Historical Perspectives of Nursing and the Computer

Virginia K. SabaWilliam Scott Erdley

Objectives

• Highlight a brief historical perspective of nursing and computers

• List the major landmark events and milestones of nursing and computers

The computer is the most powerful technological tool to transform the nursing profession prior to the new century.

Computer is an all encompassing term referring to information technology (IT), computer systems, and when they are used in nursing, refer to nursing informatics systems, nursing applications.

Computer in nursing are used to manage information in patient care, monitor the quality of care, and evaluate the outcomes of care.

Computers are also used to support nursing research, test new systems, design new knowledge databases, and advance the role of nursing in the health care industry.

Major Historical Perspectives of Nursing and Computers

• six time periods• four major nursing areas• standards initiatives• significant landmarks events• major landmark milestones chart

Six Time Periods

• Prior to the 1960sOnly a few experts who formed a cadre of pioneers that attempted to adopt computers to health care and nursing.Computers were initially used in health care facilities for basic business office functions.

punch cards – store datacard readers – read computer programsteletypewriters – print output

Six Time Periods

• 1960sQuestions arise: Why computers?

What should be computerized?

Introduce of cathode ray tube(CRT) terminals, online data communication and real-time processing.

Six Time Periods

(cont…)Hospital Information Systems (HISs) were developed primarily to process financial transactions and serve as billing and accounting systems. . . .because of technology limitations, lack of standardization and diversity of paper-based patient care records, progress was slow.

Six Time Periods

• 1970sNurses recognized the computer’s potential for improving the documentation of nursing practice, the quality of patient care and the repetitive aspects of managing patient care.Several states and large community health agencies developed or contracted for their own computer-based management information systems (MISs).

Six Time Periods

• 1980sNI became an accepted specialty and many nursing experts entered the field.Many mainframe HISs emerged with nursing subsystems.The microcomputer or PC emerged.

Six Time Periods

• 1990sComputer technology became an integral part of health care settings, nursing practice and the nursing profession.Policies and legislation were adopted promoting computer technology in health care including nursing.In 1992, NI was approved by the American Nurses Association (ANA) as a new nursing specialty.

Six Time Periods

(cont. . .)Brought smaller and faster computers to the bedside and all of the point-of-care settings.LANs were developed for hospital nursing units.WANs were developed for linking care across health care facilities.Internet started to be used for linking across the different system.

Six Time Periods

(cont. . .)Cyberspace tools:

e-mail Gopher WWW protocolsFTP Telnet

Web became the means for communicating online services and resources to the nursing community.

Six Time Periods

• Post-2000Information technologies continued to advance with mobile technology such as with wireless tablet computers, PDAs, and smart cellular telephones.Voice over Internet protocol(VoIP) promises to provide cheap voice communication for health care organizations.

Six Time Periods

(cont. . .)Smart cards were realized in Europe.Recommended the health care providers use a provider identification number (PIN) to maintain privacy and security of patient information. -eHealth Initiative and Institute -Consolidated Health Information (CHI) initiative -National Health Information Infrastructure (NHII)

initiative

Four Major Nursing Areas

• Nursing PracticeComputer systems with nursing and patient care data are integrated into one interdisciplinary patient health record in EHR.Nursing practice data emerged that were recognized by ANA and used in EHR.The electronic version of nursing practice-the computer-has revolutionized and transformed nursing practice.

Four Major Nursing Areas

• Nursing AdministrationMost policy and procedure manuals are accessed and retrieved by computer.The Internet is being used by nurses to access digital libraries, online resources and research protocols.

Four Major Nursing Areas

• Nursing EducationCampus-wide computer systems are available for students to communicate via e-mail, transfer data files, access the digital libraries, and retrieve online resources of millions of Internet WWW sites.Time, distance and cost are no longer barriers to educational programs.

Four Major Nursing Areas

• Nursing ResearchProvides the impetus to use the computer for analyzing nursing data.Software programs are available for processing both quantitative and qualitative research data.

Standards Initiatives

• Nursing practice standardsANA -the official professional nursing education - published The Standards of Clinical Nursing Practice which focused not only on the organizing principles of clinical nursing practice but also the standards of professional performance.

Standards Initiatives

(cont. . .)Has been set by the Joint Commission on Accreditation of Hospital Organizations (JCAHO) which stressed the need for adequate records on patients in hospitals and practice standards for the documentation of care by nurse.

Standards Initiatives

• Nursing data standards13 nursing terminologies that have been recognized by the ANA in which it was developed at different times, has different characteristics and is used for documenting different aspects of nursing practice.

Standards Initiatives

(cont. . .)ANA is responsible for the recognition of the terminologies and for determining if they have met the criteria to be included in the National Library of Medicine (NLM) Unified Medical Language Systems (UMLS).

Standards Initiatives

• Health care data standardsAmerican National Standards Institute (ANSI) a private nonprofit membership organization.ANSI was combined with the Health Care Informatics Standards Board(HISB) to form ANSI-HISB to fulfill a request by the European standards coordinating organization to represent the U.S. standards effort

Standards Initiatives(cont. . .)The ANSI-HISB organization acts as one linking to the two major organizing in Europe

European Standardization Committee(CEN)International Standard Organization (ISO)

American Society for Testing and Materials (ASTM): ASTM E-31 Committee on Healthcare Informatics is an accredited committee that develops standards for health information and HISs designed to assist vendors, users, and anyone interested in systematizing health information.

Standards Initiatives

(cont. . .)Health Level Seven(HL7) an organization accredited by the ANSI, which was created to develop standards for the electronic interchange of clinical, financial and administrative information among dependent healthcare-oriented information systems

Standards Initiatives

(cont. . .)SNOMED International is another organization that servers as an umbrella of the structured nomenclatures and its merger with the Read Codes from the National Health Service in UK.SNOMED CT the newly named that serves as the coding strategy and has become a national standard for EHR aspects

Standards Initiatives

(cont. . .)The National Committee on Vital and Health Statistics(NCVHS) Workgroup on Computer-based Patient Records was created to help the Department of Health and Human Services (DOHHS) investigate and approve health care standards for the federal government to use to implement federal legislation.

Landmark Events in Nursing and Computers

Categories:a) Early conferences, meetingsb) Early academic initiativesc) Initial ANA initiativesd) Initial National League for Nursing (NLN)

initiativese) Early international initiativesf) Initial educational resourcesg) Significant collaborative events