria which provided the foundation for the Nicholas E. Davies Award of Excellence Program
  The Davies Program evolved through multiple revisions
 Under HIMSS management, the Davies Award of Excellence is offered in four categories

a. Enterprise (formerly Organizational or Acute Care), first offered in 1995

b. Ambulatory Care, started in 2003

c. Public Health, initiated in 2004 d. Community Health Organizations (CHO), first presented in 2008

CHAPTER 2: LESSON ON HARDWARE

INTRODUCTION

Computer hardware

ü  defined as all of the physical components of a computer

ü  a machine that uses electronic components and instructions to the components to perform

·         Calculations

·         Repetitive and complex procedures

·         Process text

·         Manipulate data and signals

ü  Computer technology has evolved from huge, room-sized electronic calculators developed with military
funding during World War II to palm-sized machines

ü  The basic hardware of a computer composes the computer’s architecture, and includes:

·         Electronic circuits

·         Microchips, processors

·         Random Access Memory (RAM)

·         Read-Only Memory (ROM)

·         Graphic and sound cards

ü  These are attached to a component called a motherboard

ü  The motherboard is a square or rectangular board with circuits into which are plugged the main
electronics of the computer

ü  Devices that may be inside the computer case but are not part of the architecture include:

·         Main storage device which is usually an internal hard drive

·         Cooling system
·         Modem

·         Ethernet connectors

·         Optical drives

·         Universal Serial Bus (USB) connectors

·         Multi-format media card readers

ü  Devices attached or linked to a computer that are peripheral to the main computer box are part of
the system’s hardware, these include:

·         Input and output devices, including the keyboard, touch screen, mouse, printer, and fax

·         Storage components such as external hard drives, thumb drives, floppy drives, tape drives, sound
systems (earphones, microphones, speakers, subwoofers)

·         Computer monitor

ü  Computer systems are composed of many different component parts that enable the user to communicate
with the computer, and with other computers to produce work

ü  The group of required and optional hardware items that are linked together to make up a computer system
is called its configuration

ü  When computers are sold, many of the key components are placed inside a rigid plastic housing or case,
which is called the box

ü  What can typically be seen from the outside is the box containing the internal components, and the
peripherals such as a keyboard, mouse, speakers, monitor, and printer

Additional:

ü  Computers are now pervasive throughout the healthcare industry

ü  Their applications are expected to continue to expand and thereby improve the quality of healthcare while
at the same time reducing some costs

ü  The applications of computers to healthcare will greatly expand the diagnostic and therapeutic abilities of
practitioners and broaden the diagnostic and treatment options available to recipients of healthcare

ü  Computers allow for distance visualization and communication with patients in remote areas

ü  None of these changes could have happened without tremendous advances in the machinery, the
hardware, of computers

REQUIRED HARDWARE COMPONENTS OF A COMPUTER

1. The box of any computer contains a motherboard:

†        The motherboard is a thin, flat sheet made of a firm, nonconducting material on which the internal
components— (printed circuits, chips, slots, and so on)—of the computer are mounted

†        The motherboard is made of a dielectric or nonconducting plastic material

†        The motherboard contains the microchips (including the CPU), and the wiring, and slots for adding
components

†        The specific design of the components on the motherboard—especially the CPU and other
microprocessors—composes the foundation of the computer’s architecture

†        The motherboard’s storage media is called memory

Memory

Read-Only memory (ROM)

ü  It is a form of permanent storage on the computer

ü  It carries instructions that allow the computer to be booted (started), and other essential machine
instructions

ü  Its programming is stored by the manufacturer and cannot be changed by the user

ü  Data and programs in ROM can only be read by the computer, and cannot be erased or altered by users

ü  Theoretically, ROM can be changed by the factory

ü  Effectively, the programs are permanently wired into the memory

ü  ROM generally contains the programs, called firmware, used by the control unit of the CPU to oversee
computer functions

ü  In microcomputers, this may also include the software programs used to translate the computer’s high-level
programming languages into machine language (binary code)

ü  ROM storage is not erased when the computer is turned off

Random access memory (RAM)

ü  Refers to working memory used for primary storage

ü  It is used as temporary storage

ü  Also known as main memory, RAM can be accessed, used, changed, and written on repeatedly

ü  RAM is the work area available to the CPU for all processing applications

ü  When a user clicks on a program icon, the computer loads all or part of the program into RAM where it can
be accessed very quickly

ü  It saves work done through the programs until the user formally saves the work on the hard drive or other
permanent storage

ü  RAM is a permanent part of the computer

ü  RAM is called volatile memory because everything in RAM unloads (is lost) when the computer is turned off

ü  The computer programs that users install on their computers to do work or play games are stored on media
such as on the hard drive are not permanent parts of the computer itself

ü  Running programs from the hard drive would be a very slow process, so parts of the programs are loaded
and unloaded from the much faster RAM as needed

ü  They are unloaded when the user shuts the program down or turns off the computer

ü  The contents of RAM are erased whenever the power to the computer is turned off

ü  RAM is made ready for new programs when the computer is turned on again

Cache

ü  A smaller form of RAM

ü  Its purpose is to speed up processing by storing frequently called items in a small, rapid access memory
location

ü  Prior to the development of cache, all information had to be fetched from the hard drive, and then stored in
RAM

ü  To handle all the work, the processor had to move information into and out of RAM (and back to the hard
drive) in order to manage all the data from programs and their output

ü  Given that RAM is large, it takes a bit of searching to find just the pieces needed and is relatively slow

ü  Fetching from cache takes much less time than from RAM

ü  Keeping information that will be used frequently in cache greatly reduces the amount of time needed to
move data around among the memory locations

ü  It is a relatively inexpensive way to increase the speed of the computer

INPUT AND OUTPUT

Input devices
ü  These devices allow the computer to receive information from the outside world

ü  The most common input devices are the keyboard and mouse

ü  Others commonly seen on nursing workstations include the touch screen, light pen, voice detector, and
scanner

ü  A touch screen is actually both an input and output device combined

ü  Electronics allow the computer to “sense” when a particular part of the screen is pressed or touched

ü  In this way, users input information into the computer

ü  The touchscreen displays information back to the user, just as does any computer monitor

ü  A light pen is a device attached to the computer that has special software that allows the computer to sense
when the light pen is focused on a particular part of the screen

ü  It allows smaller screen location discriminations than does a touchscreen

ü  For both the touch screen and light pen, software interprets the meaning of the user identified screen
location to the program

ü  Many other input devices exist

ü  Some devices are used for security and can detect users’ fingerprints, retinal prints, voiceprints, or other
personally unique physical characteristics that identify users who have clearance to use the system

Output devices

ü  These devices allow the computer to report its results to the external world

ü  Defined as any equipment that translates the computer information into something readable by people or
other machines

ü  Output can be in the form of text, data files, sound, graphics, or signals to other devices

ü  The most obvious output devices are the monitor (display screen), and printer

ü  Other commonly used output devices include storage devices such as the Universal Serial Bus (USB) drive
(also known as flash or thumb drives), and optical media

STORAGE MEDIA

Hard Drive

ü  It is a peripheral that has very high speed and high-density

ü  It is a very fast means of storing and retrieving data as well as having a large storage capacity in
comparison with the other types of storage

ü  The hard drive is the main storage device of a computer

ü  For small computers, it is typically inside the case or box that houses the CPR and other internal hardware

ü  Internal hard drives are not portable; they are plugged directly into the motherboard

ü  The storage capacity of hard drives has increased and continues to increase exponentially every few years

ü  In 2014, most personal computers are sold with about a terabyte of storage

ü  In 1990 most personal computers came with about 500 megabytes

ü  On the biggest computers, storage is measured in petabytes, which is an almost unimaginably huge number

USB Flash Drive

ü  As demands for higher and higher density transportable storage rise, the popularity of the USB disk has also
risen

ü  A USB flash drive is actually a form of a small, removable hard drive that is inserted into the USB port of the
computer

ü  There are many names for it, including pen drive, jump drive, thistle drive, and pocket drive

ü  This is a device that can store 4 gigabytes (GB) for about $10

ü  Flash drives can be very tiny, only about ½ in by 1 in

ü  They can also be much bigger and can home 128 GB or more

ü  The flash drive is highly reliable

ü  Small enough to fit comfortably in a pants pocket or on a lanyard as a necklace, or on one’s keychain

ü  The device plugs into one of the computer box’s USB ports and instead of saving to hard drive or CD-ROM
or disk, the user simply saves to the flash drive

ü  Can store so much data in a package so much smaller than a CD or DVD, the convenience makes it worth
the slightly higher price to many users

ü  As its popularity increases, prices drop

Optical Media
ü  Include Compact Disks (CDs), Digital Versatile Disks (DVDs), and Blu-Ray

ü  CD-ROMs and DVDs are rigid disks that hold a higher density of information and have higher speed

ü  Until the late 1990s, CD-ROMs were strictly input devices

ü  CD-ROMs were designed to store sound and data, and held about 737 megabytes of information and large
laser writers were required to store data on them

ü  CD-ROMs were read-only media

ü  Technology developed in the 1980s by Philips Corporation permitted the development of a new type of CD
that could be written on by the user

ü  Those are called CD-RW for Compact Disc Read-Write

ü  As technology advanced and people wanted to store motion pictures on computer readable media, DVDs
were developed and they held approximately 4.3 gigabytes of information, which will handle a regular 2 hour
movie

ü  DVDs are too limited to handle high definition movies and movies longer than 2 hours

ü  Media moved to the even higher storage capacity of BluRay discs which store approximately 27 gigabytes of
information or the equivalent of a 2 hour high definition movie

ü  Double layer Blu-Ray discs can store 54 gigabytes or 4.5 hours of high definition motion picture media

ü  Blu-Ray is derived from the blue color of the laser that writes on the media and ray for the optical ray that
reads the media

Other Storage Devices

ü  As computers became more standard in offices during the 1990s, more and more corporate and individual
information was stored solely on computers

ü  Even when paper backup copies were kept, loss of information on the hard drive was usually inconvenient
at the least and a disaster at worst

ü  Diskettes could not store large amounts of data, so people began to search for economical and speedy
ways to back up the information on their hard drive

ü  Zip drives, which were mini magnetic tape devices, were a form of relatively fast (in their time) backup
storage for people’s data

ü  Thumb (USB) and external hard drives were faster than tape media and replaced it as the backup media of
choice

ü  Today, many people purchase services that allow them to back up their data online, which means it gets
stored on commercial computers that they have backup facilities

 
Cloud Storage

ü  An extension of the online storage service offered by individual vendors

ü  Data stored in the “Cloud” is still stored on commercial computers called servers

ü  The “Cloud” refers to a distributed system of many commercial, networked servers that communicate
through the Internet, and work together so closely that they can essentially function as one large system

ü  Physically, enormous numbers of servers that store data are located in buildings, many warehouse sized

ü  These data storage sites are called data centers

ü  Multiple data centers are linked together to create cloud storage

ü  The advantage to the customer is safety of the stored data

ü  A key factor in cloud storage is redundancy

ü  The storage vendors must maintain multiple copies of the data they store

ü  If one server in a data center becomes inoperable, copies of the data on that server are stored elsewhere
and thus the data are not lost

ü  They can be retrieved from another server

ü  There are numerous vendors who offer individuals free cloud storage space for their personal files, such as
photos and music

ü  They may also offer storage for a modest monthly or yearly fee

ü  Some continuously back up data, others back up data at specified times, and typically the user can order
files to be backed up whenever he or she wishes

ü  Cloud storage is far more secure and reliable than a personal hard drive or backup drives

ü  Most users of smartphones, tablet computers, and other portable devices store their data in the Cloud, not
only because of the security of the data, but because storage in small devices is somewhat limited

ü  The Cloud allows more data storage than most individuals need for personal use

EVOLUTION OF COMPUTERS

Major Types of Computers

Supercomputers

ü  The largest type of computer

ü  First developed by Seymour Cray in 1972

ü  The early supercomputer research, development, and production was done by Cray Corporation or one of
its affiliates (Cray, 2014)

ü  A supercomputer is a computational-oriented computer specially designed for scientific applications

requiring a gigantic amount of calculations which, to be useful, must be processed at superfast speeds

ü  The supercomputer is truly a world class “number cruncher”

ü  Designed primarily for analysis of scientific and engineering problems and for tasks requiring millions or
billions of computational operations and calculations

ü  Are huge and expensive

ü  Supercomputers are used primarily in such work as defense and weaponry, weather forecasting, advanced
engineering and physics, and other mathematically intensive scientific research applications

ü  Provides computing power for the high-performance computing and communication (HPCC) environment

Mainframes

ü  The most common fast, large, and expensive type of computer used in large businesses (including hospitals
and other large healthcare facilities) for processing, storing, and retrieving data

ü  It is a large multiuser central computer that meets the computing needs large and medium sized public and
private organizations

ü  Mainframes are used for processing the large amount of repetitive calculations involved in handling billing,
payroll, inventory control, and business operations computing

ü  The machines and software that process transactions in high volume businesses are known as transaction
processing systems (TPS)

ü  Mainframes always have very high processing speeds (calculated in millions of processes per second, or
MIPS, or in floating point operations per second, or FLOPS)

ü  Prior to the year 2000, mainframes were often defined almost entirely by their high processing speed

ü  Today’s mainframes are more defined by the following characteristics than merely processing speed: (1)
Their extensive input and output capabilities to support their multiuser environment

(2) Complex engineering to support long term stability with high reliability, allowing these machines to run
uninterrupted for decades

(3) Their ability to process the massive throughput needed for high volume business transactions and business
office operations

 
ü  A mainframe is capable of processing and accessing billions (GB) of characters of data or mathematical
calculations per second

ü  Mainframes can serve a large number (thousands) of users at the same time

ü  In some settings, hundreds of workstations (input and output devices that may or may not have any
processing power of their own) are wired directly to the mainframe for processing and communication speeds
faster than can be achieved with wireless communications

ü  There are also wireless and telephone linkages into the computer so that remote users can gain access to
the mainframe

ü  As compared with a desktop PC, a mainframe has an extremely large memory capacity, fast operating and
processing time, and it can process a large number of functions (multiprocessing) at one time

Microcomputers (Personal Computers or PCs)

ü  While mainframe computers provide critical service to the healthcare industry, much smaller computers are
also an essential part of healthcare computing systems

ü  Computers designed to support a single user are called microcomputers or personal computers (PCs)

ü  Much smaller and less powerful than a mainframe, PCs were designed to be used by one person at a time

ü  Microcomputers are also found in educational and research settings, where they are used to conduct a
multitude of special educational and scientific functions

ü  Desktops are replacing many of the mainframe attributes

ü  Desktops can serve as stand-alone workstations and can be linked to a network system to increase their
capabilities

ü  This is advantageous, since software multiuser licensing fees are usually less expensive per user than
having each user purchase his or her own copy

ü  Computer size has steadily decreased since their invention while at the same time, power has grown
exponentially

ü  The components of desktop computer are typically housed in a hard case

ü  While the size of the case can vary considerably, one common size is 2 ft long by 6 to 10 in wide

ü  The case is most typically connected via wire or wireless technology to a keyboard, monitor, mouse, and
printer

ü  Microcomputers are also available as portable or laptop computers, and as notebook, tablet, and handheld
computers

ü  Laptop computers are highly portable because they are much are smaller than the standard desktop
microcomputer
ü  Many are less than 2 in deep

ü  There is huge variation in the length and width, but if a 15 in viewing screen is used, the case is usually
about 16 in by about 12 in

ü  Notebook computers are even smaller; one size marketed in 2014 is 8.5 in × 11 in

ü  Tablet computers are smaller with a width of about 7 in and length of about 9 in, but are super thin as
compared with the laptop and notebook computers

ü  Less than an inch deep, they end up widened due to the addition of a protective case that usually also
serves as a stand

Handheld Computers

ü  Small, special function computers, although a few “full function” handheld computers were introduced in the
late 1990s

ü  Some have claimed to have almost the same functionality and processing capabilities as a laptop or
notebook

ü  Limited in their expansion possibilities, their ability to serve as full participants in the office network, and the
peripherals they can support

ü  More popular are the palm-sized computers, including personal digital assistants (PDAs), which are the
smallest of the handheld computers

ü  The PDA is a very small special function handheld computer which provides calendar, contacts, and note-
taking functions, and may provide word processing, spreadsheet, and a variety of other functions

ü  Originally sold as isolated devices, today virtually all PDAs are combined with telephone functionality and
sold as smartphones

ü  Smartphones are ubiquitous

ü  Smartphones are owned by a huge number of people worldwide, from the slums of South Africa to business
people in the most developed countries

ü  Smartphones have replaced wristwatches, pocket calendars, and other personal items people used to keep
their lives organized

ü  Many people might be more comfortable leaving home without a coat in winter than without their
smartphone.

ü  These devices provide constant connectivity and access to Internet and telephone functions

ü  They are particularly useful in that they can synchronize with other technology and provide automatic
support for such things as the user’s calendar

ü  The processors for most smartphones, tablet computers, and other small but powerful devices are made by
Advanced RISC Machines Ltd. (ARM)
ü  A RISC processor is a “Reduced Instruction Set Computer,” which means it is a special purpose processor

ü  As of 2014, these processors are 32 bit microprocessors that use the RISC architecture

ü  There are a variety of hardware platforms and operating systems for smartphones and tablet computers

ü  The three most common are the Apple Corporation’s iPhone and iPad using the iOS operating system,
smartphones, and tablets using the Android operating system (owned by Google Corporation), and the
Windows operating system for smartphones and tablets from Microsoft Corporation

ü  The Android system is an open source operating system, the other two OS are closed and proprietary

ü  There are thousands of software applications (called apps) developed for all these platforms, many of them
free or sold at a very low price

ü  Typically, the apps work on only the platform for which they were developed

ü  Quite a few will work on both smartphones and tablets using that platform

ü  For example, many apps that work on the iPad tablet will also work on the iPhone

Connectivity, Compatibility, and Incompatibility Issues

1. Communication among various hardware devices cannot be assumed.

†        Given that departments within a single organization have often bought small systems designed to
support their work, a single hospital may have literally hundreds of different computers and applications on
those computers

†        Simply wiring incompatible machines so that power can flow between them accomplishes nothing

†        Often, computers cannot transfer data meaningfully among themselves

†        This makes it difficult to create a comprehensive medical record for individual patients

†        Information stored somewhere in the facility may not be available when needed to the providers who
need the information to make good patient care decisions

†        As greater attention is placed on patient safety and quality improvement, and on analysis of
performance data for planning and evaluation, there is a need to acquire and combine data from multiple
patient care operations computers and systems

2. Different computers have different architectures, hardware configurations, and different storage schemes

†        Software must be specifically designed to communicate with another program for the two to
communicate
†        Systems not designed specifically to work together cannot communicate information and processes to
each other without the addition of complex translation programs (that usually don’t exist); that is, they are not
interoperable

3. As a result of the interoperability problems, it can be economically infeasible to move data across different
computers and programs.

†        The interoperability problem limits the nurses’ ability to obtain, combine and analyze data they need to
provide high quality, safe patient care

†        Organization progress and performance is hampered when data and information are not available to
perform the analysis required to identify problems, opportunities for improvement, safety risks, and to make
projections about future needs

†        Interoperability is necessary to meet the requirements of the Medicare and Medicaid EHR Incentive
Programs (which provide financial incentives for the “meaningful use” of certified EHR technology) as part of
the HITECH Act of 2009

†        Interoperability usually requires interoperable software programs such as SNOMED CT and

Computer Power

1. Bits and Bytes

†        A bit (binary digit) is a unit of data in the binary numbering system

†        Binary means two, so a bit can assume one of two positions

†        A bit is an ON/OFF switch—ON equals the value of 1 and OFF equals 0

†        Bits are grouped into collections of 8, which then function as a unit

†        That unit describes a single character in the computer, such as the letter A or the number 3, and is
called a byte

†        There are 255 different combinations of 0 and 1 in an 8-character (or 1-byte) unit

†        That forms the basic limit to the number of characters that can be directly expressed in the computer

†        The basic character set hardwired into most PCs contains 255 characters

†        In the early days of PCs, this was a problem because it severely limited the images that could be
produced

†        With the advent of graphics cards and the additional character sets and graphics that graphics cards
allow, virtually any character can be produced on a computer screen or printed on a printer

†        Even without graphics cards, additional character sets can be created by means of programming
techniques
†        The size of a variety of computer functions and components is measured by how many bytes they can
handle or store at one time

2. Main memory, which includes the ROM on the motherboard in today’s computers, is very large as compared
with that of just a few years ago, and continues to increase every year with new computers

†        The size of memory is an important factor in the amount of work a computer can handle

†        Large main memory is another key measure in the power of a computer

†        In the mid-1970s, the PCs on the market were typically sold with a main memory of between 48 and 64
K

†        By 2014, the size of main memory in computers sold to the public had risen exponentially

†        Most computers in 2014 are advertised with between 5 and 16 GB of main memory and computers with
20 GB or more of main memory are available

†        Cache has also become an important variable in computer power and thus in advertising the power of
computers

3. Another important selling point of a computer is the size of the hard drive that is installed in the box

†        The first hard drives sold for microcomputers in the 1970s were external devices that stored about
1,500 kilobytes

†        At that time, home computers were not sold with internal hard drives

†        When the user turned on the computer, they had to be sure the operating system (OS) diskette was in
the disk drive, or the computer could not work

†        This architecture severely limited the size and functionality of programs

†        Consumer demand for hard drives was such that their size grew exponentially while at the same time
the cost of hard drive storage decreased exponentially.

†        By late 1999, home computers sold typically had between 6 and 20 GB of space on the hard drive

†        In 2010 the typical laptop computer was sold with a 300 to 500 GB hard drive

†        Desktops often came with hard drives that offered a terabyte or more of storage

†        By 2014, most home and laptop computers were advertised with 1 to 2 terabyte hard drives

†        Hard drive space will undoubtedly continue to increase

†        Applications programs have become so large that both the main memory and the hard drive storage
space have had to increase exponentially
Computer Speed

1. The basic operations of the CPU are called cycles

†        The four types of cycles, or operations of a CPU, include: (1) Fetch (2) Decode (3) Execute (4) Store

†        It takes time for the computer to perform each of these functions or cycles

†        The CPU speed is measured in cycles per second, which is called the clock speed of the computer

†        One million cycles per second is called 1 megahertz (MHz)

†        A billion cycles per second is called 1 gigahertz (GHz)

†        CPU speed is very fast because computers perform many billions of cycles per second

†        They can be slow if their processors have insufficient speed for the work they are required to process

2. Clock speeds, like most other components, have greatly improved over time

†        For example, the original IBM PC introduced in 1981 had a clock speed of 4.77 MHz (4.77 million cycles
per second)

†        In 2010, home computers commonly had speed of 1.8 to 3 GHz. In 2014, advertised computers in the
$1000 range have clock speeds of 2.5 to 3 GHz

†        The higher the clock speed possessed by the CPU, the faster and (in one dimension) the more powerful
the computer

†        Clock rate can be misleading, since different kinds of processors may perform a different amount of
work in one cycle

†        General purpose computers are known as complex instruction set computers (CISCs) and their
processors are prepared to perform a large number of different instruction sets

†        A cycle in a CISC computer may take longer than that for a specialized type of computer called a
reduced instruction set computer (RISC)

†        Clock speed is one important measure of the power of a computer

Network Hardware

1. A network is a set of cooperative interconnected computers for the purpose of information interchange

2. The networks of greatest interest include local area networks (LANs), wide area networks (WANs), and the
Internet, which is a network of networks

†        A LAN usually supports the interconnected computer needs of a single company or agency

†        The computers are physically located close to each other, and generally, only members of the company
or agency have legitimate access to the information on the network
†        WANs support geographically dispersed facilities, such as the individual grocery stores in a national
chain

†        A subset of WANs includes the metropolitan area networks (MANs) that support and connect the many
buildings of local governmental agencies or university campuses

3. The most important components of network hardware are the adapter or interface card, cabling, and
servers

4. The role of hardware in a network is to provide an interconnection between computers

5. For a computer to participate on a network, it must have at least two pieces of hardware:

†        Network adapter or network interface card

§  A network interface card (NIC) is a computer circuit board or card that is installed in a computer so that it
can be connected to a network

§  PCs and workstations on LANs typically contain a NIC specifically designed for the LAN transmission
technology, such as Ethernet

§  NICs provide a dedicated, full-time connection to a network

§  Most home and portable computers connect to the Internet through modems on an as-needed dial-up
connection

§  The modem provides the connection interface to the Internet service provider

§  The oldest network interface (or “adapter card”) is an Ethernet card

§  Wireless network modems are used more often today

§  There exist other options such as arcnet and serial-port boards

§  The choice of NIC depends on the communication medium

†        Communication medium (cabling)

ü Distance. Relatively short distances are required for wireless, compressed video and coaxial cable
systems. For much longer distances, fiber-optics, telephone lines, and satellite transmission are used

ü Amount of data transfer. Large amounts of data (especially video) are best handled with coaxial cables and
compressed video and through satellite communications (satellite and compressed video are very
expensive). Smaller amounts of data or serial (nonvideo) streams are best handled through the other wire
types, such as twisted pair copper wire and optical fiber, and are less expensive.

ü How often the transfer is needed. Coaxial works best for locally wired networks that are used constantly by
a very limited number of users. Telephone wires work well for the relatively high usage public networks (like
the Internet) but are more likely to get overloaded when many users try to use the system at the same
time. Consider, for example, the busy Internet or phone lines getting clogged up when a tornado or hurricane
has struck a community
ü Availability. Availability depends on cost, transmission speed, number of users (who might clog up the
system), and weather conditions (satellites)
 Based on the historical perspective about Electronic Health Record, one of the major conclusions as a
result of the committee’s deliberation in introducing computer- based patient record is:

Select one:
a. None among the choices
b. There are a large number of standards organizations that impact healthcare data content
c. The computerized patient record raises increasing concerns about privacy and security
d. Computerized patient record is an essential technology for healthcare and is an integral tool for
all professional
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It is called the storage media of the motherboard.

Select one:
a. Storage Media
b. CPU
c. Memory
d. Input and Output
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This was created in the year 1992 to achieve improved outcomes in healthcare quality, cost, and
access.

Select one:
a. Computer- based Patient Record
b. Health Information Technology System
c. Electronic Health Record
d. Health Information Management System
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Which of the following is not being mentioned in the outline about the use of computers in nursing?

Select one:
a. Used in nursing for evaluating outcomes
b. Used in nursing when changing wound dressing
c. Used in nursing when communicating patient status to involved physician
d. Used in nursing for professional growth
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During this period, hospitals and public health agencies embarked in investigating computers and
nursing.

Select one:
a. Prior to the 1960’s
b. 1970’s
c. 1990’s
d. 1980’s
In 1970’s, few systems have started to include the following, except:

Select one:
a. Care planning
b. Interdisciplinary problem lists
c. Decision support
d. Medication administration
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It is the smaller form of RAM and its purpose is to speed up processing by storing frequently called
items in a small, rapid access memory location.

Select one:
a. Cache
b. RAM
c. Optical media
d. ROM
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Based on the historical perspectives of nursing and computers, computers were used for
administrative and accounting functions in:

Select one:
a. 1980’s
b. Prior to the 1960’s
c. 1990’s
d. 1970’s
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The following are expected shift in the utilization of HIT system, except:

Select one:
a. Hiring nurses who earned additional degree in informatics
b. Purchasing desktops that can download required applications
c. Touchscreen manipulation method in some of the hospital devices
d. Using cloud storage for clients’ information
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This is a form of a permanent storage on the computer that carries instructions and is stored by the
manufacturer and cannot be changed by the user.

Select one:
a. Read- Only memory
b. Random access memory
c. Read- Access memory
d. Random- Only memory
Nurse Jana was asked by her Nurse Manager about the specifics of computer, this is to assess her
knowledge regarding informatics. Nurse Jana is correct by saying that computer monitor is one
among the devices attached to a computer that is peripheral to the main computer box but is part of:

Select one:
a. the hardware
b. the software
c. the box
d. the system’s hardware
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 The following are assumed areas of concerns having the HIT system in a health facility, except:

Select one:
a. Legal implications
b. Stable finances
c. Safety and confidentiality issues
d. Trained nurses
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Among the followings are mentioned function of the Healthcare Information Technology system,
except?

Select one:
a. Captures health information
b. Develops health information
c. Generates health information
d. Processes health information
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*The biggest risk that health facility has consider in venturing into a functional HIT system is:

Select one:
a. Foreseen decrease in number of clients coming in the hospital for health care
b. None among the choices
c. The shift towards integrating new multiple technologies and telecommunication devices
d. Ability of the staff to use the system
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Basically, computer technology has evolved from huge, room-sized electronic calculators developed
with military funding during World War II to palm-sized machines.

Select one:
a. The statement is true
b. The statement is false
 When was the field of nursing informatics exploded and became visible in the healthcare and nursing?
Select one:
a. 1970s
b. 2000s
c. 1990s
d. 1980s
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Understanding nursing informatics in a bigger perspective, a “human-machine” interaction of nursing and

computers has become a new and lasting symbiotic relationship.

Select one:
a. The statement is false
b. The statement is true
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When you save a file, it is permanently saved on the:

Select one:
a. CPU
b. ROM
c. RAM
d. Hard drive
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Select the input devices among the choices below:

Select one:
a. Keyboard, mouse, scanner
b. Mouse, keyboard, monitor
c. Mouse, scanner, printer
d. Mouse, printer, monitor
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Who among the different theorists contributed in setting a standard for nursing practice?
 Select one:
a. Henderson and Virginia
b. Nightingale and Orem
c. Nightingale and Abdellah
d. Henderson and Nightingale

The following basic hardware are attached to the motherboard, except:

Select one:
a. Universal Serial Bus
b. Random Access Memory
c. Graphic and Sounds
d. Processors
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This is a square or rectangular board with circuits into which are plugged the main electronics of the
computer.

Select one:
a. Keyboard
b. CPU
c. The box
d. Motherboard
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The group of required and optional hardware items that are linked together to make up a computer
system is called its:

Select one:
a. Software
b. Configuration
c. None among the choices
d. Setting- up
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 During the late 1960s through the 1970s, hospitals began developing computer- based information
systems which initially focused on the following, except:

Select one:
a. Laboratory
b. Pharmacy
c. Physician order entry
d. E- library
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 Nurse Andrei is right in telling that using computer in the healthcare delivery positively affects
the education of healthcare providers by:
Select one:
a. Allowing them to practice nursing while taking advantage on the availability of technology in
enhancing their skills
b. All of the given choices
c. Ensuring safety in the implementation of interventions
d. Documenting all the patient care rendered to clients
The                                     is a truly world class “number cruncher”.

Select one:
a. Microcomputers
b. Mainframes
c. Supercomputers
d. Handheld computers
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Standardization of date began in the year:

Select one:
a. 1880
b. 1895
c. 1893
d. 1890
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 Question text

In the creation of CPR, CPR Project Evaluation Criteria was also developed for self- assessment in the
utilization of the CPR project. All but one are the major areas of the criteria.

Select one:
a. Functionality
b. Effectivity
c. Technology
d. Impact
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Which one of the following is an example of internal hardware component?

Select one:
a. Motherboard
b. Keyboard
c. Monitor
d. Mouse
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These devices allow the computer to receive information from the outside world.

Select one:
a. Storage devices
b. Input devices
c. Output devices
d. None among the choices