Historical Perspective of

Nursing Informatics
Objectives
● Describe the historical perspective of nursing informatics.
● Explore lessons learned from the pioneers in nursing informatics.
● Describe the types of nursing standards initiatives.
● Review the historical perspectives of electronic health records.
● List the major landmark events and milestones of nursing informatics.
 Major Historical Perspectives
of Nursing and Computers
1. Seven Time Periods 2. 1960’s

A. Developed in the late 1930s and early A. Use of computer technology began to
1940s be explored
B. Studies were conducted to determine
how computer technology could be
B. Use in healthcare did not begin until utilized
the 1950s and 1960s
C. The nurses’ station was viewed as the
most appropriate center for the
C. A few experts formed a cadre to development of computer applications
adapt computers to healthcare and D. The mid-1960s presented nurses with
nursing new opportunities for computer use
E. Increased time devoted to
D. Computers in healthcare were used documentation and a rise in medication
for administrative and accounting errors prompted the investigation of
emerging computer-based information
 3. 1970’s
A. During the late 1960s through the B. A few systems started to include
1970s, hospitals began developing
computer-based information systems 1. Care planning
which initially focused on; 2. Decision support
2. Physician order entry 3. Interdisciplinary problem lists
3. Results reporting
4. Pharmacy C. Nurses were often involved in
5. Laboratory implementing systems

6. Radiology reports
7. Information for financial and D. Interest in computers and nursing began
managerial purposes to emerge in public and home health and
education
8. Physiologic monitoring systems in the
intensive care units
 3. 1970’s
E. In the 1970s, conferences helped public G. The opportunity to improve education
and home health nurses to; using computer technology also began
1. Understand the importance of nursing H. Early nursing networks helped to expand
data and their relationship to new nursing awareness of computers and the
Medicare and Medicaid legislation impact HIT could have on practice
2. Provide information on the usefulness I. The Clinical Center at the National
of computers for capturing and Institutes of Health implemented the
aggregating home health and public Technicon Medical Information System
health information (TDS) computer system
J. TDS one of the earliest clinical
information systems (called Eclipsys &
F. Hospitals and public health agencies Allscripts)
embarked on investigating computers and
nursing K. TDS was the first system to include
nursing practice protocols
4. 1989’S
A. The field of nursing informatics exploded E. The microcomputer or personal computer
and became visible in the healthcare and (PC) emerged during this period
nursing
F. The first Nursing Special Interest Group
B. The nursing profession needed to update on Computers met for the first time during
its practice standards and determine its data SCAMC (Symposium on Computer
standards, vocabularies, and classification Applications in Medical Care) in 1981
schemes that could be used for the
computer-based patient record systems G. In 1985, the ANA approved the
formation of the Council on Computer
C. Many mainframe healthcare information Applications in Nursing (CCAN)
systems (HISs) emerged with nursing
subsystems H. CCAN became a very powerful force in
integrating computer applications into the
D. These systems documented several nursing profession
aspects of the patient record
I. The first edition of this book published in
1986
5. 1990’S
A. Advances in relational databases, client- F. The demand for nursing informatics (NI)
server architectures, and new programming expertise increased
methods
G. The ANA developed the Nursing
Information and Data Set Evaluation
Standards (NIDSEC) to evaluate and
B .Better application development at lower recognize nursing technology rapidly
costs changed in the 1990s
C. Legislative activity in the mid-1990s 1. PCs became smaller
paved the way for electronic health records
through the Health Insurance Portability and 2. Computer notebooks became affordable
Accountability Act (HIPAA) of 1996
(public-law 104-19) 3. Computers were linked through networks
4. The Internet became mainstream

D. The complexity of technology, workflow 5. The World Wide Web (WWW) increased
analysis, and regulations shaped new roles access to information
in nursing
H. The purpose of Information systems was
E. In 1992, the ANA recognized nursing to guide the development and selection of
informatics as a new nursing specialty nursing systems that included standardized
6. 2000’S
A. More healthcare information became E. Smaller mobile devices with wireless or
digitalized and newer technologies emerged Internet access increased access to
information for nurses within hospitals and
B. In 2004 an Executive Order 13335 in the community
1. Established the Office of the National F. The development and refinement of voice
Coordinator (ONC) for Healthcare over Internet protocol (VoIP) provided voice
Information Technology (HIT) cost-effective communication
2. Issued a recommendation calling for all G. The Internet provided a means for
healthcare providers to adopt interoperable development of clinical applications
electronic health records (EHRs) by
2014/2015 H. The nursing informatics research agenda
promoted the integration of nursing care
C. Wireless, point of care, regional database data in HIT systems that would also
projects, and increased IT solutions generate data for analysis, reuse, and
proliferated aggregation.
D. The use of bar coding and radio-
freque
7. 2010’S
A. The impact of the Nursing Minimum D. During 2010, the ONC convened two
Data Set (NMDS) demonstrated that national committees:
continued consensus and effort was needed
to bring to fruition the vision and 1. National Committee on Health Policy
implementation of minimum nursing data 2. National Committee on Health Standards
into clinical practice which outlined and designed the focus for
B. A new nursing informatics research the “Meaningful Use” (MU) legislation
agenda for 2008–2018 emerged as critical E. Meaningful Use was designed to be
for this specialty implemented in at least three stages
C. The new agenda is built on one originally
developed and published by the National
Institute for Nursing Research (NINR) in
1993
7. 2010’S
F. Consists of the regulations which built I. The Quality Indicators are used to guide
onto each other with the ultimate goal of hospitals in patient safety and if not
implementing a complete an interoperable implemented used as indicators subject to
EHR and/or HIT system in all US hospitals financial penalties
G. . In 2011/2012 MU Stage 1 was initiated J. It is anticipated that MU Stage 3 will be
focusing primarily on the Computerized implemented in 2014/2015
Physician Order Entry (CPOE) initiative for
physicians K. The Center for Medicare and Medicaid
Services (CMS) plans to increase
H. In 2012/2013 MU Stage 2 was reimbursement for the implementation of
introduced focusing primarily on the “MU” regulations in their HIT and/or EHR
implementation of Quality Indicators systems through 2015
7. 2010’S
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
● There is a shift to a consumer-centric healthcare system due to escalating costs
● Consumers are encouraged to be active partners in their care
● A variety of technologies have evolved to enable consumers to have access to their health
information
● Consumers can choose whether to share this across healthcare providers and settings
● Personal health records multiplied as either stand-alone systems or those tethered to EHRs
● Consumers are more literate regarding healthcare information literacy and expect to become
more involved in managing their own health
Nursing Informatics Pioneers
History Project
1. In 1995, Saba initiated a history of NI at 6. In 2004, the rich stories of pioneers in
the National Library of Medicine, which nursing informatics were captured through a
consisted of the collection of archival project sponsored by the AMIA-NIWG
documents from the NI pioneers
7. Pioneers were defined as those who
2. The history project was initiated based on “opened up” a new area in nursing
a recommendation by Dr. Morris Collen informatics and provided a sustained
contribution to the specialty
3. In 2001, that the Nursing Informatics
Working Group (NIWG) of the American 8. Through multiple contacts and review of
Medical Informatics Association (AMIA) the literature, 145 pioneers and contributors
became involved were identified as having shaped nursing
informatics since the 1950s
4. The NI History Committee was
established to take on this project 9. Each identified pioneer was contacted to
submit their nonpublished documents and/or
5. The committee solicited archival material historical materials to the NLM to be
from the known NI pioneers for a History of indexed and archived for the Nursing
Nursing Informatics to be housed in the Informatics History Collection
NLM as part of its History Collection
10. The catalogued document descriptions 16. They also are useful for nurses in the
can be searched online: workforce who want to learn more about
www.nlm.nih.gov/hmd/manuscripts/accessio nursing informatics history
ns.html
17. The early pioneers came from a variety
11. A convenience sample of pioneers was of backgrounds as nursing education in
interviewed over a 4-year period at various nursing informatics didn’t exist in the 1960s
nursing informatics meetings
18. Almost all of the pioneers were educated
12. Videotaped stories from 33 pioneers as nurses, though a few were not
were recorded
19. The pioneers had a vision that
13. The 33 videotaped stories are available technology could make nursing practice
on the AMIA website: www.amia.org/niwg- better
history-page
20. The nursing pioneers influenced the
14. The website also provides “use cases” evolution of informatics as a specialty from
for ideas about how to use the information granular-level data through health policy
for teaching and learning more about the and funding
pioneers
15. These resources are particularly useful
for courses in informatics, leadership, and
research
Nursing Standards Initiatives
Nursing Practice Standards Nursing Education Standards

1. Nursing practice standards have been 1. Since the NLN’s Nursing Forum on
developed and recommended by the ANA Computers in Healthcare and Nursing was
formed in 1985, it has supported the
2. Nursing Scope and Standards of Practice integration of computer technology in the
that focused nursing curriculum
A. On the organizing principles of clinical 2. The American Association of Colleges of
nursing practice Nursing (AACN), revised The Essentials for
B. The standards of professional Doctoral Education for Advanced Nursing
performance Practice and The Essentials of Baccalaureate
Education for Professional Nursing Practice
3. Nursing Informatics Scope and Standards to require the use of computers and
of Practice builds on informatics for both baccalaureate and
A. Clinical practice standards graduate education
B. Outlines further the importance for
implementing standardized content to
support nursing practice by specialists in
nursing informatics
Nursing Content Standards

1. The nursing process data elements in 5. In 1970, the ANA accepted the Nursing
EHRs are essential for the exchange of Process as the professional standards for
nursing information across information nursing practice and which was followed by
systems and settings the standardization of nursing content-data
elements in 1973
2. Standardization of healthcare data began
in 1893 with the List of International Causes 6. Currently, the ANA has recognized 12
of Death for the reporting of morbidity cases nursing terminologies
worldwide
7. The ANA selected six of the ANA
3. The standardization of nursing began with recognized nursing languages for inclusion
Florence Nightingale’s six cannons in her in the NLM’s Meta thesaurus of the Unified
“Notes on Nursing” Medical Language System (UMLS) and for
inclusion in the Systematized Nomenclature
4. In 1955, Virginia Henderson published of Medicine—Clinical Terms (SNOMED-
her 14 Daily Patterns of Living as the list of CT)
activities and conditions that became the
beginning of nursing practice standards in 8. There are many standards organizations
the United States that impact healthcare data content as well
as healthcare technology systems
 Confidentiality and Security
Standards
• 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 Computer-Based Patient Record
The Institute of Medicine (IOM) Institute
1. In 1989, the Institute of Medicine (IOM) 1. Created in 1992
convened a committee and asked the
question, “Why is healthcare still 2. Given the mission to initiate and
predominantly using paper-based records coordinate the urgently needed activities to
when so many new computer-based develop, deploy, and routinely use CPRs to
information technologies are emerging?” achieve improved outcomes in healthcare
quality, cost, and access
2. Two major conclusions resulted from the
committee’s deliberations. 3. Developed the CPR Project Evaluation
Criteria in 1993 modeled after the Baldridge
A. First, computerized patient record (CPR) Award
is an essential technology for healthcare and
is an integral tool for all professionals A. These criteria formed the basis of a self-
assessment that could be used by
B. Second, the committee after hearing from organizations and outside reviewers to
numerous stakeholders recognized that there measure and evaluate the accomplishments
was no national coordination or champion of CPR projects
for CPRs
 The Computer-Based Patient Record
Institute
B. The four major areas of the initial criteria 4. The Davies Program evolved through
multiple revisions
1. Management
5. Under HIMSS management, the Davies
2. Functionality Award of Excellence is offered in four
3. Technology categories
4. Impact A. Enterprise (formerly Organizational or
Acute Care), first offered in 1995
C. Provided a framework through which to
view an implementation of computerized B. Ambulatory Care, started in 2003
records C. Public Health, initiated in 2004
D. The criteria which provided the D. Community Health Organizations
foundation for the Nicholas E. Davies (CHO), first presented in 2008
Award of Excellence Program
Landmark Events in Nursing
and Computers
4. There are currently several key events in
Major Milestones which the NI community participates
1. Computers were introduced into the A. Conferences
nursing profession over 40 years ago
B. Symposia
2. Major milestones of nursing are
interwoven with the advancement of C. Institutes
computer and information technologies D. Workshops
3. The increased need for nursing data, 5. Key events provide
development of nursing applications, and
changes, making the nursing profession an A. An opportunity for nursing informatics
autonomous discipline novices and experts to network and share
their experiences
B Key events provide the latest information,
newest exhibits, and demonstrations