NCM110: Nursing Informatics Lecture

SESSION TOPIC CONTENT: Introduction to Nursing Informatics

A. Historical Overview of Informatics

Nursing Informatics is a phrase that evolved from the French word “informatique”
which refers to the field of applied computer science concerned with the processing
of information such as nursing information.

The computer was seen as a tool that could be used in many environments.

In the early 1960s, the computer was introduced into healthcare facilities for the
processing of basic administrative tasks. Computers were first developed in the late
1930’s to 1940’s.

In application to Healthcare Information Technology (HIT) the computerization and/or

electronic processing affect all aspects of healthcare delivery including:

(a) Provision and documentation of patient care

(b) Education of healthcare providers,
(c) Scientific research for advancing healthcare delivery,
(d) Administration of healthcare delivery services,
(e) Reimbursement for patient care,
(f) Legal and ethical implications,
(g) Safety and quality issues.

* HIT is an all-encompassing term referring to technology that captures, processes,

and generates healthcare information.

B. Historical Perspective of Nursing Informatics:

Seven Time Period

1. Pre-1960’s

• Computers were first developed in the late 1930s to early 1940s.

• As computers have evolved, computing power has increased. Attributed to
the increasing number of transistors or chips placed in an integrated circuit. In
the mid-1960s Gordon Moore noted that the number doubled approximately
every two years. This argument has become known as Moore’s law.
• Computers were initially used in healthcare facilities for basic office,
administrative, and financial accounting functions.
• These early computers used punch cards to store data and card readers to
read computer programs, sort, and prepare data for processing.
• Computers were linked together and operated by paper tape using
teletypewriters to print their output. As computer technology advanced,
healthcare technologies also advanced.

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2. 1960’s

• During the 1960s the uses of computer technology in healthcare settings

began to be explored.

• Questions such as “Why use computers?” and “What should be

computerized?” were discussed.

• Nurses’ station in the hospital was viewed as the hub of information

exchange; therefore, numerous initial computer applications were developed
and implemented in this location.
• Mid-1960s, clinical practice presented nurses with new opportunities for
computer use.
• Increasingly complex patient care requirements and the proliferation of
intensive care units (ICUs) required that nurses become super users of
computer technology as nurses monitored patients’ status via cardiac
monitors and instituted treatment regimens through ventilators and other
computerized devices such as infusion pumps.

4. 1970’s

• Regardless of the focus, which remained primarily on medical practice,

nurses often were involved in implementing health information technology
(HIT) systems.
• Interest in computers and nursing began to emerge in public health, home
health, and education during the 1960s to 1970s.
• Automation in public health agencies began as a result of pressure to
standardize data collection procedures and provide state-wide reports on the
activities and health of the public.
• Hospitals and public health agencies embarked on investigating computers
and nursing; the opportunity to improve education using computer technology
commenced.
• First uses of a computerized teaching system called PLATO, which was
implemented to teach classes in offcampus sites as an alternative to
traditional classroom education.
• First point-of-care blood glucose monitor became available for use in the
clinical setting in 1970. The devices became smaller and more widespread in
the 1980s.
• One of the earliest clinical information systems (called Eclipsys & Allscripts)
was the first system to include nursing practice protocols

5. 1980’s

• Microcomputer or personal computer (PC) emerged. This revolutionary

technology made computers more accessible, affordable, and usable by
nurses and other healthcare providers.

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• During this period, many mainframe healthcare information systems (HISs)

emerged with nursing subsystems, these documented several aspects of the
patient record.
• Nurses began presenting at multidisciplinary conferences and formed their
working groups within HIT organizations, such as the first Nursing Special
Interest Group on Computers which met for the first time during SCAMC
(Symposium on Computer Applications in Medical Care) in 1981.

6. 1990’s

• ANA recognized nursing informatics as a new nursing specialty with a

separate Scope of Nursing Informatics Practice Standards and also
established a specific credentialing examination for it.
• In 1997, the ANA developed the Nursing Information and Data Set Evaluation
Center (NIDSEC) to evaluate and recognize nursing information systems (the
purpose was to guide the development and selection of nursing systems that
included standardized nursing terminologies integrated throughout the system
whenever it was appropriate.)
• By 1995, the Internet began providing access to information and knowledge
databases to be integrated into desktop computer systems. It revolutionized
information technologies

6. 2000’s

• Barcoding and radiofrequency identification (RFID)emerged as a useful

technology to match the “right patient with the right medication” to improve
patient safety.
• Internet which appeared in 1995 provided a means for the development of
clinical applications. Also, databases for EHRs could be hosted remotely on
the Internet, decreasing the costs of implementing EHRs.
• Telehealth applications, a recognized specialty for nursing since the late
1990s, provided a means for nurses to monitor patients at home and support
specialty consultation in rural and underserved areas.
• A barcode medication administration (BCMA) system was first implemented in
2000 in an acute care hospital to electronically capture medication
management.

7. 2010

• Two (2) national committees, outlined and designed to address the Health
Information Technology for Economic and Clinical Health (HITECH) Act of
2009.
• 2 involved committees: (a) National Committee on Health Policy and (b)
National Committee on Health Standards.
• The committees designed the “Meaningful Use” (MU) program to secure
complete and interoperable EHR and/or HIT system.
• Field of nursing informatics (NI) continued to grow due to the MU regulations
which continue to impact on every inpatient hospital setting.

Reference Source: Saba, V. K., & McCormick, K. A. (2021). Essentials of Nursing Informatics (7th ed.). McGraw-Hill Education
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NCM110: Nursing Informatics Lecture

SESSION TOPIC CONTENT: Computer System Basics

A. COMPUTER HARDWARE:

All of the physical components of a computer. 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), the BIOS
chip, and graphic and sound cards. These are attached to a component called a
motherboard.

● Motherboard:
- “Guts” of a computer (heart of any computer). It is a square or rectangular board
made of nonconducting material such as fiberglass or heat-resistant plastic. The
motherboard consists of layers of material that have been sealed together with resin
and “printed” with copper tracts.
- Copper (or other metal) conducting lines (circuits) are embedded into the board.

a.1 Memory:

- The motherboard’s storage media is called memory. The memory includes the
locations of the computer’s internal or main working storage.
Memory consists of registers (a small number of very high-speed memory locations),
RAM, which is the main storage area in which the computer places the programs and
data it is working on, and cache (a small memory storage area holding recently
accessed data).
- There are three key types of memory in a computer:

1. Random access memory (RAM)

2. Read-only memory (ROM)
3. Cache.

- Random Access Memory (RAM):

>Working memory used for primary storage. It is used as temporary storage by the
CPU and other processors for holding data and commands the processors are
actively using.
>RAM can be accessed, used, changed, and written on repeatedly. RAM is the work
area available to the CPU for all processing applications.

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RAM ROM Cache

- Cache:
>Smaller form of RAM. Its purpose is to speed up processing by storing frequently
called (used) data and commands in a small, rapid-access memory location.
>Given that RAM is large, it takes the computer more time to search RAM to find just
the pieces needed.
>Cache is much smaller than RAM, and thus fetching from cache takes much less
time than from RAM.
- Read Only Memory (ROM):
>Form of permanent storage in the computer. It carries instructions that allow the
computer to be booted (started) and other essential machine instructions.
>ROM chips are called firmware (as opposed to software that can be changed by
programmers.
>Generally contains the programs used by the control unit of the CPU to oversee
computer functions.
>ROM storage is never erased.
● Input and Output devices:
>To do work, the computer must have a way of receiving commands and data from
the outside and a way of reporting out its work.
>Input and output devices are wired to a controller that is plugged into the slots or
circuit boards of the computer.

-Input Devices:
> Devices that allow the computer to receive information from the outside world. The
most common input devices are the keyboard and mouse.
> Other commonly seen input devices on nursing workstations:
-Touch screen: Both an input and output device combined, displays information
back to the user, just as does any computer monitor.
-Light pen: device attached to the computer that has special software that allows the
computer to sense when the light pen is focused on a designated part of the screen.
-Microphone: Voice systems allow the nurse to speak into a microphone (which is
the input device) to record data, submit laboratory orders, or request information from
the computer.
-Scanner: 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:
> These devices allow the computer to report its results to the external world. Output
devices are defined as any equipment that translates the computer information into
something usable by people or other machines.

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> Output can be in the form of text, data files, sound, graphics, or signals to other
devices. The most obvious output devices are the monitor (display screen) and
printer.
> Other commonly used output devices include storage devices such as the USB
drive (also known as flash or thumb drive) and optical media:
> Heart monitors are output devices recording and displaying heart rhythm patterns
and initiating alarms when certain conditions are met
> Volumetric infusion pump outputs include both fluids infused into the patient’s body
and images displayed on a screen. The pump delivers a specific volume of IV fluids
based on commands that the nurse enters so the ordered fluid volume will be infused
in the correct time period.
|
● Storage Media:
- Storage includes the main memory but also external devices on which programs
and data are stored:

> Hard drive:

- Main storage device of many personal computers and is typically inside the case or
box that houses other internal hardware.
- Peripheral component that has very high speed and high density (that is, it is a very
fast means of storing and retrieving data as well as having a large storage capacity in
comparison with some other types of storage)
- Most personal computers (PCs) were sold with between 500 gigabytes (GB) and up
to about a terabyte of storage; in 1990 the PCs had about 500 megabytes (MB)
capacity.

> USB Flash drive:

- Form of a small, erasable, programmable, read-only memory (EPROM), (similar to
the ROM chips in a computer)
- Pen drive, jump drive, thistle drive and pocket drive (other names)
- It functions a bit like a removable hard drive that is inserted into the USB port of the
computer.
- It should be noted that flash drives are not really used in clinical settings, at least
not for business or patient care purposes.
- There is a danger that these devices can end up being used to compromise patient
or company confidentiality.

> Optical Media:

- Include compact disks, digital versatile disks, and Blu-Ray.
- (late 1990s) CD-ROMs were strictly input devices (designed to store sound and
data, held about 737 MB of information)
- Philips Corporation permitted the development of a new type of CD, CD-RW for
Compact Disc Read-Write, that could be written on by the user.
> Cloud Storage
- An extension of the online storage service offered by individual vendors is cloud
storage.
- Storage service offered by individual vendors is cloud storage.
- Data stored “in the Cloud” is still stored on commercial computers called servers.
- “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.
- Data Centers: Data storage sites with enormous numbers of servers that store data
are physically located in many warehouse-sized buildings.

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● Major Types of Computers:

1. Super Computers:

- Largest type of computer

- Computational-oriented computer specially designed for scientific application
- Used primarily in such work as defense and weaponry, weather forecasting,
advanced engineering and physics, and other mathematically intensive scientific
research applications.

2. Mainframes:

- 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.
- Used for processing the large amount of repetitive calculations involved in handling
billing, payroll, inventory control, and business operations computing via transaction
processing system (TPS).

3. Micro Computers

- Also termed as Personal Computer (PC’s)

- Computers designed to support a single-user
- Much smaller and less powerful than a mainframe, designed to be used by one
person at a time.

4. Handheld Computers/ PDA (Personal Digital Assistant)

- Handheld computers are small, special-function computers, although a few “full

function” handheld computers were introduced in the late 1990s.
- Smaller size than the laptop and notebook microcomputers, yet almost the same
functionality and processing capabilities.
- Limited in their expansion possibilities, their ability to serve as full participants in the
office network, and the peripherals they can support.

- Personal Digital Assistant (PDA):

- Smallest of the handheld computers.
- Very small special function handheld computer that provides calendar, contacts,
and note-taking functions, and may provide word processing, spreadsheet, and a
variety of other functions.

- Smartphones:

- Mostly supplanted PDA with combined limited computing power with telephone
functionality.
- Particularly useful in that they can synchronize with other technology and provide
automatic support for such things as the user’s electronic calendar.
- Processors for most smartphones, tablet computers, and other small but powerful
devices are made by several companies, such as Apple, Samsung, Qualcomm, and
Huawei.

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- 2 major hardware platforms and operating systems for smartphones and tablet
computers:
1. Apple Corporation’s iPhone and iPad using the iOS operating system
2. Smartphones and tablets using the Android operating system (including the
Samsung products).

B. CATEGORIES OF SOFTWARE

● Software:

- General term applied to the instructions that direct the computer’s hardware to
perform work.
- Consists of instructions communicated electronically to the hardware.

2 Purposes for software:

1. Translate instructions created in human language into machine language.

2. Packaged or stored software is needed to make the computer an economical work
tool.

(3) three basic types of software:

1. System Software
2. Utility Programs
3. Applications Software

1. System software:

● Basic Input/Output System (BIOS):

- First level of system software stored on a read-only memory (ROM) chip on the
motherboard.
- Software on the BIOS chip is the first part of the computer to function when the
system is turned on.
- It first searches for an operating system (OS) and loads it into the random-access
memory (RAM).

● Operating System:

- Overall controller of the work of the computer.

- Software loaded from the hard drive into RAM as soon as the computer is turned
on.
- Most users purchase a computer with the OS already installed on the hard drive.
- OS can also be purchased separately and installed by the user.
- Without OS, there could be no home computers, except for machines owned by
skilled programmers.

2. Utility Programs:

- Utility programs include programs designed to keep the computer system operating
efficiently by adding power to the functioning of the system software or supporting the
OS or applications software programs.

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- Categories:

a. Security programs:

Including primarily anti-virus, firewall, and encryption programs, protects the

computer and its data from attacks that can destroy programs and data.

b. System management utilities:

Designed to help the user keep the computer system running efficiently. For
example, disk management utilities serve to keep hard disk space clean and efficient.
They do this by analyzing the use of disk space, defragmenting the drive, and
deleting duplicate files if the user so commands.

c. Backup for the user’s data:

Serve to help the users back up their data, when a hard drive fails (or crashes), the
user who has not backed up that drive is at risk of permanently losing photos,
personal and work information, songs, videos, and anything else stored on the
computer,
d. Screen savers:

Computer programs that either blank the monitor screen or fill it with constantly
moving images when the user is away from the computer but does not turn it (and
the monitor) completely off.

e. Archival assistance software:

- Usually performs at least two functions. (1) it compresses information in files to be

archived, and (2) stores them in a compressed form in some long-term storage
device.

- For Windows, programs such as WinZip and WinRar are well-known archival
utilities. When the files are retrieved, software must be used to unpack (or
decompress) the data so that it can be read

f. Programming environment support program:

- Used by program developers to support their programming work or to run their

programs.
- Computers cannot read or understand English or any other human language.
- Ultimately, programs must change the language in which developers write
programs (the source code) into a machine language the computer can understand
(assembler or machine language).

3. Applications Software:

- Applications software includes all the various programs people use to do work,
process data, play games, communicate with others, and watch videos and
multimedia programs on a computer.

- The most popular office packages include Microsoft Office, Office 365, Google
Docs, Apache OpenOffice, and LibreOffice, but there are many other office program
packages.

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C. COMMON SOFTWARE USEFUL TO NURSES AND COMPUTER SYSTEMS

- In most hospitals, much of the software used by nurses is based in an HIS, a

multipurpose program designed to support many applications in hospitals and their
associated clinics.

- Components nurses use most include:

a. Electronic medical record for charting patient care

b. Admission-discharge-transfer (ADT) systems that help with patient tracking
c. Medication administration record (MAR) software,
d. Laboratory systems that are used to order laboratory tests and report the results
e. Supplies inventory systems through which nurses charge IVs, dressings, and other
supplies used in patient care.

Dashboard

- Some nursing applications include a handy “dashboard,” which is an application

that provides a sort of a menu display of options from which the nurse can choose.

- Provide the nurse a quick way to order common output from certain (or all) screens,
or may provide some kind of alert that a task is due to be performed.

Personal Digital Assistants (PDA)

- Given that many people have personal digital assistants (PDAs) as part of their
cellular phones, nurses may download any of thousands of software applications
(apps) onto their PDA to assist them with patient care.

- Common programs for nurses:

a. Drug guides
b. Medical dictionaries
c. Consult guides ( pediatric pocket consultation, toxicology guide, guide to clinical
procedures, laboratory results guides )

Software can now be downloaded onto a PDA to:

a. Measure heart and respiratory rate

b. Perform ultrasounds on various organs
c. Test hearing
d. Perform a simple EKG
e. Physical assessment parameters.

Pitfalls for nurses in their use in clinical areas:

- It can be very easy to forget the legal requirement for permission to photograph
anything on or about a patient, including a photo of a patient’s face when the
technology is so available.
- Few nurses have found themselves in serious trouble when they forget that social
media, such as Facebook, Twitter, and LinkedIn, are not private spaces and they
upload photographs of patients or confidential patient information on social media.

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- Nurses must remember that most information in their workplace has confidentiality
requirements that can be protected only with sophisticated technical barriers to
unauthorized access. Those barriers are typically not available on an individual’s
smartphone.

Reference Source: Saba, V. K., & McCormick, K. A. (2021). Essentials of Nursing Informatics (7th ed.). McGraw-Hill Education

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