NURSING INFORMATICS

CHRISTIAN S. TU, RN MSN

Nursing Informatics. is a title that evolved from the French word “informatics” which
referred to the field of applied computer science concerned with the processing of
information such as nursing information (Nelson, 2013).
The importance of the computer as an essential tool in HIT systems and in the delivery of
contemporary healthcare is indisputable.
Health Information Technology (HIT) is an all-encompassing term referring to technology that
captures, processes, and generates healthcare information. 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, as well as
G. safety and quality issues.

Seven Time Periods

Prior to 1960s.
 Computers were first developed in the late 1930s to early 1940s, but their use in the
healthcare industry occurred in the 1950s and 1960s.
 During this time, there were only a few experts nationally and internationally who
formed a cadre of pioneers that attempted to adapt computers to healthcare and
nursing.
 At that time the nursing profession was also undergoing major changes. The image of
nursing was evolving, the number of educational programs and nurses increasing, and
nursing practices and services were expanding in scope, autonomy, and complexity
from physicians’ handmaidens to professional status.

1960s.
 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.
 Nursing practice standards were reviewed, and nursing resources were analyzed.
 Studies were conducted to determine how computer technology could be utilized
effectively in the healthcare industry and what areas of nursing should be automated.
The nurses’ station in the hospital was viewed as the hub of information exchange, the
most appropriate center for the development of computer applications.
1970s.
 During the late 1960s through the 1970s, hospitals began developing computer-based
information systems which initially focused on physician order entry and results
reporting, pharmacy, laboratory, and radiology reports, information for financial and
managerial purposes, and physiologic monitoring systems in the intensive care units,
and a few systems started to include care planning, decision support, and
interdisciplinary problem lists.

 While the content contained in early hospital information systems frequently was not
specific to nursing practice, a few systems did provide a few pioneer nurses with a
foundation on which to base future nursing information systems (Blackmon et al.,
1982; Collen, 1995; Ozbolt & Bakken, 2003; Romano, McCormick, & McNeely, 1982;
Van Bemmel & Munsen, 1997).

1980s.
 In the 1980s, the field of nursing informatics exploded and became visible in the
healthcare industry and nursing. Technology challenged creative professionals in the
use of computers in nursing, which became revolutionary.
 As computer systems were implemented, the needs of nursing took on a cause-and-
effect modality; that is, as new computer technologies emerged and as computer
architecture advanced, the need for nursing software evolved. It became apparent
that 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.

1990s.
 By the 1990s, large integrated healthcare delivery systems evolved, further creating
the need for information across healthcare facilities within these large systems to
standardize processes, control costs, and assure quality of care (Shortliffe, Perreault,
Wiederhold, & Pagan, 2003). Advances in relational databases, client-server
architectures, and new programming methods created the opportunity for better
application development at lower costs.
 The complexity of technology, workflow analysis, and regulations shaped new roles for
nursing.
 2000s.
 A change occurred in the new millennium as more and more healthcare information
became digitalized and newer technologies emerged. In 2004, an Executive Order
13335 established the Office of the National Coordinator for Healthcare Information
Technology (ONC) and issued a recommendation calling for all healthcare providers to
adopt interoperable EHRs by 2014–2015.
 This challenged nurses to get involved in the design of systems to support their
workflow as well as in the integration of information from multiple sources to
support nurses’ knowledge of technology. In late 2000s, as hospitals became
“paperless,” they began employing new nurses who had never charted on paper.

2010s.
 A historical analysis of 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 (Hobbs, 2011).

NURSING INFORMATICS PIONEERS

In History Project

 1995, Saba initiated a history of NI at the National Library of Medicine that consisted of
the collection of archival documents from the NI pioneers. The History Project was
initiated based on a recommendation by Dr. Morris Collen who published the History of
Medical Informatics in 1995 (Colleen, 1995). However, it was not until 2001 that the
Nursing Informatics Working Group (NIWG) of the American Medical Informatics
Association (AMIA) became involved and the NI History Committee was established to
take on this project.
 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 (Newbold,
Berg, McCormick, Saba, & Skiba, 2012).

Videotaped Interviews. The American Medical Informatics Association (AMIA) Nursing

Informatics History page contains a wealth of information. The 33 videotaped interviews are
divided into two libraries. The full interviews are available in Library 1: Nursing Informatics
Pioneers. For each pioneer, a picture, short biographical sketch, transcript of the interview,
and MP3 audio file are included in addition to the videotaped interview. In Library 2: Themes
from Interviews, selected segments from the interviews are shared for easy comparison
across the pioneers. The themes include the following:
• Nursing Informatics—what it is, present, future, what nursing brings to the table
• Significant events that have shaped the field of nursing informatics
• Pioneers’ paths—careers that lead up to involvement in (nursing) informatics
• When they first considered themselves informatics nurses
 • Pioneers’ first involvement—earliest events they recall

• Informatics—its value, pioneers’ realizations of the value of informatics, how they

came to understand the value of informatics
• Demography of pioneers including names, educational backgrounds, and current positions
• Personal aspirations and accomplishments, overall vision that guided the pioneers’
work, people the pioneer collaborated with to accomplish their visions, and goals
• Pioneers’ lessons learned that they would like to pass on

LANDMARK EVENTS IN NURSING AND COMPUTERS

Major Milestones
Computers were introduced into the nursing profession over 40 years ago. Major milestones
of nursing are interwoven with the advancement of computer and information technologies,
the increased need for nursing data, development of nursing applications, and changes
making the nursing profession an autonomous discipline.
HISTORICAL MILESTONES IN NURSING INFORMATICS