Overview of Nursing Informatics

Notes on the Historical Perspective of Nursing Informatics

Overview of Nursing Informatics

• Origin: The term "informatics" derives from the French language, referencing a field of
applied computer science.
• Focus: Primarily concerned with the processing and management of nursing information.

Introduction of Computers in Healthcare

• 1960s: The advent of computers in healthcare facilities began, mainly for basic
administrative tasks.
• Role: Computers became essential tools in Health Information Technology (HIT)
systems.

Health Information Technology (HIT)

• Definition: HIT encompasses technologies that capture, process, and generate health
information.
• Impact: Computerization has revolutionized various healthcare domains, including:
o Patient Care: Facilitates provisioning and documentation.
o Education: Enhances training for healthcare providers.
o Research: Advances scientific inquiry for improved healthcare delivery.
o Administration: Streamlines healthcare delivery services and reimbursement
processes.
o Legal and Ethical Considerations: Addresses compliance and ethical practices.
o Safety and Quality: Focuses on improving patient safety and quality of care.

Trends in HIT

• Integration: Emphasizes the use of multiple technologies and telecommunications.

• Storage Solutions: Adoption of cloud-based storage as "invisible" data management
systems.
• User Interfaces: Shift towards user-friendly, menu-driven, and touchscreen technologies.

Applications of Computers in Nursing

• Patient Care Management: Streamlines the management of patient care information.

• Quality Monitoring: Aids in the evaluation and enhancement of healthcare outcomes.
• Data Communication: Facilitates the Internet-based exchange of data and messages.
• Resource Access: Provides healthcare professionals with online resources.
 • Patient Interaction: Enhances capabilities for online patient communication.

Specific Uses in Nursing Informatics

• Documentation: Records and processes real-time nursing care plans.

• Research Support: Assists in conducting nursing research.
• System Testing: Evaluates and tests new healthcare systems.
• Knowledge Database Design: Involves creating and maintaining nursing knowledge
databases.

Summary of the Historical Perspective of Nursing Informatics

Overview of Nursing Informatics

• Origin: The term "informatics" comes from French, highlighting its roots in applied
computer science.
• Focus: Nursing informatics mainly deals with the processing and management of nursing
information.

Introduction of Computers in Healthcare

• 1960s: Computers were first introduced in healthcare for basic administrative functions
and evolved to become critical tools in Health Information Technology (HIT) systems.

Health Information Technology (HIT)

• Definition: HIT includes technologies that capture, process, and generate health
information.
• Impact: The computerization of healthcare has transformed many areas:
o Patient Care: Improves documentation and provisioning of care.
o Education: Enhances the training of healthcare providers.
o Research: Facilitates scientific inquiry to improve healthcare delivery.
o Administration: Streamlines delivery services and reimbursement processes.
o Legal and Ethical Considerations: Addresses compliance and ethical issues.
o Safety and Quality: Focuses on enhancing patient safety and care quality.

Trends in HIT

• Integration: Encourages the use of various technologies and telecommunications.

• Storage Solutions: Emphasizes the shift towards cloud-based storage systems for data
management.
• User Interfaces: A movement towards more user-friendly, menu-driven, and touchscreen
technologies.

Applications of Computers in Nursing

 • Patient Care Management: Streamlines management of patient information.
• Quality Monitoring: Helps evaluate and improve healthcare outcomes.
• Data Communication: Facilitates online communication and data exchange.
• Resource Access: Provides healthcare professionals with online tools and information.
• Patient Interaction: Improves the ability to communicate with patients remotely.

Specific Uses in Nursing Informatics

• Documentation: Captures and processes real-time care plans.

• Research Support: Aids in nursing research initiatives.
• System Testing: Involves the evaluation of new healthcare systems.
• Knowledge Database Design: Focuses on creating and maintaining databases of nursing
knowledge.
Historic Perspective of nursing and
computers

Notes on the Historic Perspective of Nursing & Computers

Prior to the 1960s

• Early Development: Computer technology began development in the late 1930s and
early 1940s.
• Healthcare Application: Use in healthcare did not commence until the 1950s and 1960s.
• Adaptation to Nursing: A small group of experts worked to tailor computers specifically
for healthcare and nursing applications.
• Initial Uses: Computers were primarily utilized for administrative and accounting
functions within healthcare settings.

1960s

• Exploration of Technology: The potential for computer technology in healthcare began

to be systematically explored.
• Research Initiatives: Studies were carried out to identify effective applications for
computer technology in nursing.
• Nurses’ Station Focus: The nurses' station was identified as the key area for developing
computer applications.
• Emerging Opportunities: The mid-1960s opened up new opportunities for nurses to use
computers, especially as documentation needs grew and medication errors rose.
• Investigation of Systems: These challenges led to investigations into emerging
computer-based information systems to enhance patient care.

1970s

• Development of Information Systems:

o Hospitals began creating computer-based information systems focusing on:
1. Physician order entry
2. Results reporting
3. Pharmacy management
4. Laboratory services
5. Radiology reports
6. Financial and managerial information
7. Physiological monitoring in intensive care units (ICUs)
• Expanded Functionality: Some systems began to incorporate care planning, decision
support, and interdisciplinary problem lists.
 • Nurse Involvement: Nurses played a significant role in the implementation and usage of
these systems.
• Interest in Public Health: Interest in utilizing computers in nursing and health extended
into public and home health sectors.
• Education and Awareness:
o Conferences educated public and home health nurses on the importance of
nursing data and its relationship to Medicare and Medicaid.
o These events highlighted the value of computers in capturing and aggregating
health information.
• Clinical Center Advances: The NIH Clinical Center implemented the Technicon
Medical Information System (TDS), one of the earliest clinical information systems to
include nursing practice protocols.

1980s

• Explosion of Nursing Informatics: The field gained visibility and rapidly expanded
within healthcare.
• Need for Standards: The nursing profession recognized the necessity to update practice
standards and develop data standards, vocabularies, and classification schemes for
computer-based patient record systems.
• Healthcare Information Systems: Many mainframe healthcare information systems
(HISs) emerged, incorporating nursing subsystems to document various aspects of patient
records.
• Rise of Personal Computers: The introduction of microcomputers, or personal
computers (PCs), further transformed the landscape of nursing informatics.

1980s

• Formation of Professional Groups:

o The first Nursing Special Interest Group on Computers convened at the
SCAMC (Symposium on Computer Applications in Medical Care) in 1981.
o In 1985, the American Nurses Association (ANA) approved the establishment of
the Council on Computer Applications in Nursing (CCAN), which became
influential in integrating computing into nursing.
• Publication Milestone: The first edition of a significant nursing informatics book was
published in 1986, marking an important milestone in nursing informatics literature.

1990s

• Technological Advancements:
o The decade saw significant improvements in relational databases, client-server
architectures, and programming methods, which facilitated better and more cost-
effective application development.
• Legislation:
 o The Health Insurance Portability and Accountability Act (HIPAA) of 1996
was a crucial legislative milestone, enabling the establishment of electronic health
records (EHRs).
• Professional Recognition:
o In 1992, nursing informatics was officially recognized by the ANA as a distinct
nursing specialty.
o The Scope of Nursing Informatics Practice Standards was developed, coupled
with a specific credentialing examination.
• Growing Demand: The demand for nursing informatics expertise surged, leading to the
creation of Nursing Information and Data Set Evaluation Standards (NIDSEC) for
evaluating nursing technologies.
• Technological Changes:
o Notable developments included smaller PCs, affordable computer notebooks,
network-linked computers, mainstream Internet access, and the rise of the World
Wide Web which expanded information accessibility.
• Standardized Terminologies: The focus on information systems shifted to guiding the
development and selection of nursing systems that incorporated standardized nursing
terminologies.

2000s

• Digitalization of Healthcare: A shift occurred towards more digitized healthcare

information coupled with the emergence of new technologies.
• Executive Initiatives:
o In 2004, Executive Order 13335 established the Office of the National
Coordinator (ONC) for Healthcare Information Technology (HIT) and
encouraged healthcare providers to adopt interoperable electronic health records
by 2014/2015.
• Emerging Technologies:
o Proliferation of wireless technologies, point-of-care applications, regional
databases, and advanced IT solutions.
o Adoption of barcoding and radio-frequency identification (RFID) technology
emerged as significant tools in healthcare management.
• Access to Information:
o Smaller mobile devices with wireless and Internet capability dramatically
increased nurses' access to information both in hospitals and community settings.
• Communication Advancements: The development of Voice over Internet Protocol
(VoIP) enabled cost-effective communication.
• Research Agenda: The nursing informatics research agenda emphasized the integration
of nursing care data in HIT systems to facilitate data analysis, reuse, and aggregation.

2010s

• Nursing Minimum Data Set (NMDS):

o The impact of the NMDS highlighted the need for continued consensus and effort
to effectively integrate minimum nursing data into clinical practice.
• Research Agenda:
o A new nursing informatics research agenda for 2008–2018 was established,
building on the original agenda published by the National Institute for Nursing
Research (NINR) in 1993, emphasizing the need for focused research within this
specialty.
• Meaningful Use (MU) Legislation:
o In 2010, the Office of the National Coordinator (ONC) convened two national
committees:
▪ National Committee on Health Policy
▪ National Committee on Health Standards
o These committees outlined the framework for Meaningful Use (MU), aimed at
ensuring the implementation of a complete and interoperable Electronic Health
Record (EHR) and Health Information Technology (HIT) systems across US
hospitals.
o Implementation Stages: MU was designed to be rolled out in three stages,
building on each other to achieve the overarching goal of comprehensive EHR
adoption.
• Stages of Meaningful Use:
o Stage 1 (2011/2012): Focused on the implementation of Computerized
Physician Order Entry (CPOE) for improved ordering processes by physicians.
o Stage 2 (2012/2013): Introduced with an emphasis on implementing Quality
Indicators to enhance patient safety; failure to implement these indicators could
result in financial penalties for hospitals.
o Stage 3 (Anticipated 2014/2015): Expected to further enhance the scope of MU
requirements.
• Reimbursement Changes:
o The Centers for Medicare and Medicaid Services (CMS) announced plans to
increase reimbursements for hospitals complying with MU regulations in their
HIT and EHR systems through 2015.
o CMS proposed penalties for eligible providers and facilities that fail to meet MU
criteria, emphasizing the importance of adherence to these regulations.
• Impact on Nursing Informatics:
o The increasing MU requirements transformed the role of Nursing Informatics (NI)
experts in hospitals, making NI integral to nursing services within inpatient
facilities.
o These requirements also influenced the overall responsibilities of all nurses,
underscoring the importance of informatics in improving patient care.
• Shift to Consumer-Centric Healthcare:
o There was a notable transition towards a consumer-centric healthcare system,
largely driven by rising healthcare costs.
o Consumer Engagement: Individuals are encouraged to actively participate in
their healthcare management, supported by various technologies that provide
access to personal health information.
o Personal Health Records (PHRs): The number of personal health records grew,
offering consumers options—both as standalone systems and those connected to
EHRs.
o Health Information Literacy: Consumers have become more health literate and
expect to take a more active role in managing their health.
Summary of Nursing Informatics: Historical Perspective and Overview

Overview of Nursing Informatics

• Origin: The term "informatics" originates from French, emphasizing its foundation in
applied computer science, primarily focusing on the processing and management of
nursing information.
• Introduction of Computers in Healthcare: The 1960s marked the beginning of
computer use in healthcare, mainly for administrative tasks, leading to the establishment
of Health Information Technology (HIT).

Health Information Technology (HIT)

• Definition: HIT includes technologies that capture, process, and generate health
information, significantly impacting various healthcare domains:
o Patient Care: Enhances documentation and care provisioning.
o Education: Improves training for healthcare providers.
o Research: Facilitates scientific inquiry and healthcare delivery improvement.
o Administration: Streamlines service delivery and reimbursement.
o Legal and Ethical Considerations: Ensures compliance and ethical practices.
o Safety and Quality: Focuses on improving patient safety and healthcare quality.

Trends in HIT

• Integration: Emphasizes the use of multiple technologies and telecommunications.

• Storage Solutions: Adoption of cloud-based, "invisible" data management systems.
• User Interfaces: Shift towards user-friendly, touchscreen technologies.

Applications of Computers in Nursing

• Patient Care Management: Streamlines patient care information management.

• Quality Monitoring: Assists in evaluating and enhancing healthcare outcomes.
• Data Communication: Facilitates Internet-based data exchange.
• Resource Access: Offers online resources for healthcare professionals.
• Patient Interaction: Improves online communication capabilities with patients.

Historical Development

• Pre-1960s: Initial computer technology began in the late 1930s, expanding into
healthcare during the 1950s and 1960s for administrative functions.
• 1960s: Systematic exploration of computer technology in healthcare started, focusing on
enhancing nursing documentation and addressing medication errors.
• 1970s: Development of computer-based information systems for various healthcare
functions, with increased nurse involvement. Education initiatives highlighted the
importance of nursing data.
• 1980s: Rapid expansion of nursing informatics; first professional groups formed, and
national recognition of nursing informatics as a specialty by the ANA.
• 1990s: Technological advancements and the introduction of HIPAA led to significant
developments in electronic health records (EHR). The demand for nursing informatics
expertise surged.
• 2000s: Digitalization of healthcare and emerging technologies, including barcoding and
RFID technologies, expanded access to information for nurses, transforming care
delivery.
• 2010s: Introduction of Meaningful Use (MU) legislation aimed at implementing complete
EHR systems, impacting nursing informatics roles and emphasizing consumer
engagement in healthcare.