Overview

A. Nursing informatics refers to the field of applied

computer science
B. Computers are an essential tool in HIT systems
C. Health Information Technology refers to technology
that:
a) Captures health information
b) Processes health information
c) Generates health information
 Overview

3. Computerization affects:
a. Documentation of patient care
b. Education of providers
c. Research for advancing healthcare delivery
d. Administration
e. Reimbursement
f. Legal and ethical implications
g. Safety and quality issues
 Overview

4. Shift towards
a. Integrating multiple technologies
b. Invisible storage devices
c. User-friendly, menu driven, touchscreen
5. Computers in nursing are used for
a. Managing patient care
b. Monitoring quality
c. Evaluating outcomes
 Overview

d. Communicating data
e. Accessing resources
f. Interacting with patients
g. Documenting care
h. Supporting nursing research
i. Testing new systems
j. Designing new knowledge databases
k. Developing date warehouses
l. Advancing the role of nursing
 Major Historical Perspectives of
Nursing and Computers

1. Prior to the 1960s

a. Computers were used for administrative work and accounting
2. 1960s
a. Increased time devoted to documentation
b. Emerging computer-based information systems
 Major Historical Perspectives of
Nursing and Computers

1. 1970s
a. Hospitals began developing information systems
i. Physician order entry
ii. Results reporting
iii. Pharmacy
iv. Laboratory
v. Radiology reports
vi. Information for financial and management
vii. Monitoring for intensive care units
b. Some systems included:
i. Decision support,
ii. Problem lists
iii. Interdisciplinary problem lists
Major Historical Perspectives of
Nursing and Computers

c. Nurses were often involved in implementing systems

d. Interest began to emerge in public and home health
e. Conferences helped public and home health nurses:
i. Understand the importance of data to Medicare and
Medicaid
ii. See the usefulness of computers for capturing information
f. Hospitals and public health agencies investigated
computers
g. Educational use of computers began
h. Early networks expanded awareness on practice
i. NIH implemented TDS
j. TDS was the first system to include nursing practice
protocols
 Major Historical Perspectives of
Nursing and Computers

4. 1980s
a. Field of nursing informatics exploded
b. Nursing profession updated practice standards
c. Many mainframe systems emerged with nursing subsystems
d. Systems documented aspects of patient records
e. PCs emerged
f. First Nursing special interest group on computers met during
SCAMC - 1981
g. ANA approved formation of CCAN
h. CCAN became powerful force
i. First edition of this book - 1986
 Major Historical Perspectives of
Nursing and Computers

5. 1990s
a. Advances in relational databases
b. Better application development
c. Legislative action paved the way for HIPPA
d. Technology shaped new roles for nursing
e. ANA recognized new nursing specialty
f. Demand for Nursing Informatics increased
g. ANA developed NIDSEC
 Major Historical Perspectives of
Nursing and Computers

5. 1990s continued
h. Technology rapidly changed in the 1990s
I. PCs became smaller
II. Computer notebooks became affordable
III. Computers were linked through networks
IV. The Internet became mainstream
V. The World Wide Web (WWW) increased access to
information
 Major Historical Perspectives of
Nursing and Computers

6. 2000s
a. Healthcare information became digitalized
b. In 2004 Executive Order 13335
i. Established Office of the National Coordinator (ONC)
ii. Recommendation issued for adoption of EHRs
c. IT solutions increased
d. Bar coding and RFID use increased
e. Mobile devices in hospitals increased
f. VOIP provided cheap communications
g. Development of clinical applications
h. Integration of nursing data into HIT systems
 Major Historical Perspectives of
Nursing and Computers

7. 2010s
a. Impact of NMSD showed need for continued effort
b. New nursing research agenda emerged as critical
c. New agenda based on NINR
d. Meaningful Use (MU) legislation outlined
e. MU designed to be implemented in three stages
f. Ultimate goal is interoperable EHR in all hospitals
g. MU stage1 focused on CPOE
h. MU stage 2 focused on Quality Indicators
 Major Historical Perspectives of
Nursing and Computers

7. 2010s continued
i. Quality Indicators guide in patient safety
j. MU stage3 to be optional in 2017
k. CMS to increase reimbursement for MU
l. CMS may penalize for failure to meet MU
m. MU made NI part of all nursing services
Historical Perspective of Nursing
Informatics

B. Consumer-centric healthcare system

1. Shift due to escalating costs
2. Consumers encouraged to be active partners
3. Variety of technologies have evolved
4. Consumers can share across healthcare providers
5. Personal Health Records have multiplied
6. Consumers increasingly healthcare literate
 Nursing Informatics Pioneers

A. History Project
1. 1995, Saba initiated history of NI at the NLM
2. 2001 the NIWG of the AMIA became involved
3. The NI History Committee was established
4. Archival material to be housed in the NLM
5. 145 pioneers were identified
6. Each pioneer contacted to submit historical documents
7. Videotaped stories recorded
8. Videos and documents available online
 Nursing Informatics Pioneers

A. History project continued

9. The website provides “use cases”
10. The pioneers came from a variety of backgrounds
11. Pioneers influenced informatics from data through
health policy and funding
 Nursing Standards Initiatives

A. Nursing Practice Standards

1. Standards developed by ANA
2. Nursing Scope & Standards of Practice (ANA, 2010)
focused on:
a. The organizing principles of clinical nursing practice
b. Standards of professional performance
 Nursing Standards Initiatives

A. Nursing Practice Standards

3. Nursing Scope & Standards of Practice (ANA, 2010):
a. Builds on clinical practice standards
b. Outlines importance of standards to support nursing
B. Nursing Education Standards
1. NLN’s Nursing Forum on Computers in Healthcare and
Nursing supported integration of computers in
nursing curriculum
 Nursing Standards Initiatives

A. Nursing Education Standards continued

2. The American Association of Colleges of Nursing
(AACN) revised The Essentials for Doctoral Education
for Advanced Nursing Practice (AACN, 2006) and The
Essentials of Baccalaureate Education for Professional
Nursing Practice (AACN, 2008) to require the use of
computers
 Nursing Standards Initiatives

C. Nursing Content Standards

1. Nursing data elements in EHRs are essential for
exchange
2. Standardization of healthcare data began in 1893
with the List of International Causes of Death
3. Standardization of nursing began with Florence
Nightingale’s six cannons - ‘Notes on Nursing’
 Nursing Standards Initiatives

C. Nursing Content Standards

4. In 1955, Virginia Henderson published her 14 Patterns
of Living
5. The ANA has recognized 12 nursing terminologies
6. The ANA selected 6 ANA recognized nursing
languages for inclusion in UMLS
7. There are a large number of standards organizations
 Nursing Standards Initiatives

D. Confidentiality and Security Standards

1. Electronic exchange of data raises privacy concerns
2. 2009 HIPAA strengthened in HITECH Act
Electronic Health Records from a
Historical Perspective

A. The Institute of Medicine (IOM)

1. Raised awareness of paper patient records
B. The computer based Patient Record Institute
1. Made criteria to evaluate CPR accomplishments
2. Framework to view implementation
3. Davies Award offered in four categories
 Landmark Events in Nursing and
Computers

A. Major Milestones
1. Computers introduced over 40 years ago
2. Major milestones in nursing and computers
interwoven
3. Increased need for nursing data makes nursing
profession an autonomous discipline
4. Conferences and symposia provide chances for
nursing informatics to network