HISTORICAL PERSPECTIVES OF NURSING AND ❑ development of Hospital Information System (HIS)-

COMPUTERS billing & accounting dept

Prior to 1960’s ❑ introduction of cathode ray tubes
❑ late 1930s to early 1940s Cathode ray tube (CRT) - a device that uses a beam of
✓ computers first developed electrons in order to produce an image on a screen
❑ 1950s and 1960s
✓ computers are used in healthcare industry-
office function
✓ few experts attempted to adapt computers to
healthcare and nursing
✓ nursing profession embraces a new technology
tool- computer
(d/t nursing profession undergoing major changes)
❑ use of punch card and teletypewriter

Mid 1960’s
❑ clinical practice presented nurses w/ new
opportunities for computer use.
✓ increasing complex patient care
✓ ICU nurses are required to be super users of
computer technology in monitoring patient via
cardiac monitor, ventilators and other
computerized devices

1960’s
❑ use of computer in healthcare was questioned
❑ studies on computers in nursing started
❑ nurse station as hub of information exchange

1970’s
❑ hospitals began to develop computer-based
management information system (MIS) aside from
HIS
❑ Focus of HIS
✓ Physician order and recording
✓ Financial
✓ Managerial purposes
✓ Monitoring systems (like in ICU)
❑ nurses began to recognize the value of computer
thus nurses assisted in the design of HIS
❑ computers are used in financial and management
functions
❑ several communities developed management
information system
❑ improve education using computer technology also
begun
❑ PLATO (Programmed Logic for Automatic Teaching
Operations) – first computerized teaching system
which was implemented to teach classes in off-
campus site as an alternative to traditional
classroom education
❑ TDS (TABULAR DATA STREAM) – computer system-
earliest clinical information system (former Eclipsys
and now Allscripts) that includes nursing practice
protocol
Automated System in the Philippines
1970s
✓ computers are mainly used to automate billing.
✓ Hospital networks expanded to include information
process in admission, discharge and transfer (ADT)
(mid 70s)
✓ Networks now include pharmacy section, now
connecting 3 big departments: ACCOUNTING, ADT
and PHARMACY. (late 70s)
1980’s
❑ Nursing Informatics was formally accepted as new
nursing specialty
❑ Nursing Education identified need for update
❑ microcomputers/ PC (personal computers) emerged
❑ 1985 – ANA approved the formation of
Council on Computer Applications in
Nursing (CCAN)
❑ Laboratory and imaging departments are already
using their special computers (early 80s)
❑ Integrated system expanded to the clinical area.
(mid 80s) CLINICAL INFORMATION SYSTEM -
ORDER ENTRY on MEDICATION & LAB EXAM
(pharmacy & lab dept)
❑ 90’s hospital bought conversion software and
hardware in order to deliver the laboratory and
imaging machines to link their main system creating
interfaced systems (exchange information)
1990’s
❑ computer technology became integral part of
healthcare setting
❑ policies and legislations on promoting computers in
the healthcare were adopted
✓ HIPPA, 1996 – Health Insurance Portability &
Accountability Act
❑ 1992- approval of NI by ANA as a new nursing ❑ 2004- protect the security, ensure privacy &
specialty confidentiality was implemented
❑ Dr. Nicholas Davies Excellence Award – is given for
excellence in health information technology
(managed by HIMSS)
❑ 1995 – the internet began providing access to
information and knowledge databases to be
integrated into bedside system
✓ electronic mail (email)
✓ file transfer protocol (FTP)
✓ Gopher,
✓ Telnet
✓ world wide web (www)

❑ LABORATORY INFORMATION SYSTEM (LIS) &

2000s
❑ “paperless”
❑ individualized electronic patient record (EPR) & EHR
❑ the use of bar coding and radiofrequency
identification (RFID)
❑ smaller mobile devices w/ wireless or internet
access
❑ telehealth application – to monitor patient at home
& support specialty consultation in rural and
underserved area
RADIOLOGY INFORMATION SYSTEM (RIS) started
to encroach into the main hospital information
systems.
❑ Late 2000s – The Philippine Heart Center
implemented the internet-based hospital
information system (HIS) to allow healthcare team
to access it anywhere
❑ 2010
❑ MU - “Meaningful Use”
Goal: implementing a complete and interoperable EHR
and/or HIT system in all US hospitals
✓ 2011-2012 (Stage 1)
- Computerized Physician Order Entry (CPOE)
✓ 2012-2013 (Stage 2)
- Implementation of Quality Indicators
✓ 2015-2016 (Stage 3)
- Outcome Measures to propose Care Plans
UPDATE:
***Nurses are involved in all phase of MU. Up to date,
hospital hires NI expert in order to assist with the
implementation of MU for they have impact on
professional nursing services.
CONCLUSION:
❑ at present, NI is an emerging field of study
❑ National Nursing Organizations support the need
for nurses to become computer literate & versed in
the dynamics of NI
❑ programs that offer basic & further education in NI
are beginning spring up around the globe
❑ many are needed to provide easy access for
motivated nurses

POINTS TO PONDER...
❑ “Computers are incredibly fast, accurate and stupid.
❑ Humans are incredibly slow, inaccurate and
brilliant.
❑ Together they are powerful beyond imagination.....
- Albert Einstein

Virginia Saba (1992) predicted…

“By the turn of the century, most health care delivery
system will function w/ computers & will be managed by
computer literate nurses. I believe, that by the turn of
the century, “high tech & high touch” will be an integral
part of the healthcare delivery system.”

WHAT DO WE NEED TO ACHIEVE NURSING

INFORMATICS?
“Nursing practice will be revolutionized and we will truly
be a profession of nurses with our own classification
systems, bibliographic systems, and payment systems.”
❑ We need to think outside the box
❑ We need to use the Internet to enhance our
practice and provide tele-nursing care.
❑ We need to become wireless and conduct our
services using all the newer IT tools

“We have a long way to go, but if we utilize information

technology effectively, informatics will become an
integral part of our profession and the health care
industry. I do believe we have the knowledge and
perseverance and I am convinced it will come to pass.”
- Dr. Virginia Saba