HARDWARE

- Computer hardware is defined as all of the physical

components of the machine itself. The basic hardware

of a computer includes the electronic circuits,
microchips, processors, and the motherboard itself
inside the computer housing. In addition, hardware
typically includes devices that are peripheral to the
main computer box such as input and output devices
including the keyboard, mouse, printer, fax, and
storage components such as the hard drive, Universal
- Serial Bus (USB) drive, floppy drives, tape drives, and

so on.
1
2
- A computer is a machine that uses electronic
components and instructions to the components
to perform calculations and repetitive and
complex procedures, process text, and
manipulate data and signals. Today, computer
processors are encountered in most areas of
people's lives. From the grocery store to the
movie theater; from infusion pumps to
physiologic monitors; from the bedside alarm
clock to the automobile accelerator, computer
processors are employed so widely that the late
twentieth century can accurately be described3 as
the beginning of the information age.
4
The application of computers to health care will
greatly expand the diagnostic and therapeutic
abilities of practitioners and broaden the options
available to recipients of health care.

COMPUTER HARDWARE FUNDAMENTALS

The box of any computer contains a motherboard.
The motherboard is a thin, flat sheet made of a
firm, nonconducting material on which the
internal components - printed circuits, chips,
slots, and so on – of the computer are mounted.
5
6
Central Processing Unit
- The CPU is the “brains” of the computer. It
consists of at least one arithmetic and logic
unit, a control unit, and memory.

7
Memory
- Read Only Memory ROM - is a form of
permanent storage. This means that data
means that data and programs in ROM can
only be read by the computer, and cannot be
erased or altered
Random Access Memory – RAM refers to
working memory used for primary storage.
It is volatile (changeable) and used as
temporary storage. RAM can be
accessed, used, changed, and written on
repeatedly. 8
9
INPUT AND OUTPUT
Input Devices – These allow the computers to
receive information from the outside world.
The most common input devices are
keyboard and mouse.

10
•Output Devices – These allow the computers to report
its results to the external world. Output can be in the
form of text, data files, sound, graphics, or signals to
other devices. The two most obvious output devices
are the monitor (display screen) and printers.

11
Storage Media – The most common storage
devices include the hard drive, diskettes, CD-
ROMs, and USB Disk.

12
History of Computers
First Generation Computers – The first true
digital computer, called the Colossus Mark I,
was built in 1943 with funding from the U.S.
Military and used in airplane design and other
complex engineering application.
ENIAC (Electronic Numerical Integrator and
Computer) – first vacuum tube computer

13
14
•Second Generation Computers – They included the
IBM 1401 AND 1620. They used transistors instead of
vacuum tubes.

15
Third Generation Computers – were introduced in the
mid-1960s. These used microminiature, solid state
components. The IBM 360 and 370 were classic
computers in this generation. The replacement of
the transistor with integrated circuits (ICs) marked
the beginning of the third generation computers.

16
•Fourth Generation Computers – The invention of
microprocessor in 1971 ushered in the fourth generation of
computers. A microprocessor contains the core processing
capabilities of an entire computer on one single chip.

17
Classes of Computers
Analog Computer – operates on continuous physical or electrical
magnitudes, measuring ongoing continuous analog quantities
such as voltage, current, temperature, and pressure.
An example of these machines in the clinical setting include heart
monitors and fetal monitors.

18
Digital Computer – Its data are represented by
numbers, letters, and symbol rather than waveforms
such as on a heart monitor. Most of the computers
used in the health care industry for charting and
decision support computers.

19
Hybrid Computer – contains features of both the
analog and the digital computer. It is used for
specific applications, such as complex signal and
other engineering-oriented applications.

20
Types of Computers

Supercomputer – The supercomputer is designed

primarily for analysis of scientific and engineering
problems and for tasks requiring millions or billions
of computational operations and calculations.

The first supercomputer was developed by a

computer engineer named Seymour Cray. His work
at Control Data Corporation culminated in the
production of the CDC 7600, a computer 10 times
more powerful that CDC 6600, often called the first
supercomputer.
21
22
Mainframes – fastest, largest, and most expensive type
of computer used in corporate America for processing,
storing, and retrieving data. It is a large multiuser central
computer that meets the computing needs – especially
the large amount of repetitive calculations of bills,
payroll, and the like – of a large organization.

23
Microcomputers (Personal Computers or PCs)
- are being used for an increasing number of
independent applications as well as serving as a
desktop link to the programs of mainframe.
- Microcomputers are available as portable, laptop,
notebook, and handheld computers.

24
Common Hardware Peripherals
Keyboard – is the most common input device.
Monitor – is a display screen component of a
terminal that allows the user to see images,
programs, commands the user sends to the
computer, and results of the computer's work.

25
Mouse and Trackball – The mouse was
introduced with the microcomputer as a new
type of input device to replace moving the
arrow keys on the keyboard.

Floppy Disks/Diskettes and CD-ROMs

- They serve as both input and output media.
Data are read and written, using disk drives in
the same manner as with magnetic tapes and
magnetic disks or CD readers. 26
Touch Pad and Mouse Button
- the touch pad was developed by the makers of
laptop computers for use in place of the
mouse.

Light Pen/ Touch Screen – A light pen is a

photosensitive device that responds to light
images when placed against a monitor
screen. Touch screens involve the use of a
special filter on a monitor screen on monitor
screen that allows the screen to “sense” the
pressure of the user's finger on a particular
27

position of the screen.

Optical Character Recognition (OCR) – is a
specialized computer input medium that
allows data to be read directly from a form or
document. An electronic optical scanning
device, a wand reader, or a bar code reader
reads special marks, bar codes, numbers,
letters, or characters.

Magnetic-Ink Character Recognition(MICR)

- The most common example of a MICR is the
magnetized characters imprinted on checks,
which most bank use. 28
Voice Synthesizer – allows users to input data
into computer by speaking into a conneced
microphone.

Imaging – Several different types of image input

devices are available that primarily transform
images from various types of graphics into
digital form, which the computer can accept,
represent on the screen, and process.
Examples are computerized axial tomography
(CAT scans)and magnetic resonance imaging
(MRI) 29
Digital Versatile Disk
- While DVD began as digital video disk, it is now a commonly
and more correctly referred as digital versatile disk to better
reflect its capabilities of playing audio and multimedia as well
as video.

Blu-ray Disc (BD) is an optical disc storage medium designed to

supersede the DVD format.. Conventional (pre-BD-XL) Blu-ray Discs
contain 25 GB per layer, with dual layer discs (50 GB) being the
industry standard for feature-length video discs. Triple layer discs
(100 GB) and quadruple layers (150 GB) are available for BD-XL re-
writer drives

Printers – the most important output device, converts

information produced by computer system into printed form,
rendering data in the binary code into readable English.
30
Modems – A modem (modulating and
demodulating device) translates digital data
into waves (analog) for transmission over the
communication lines to the computer system
and converts the waves back to their original
digital form for input into the computer.

Basic of Computer Network Hardware

Network Hardware – The role of hardware in a

network is to provide an interconnection
between computers. 31
1. Network adapter or network interface card- is a
computer circuit board or card that is installed in a
computer so that it can be connected to a network.
2. Communication Medium (Cabling) – Commonly
used include twisted pair cable, coaxial cable, fiber-
optics, telephone lines, satellites, and compressed
video.

Telephone Line Communication – Specialized phone

lines called integrated services digital
network(ISDN) lines are used to carry
communications across phone lines. ISDN is a set of
communication standards for optical fibers that carry
32
voice, digital, and video signals across phone lines.
Cable Modem – For many people, telephone
modems have proven much too slow a
medium for their internet connection and
many have moved to cable modem for their
home Internet connectivity.

Servers – In a pure client/server approach, on

computer is the core or server computer that
receives requests from the client (user)
computer and fulfills those requests.

33
Architecture
– refers to overall physical structure, peripherals,
interconnections within the computer, and its system
software, especially the operating system.

Network Architecture – two types

1. Broadcast – communication is done by transmitting
the same information to all the computers in the
network that are expected to respond to it.
2. Point-to-point – The computer for which information
is intended is identified first, and the communication
is only to that particular computer. This is typically
used in “dial-up” networking.
34
Topology – defines how the network
computers in a Local Area Network
(LAN) are interconnected within physical
area and describes their physical
interconnection.

35
1. Bus – a bus is a network topology or circuit
arrangement in which all the node computers are
directly attached to a line.

36
2. Star – This is a centralized structure where all
computers are connected through a central
computer, called the server.

37
3. Ring – Originally, all LAN computer were connected in a
ring fashion with wires or cables that directly connected
all the computers.

38
a. Hub – a form of ring topology. In a hub all computers
are connected to a central hub processor that contains
the networking software and provides for communication
among the various computers on the network.

39
b. Arcnet – it uses what is called a “token-bus” system
for managing line sharing among all the users on the
network. It works well for LANs in which all the links are
physically near each other.

40
COMPUTER SOFTWARE AND SYSTEMS
Software – is a general term applied to the instructions that
direct the computer's hardware to perform work. Software is
needed for two purposes. First, computers do not directly
understand human language, and software is needed to
translate instructions created in human language into
machine language. Second, packaged or stored software is
needed to make the computer an economical work tool.

41
Augusta Ada Byron –
Mathematician and
coresearcher, First
Programmer

Charles Babbage –
Mathematician and Inventor
- He invented the analytical
machine – to perform
mathematical functions,
42
considered a “father of computer”
John Von Neumann –
proposed that both data
and instruction could be
stored in the computer and
that the instructions could
be automatically carried
out.

Joseph Jacquard – invented

the jacquard loom (weaver), a
device that used blocks wood
with holes drilled in such a way
that the threads to be woven
into cloth could form a
“program,” or set of machine
instructions, to the loom. 43

Development of Data
processing.
 Herman Hollerith – developed a
machine that could read punched
cards and tabulate the results. He
formed a company called
Tabulating Machine that became
International Business Machines
or IBM.
`

Grace Murray Hooper – Rear Admiral

U.S. Navy Reserve,
– “The Mother of Computing,”
- coined the major activity in program
testing which is debugging
- formed the foundation for the first
truly English-like language, the
Common Bussiness-Oriented
Language (COBOL) – considered 44 the
first “universal” language
Types of Software

System Software - “boots up” (starts up and initializes) the

computer system; controls input, output, and storage; and
controls the operations of the application software.

Application Software – includes the various programs that users

require to perform day-to-day tasks.

Utility Programs – used to help maintain the system, clean up

unwanted programs, protect the system against virus attacks,
access the World Wide Web (WWW).

Basic Input Output System (BIOS) – The first level of system

control is handled by the BIOS stored on a read only memory
(ROM) chip on the motherboard. Programs on chips are45often
called “firmware”
Operating System – OSs are actual software,
loaded from the hard drive into RAM as soon
as the computer is turned on.

User Interfaces
Disk Operating System (DOS) – present a blank
screen to the user, and the user submits
typed command.

Graphical User Interface (GUI)

Steve Jobs – made strategic decision to abandon the
DOS interface and move a GUI system for a46new
product to be called Macintosh
 Bill Gates – founder and CEO of Microsoft
Corporation
- Began the development of Windows
GUI for the IBM PC platform

Utility Programs

The World Wide Web (WWW) and Web Browsers

Tim Berners-Lee concieved the WWW as system utility
program that requires all users to adhere to a
standard set of text retrieval protocols. This set of
protocols is called hypertext transfer protocol (HTTP).
Universal Resource Locator (URL) – standard
addressing system
47
Hypertext Markup Language (HTML) – allows
document creators to format their text
Programming Languages
- divided into five generations, or sometimes into
three levels. The term “level” refers to how close the
language is to the actual machine. The first level
includes the first two generations of programming
languages: machine language and assembly
language. The second level includes the next two
generations: high level procedural and
nonprocedural languages. The third level (and fifth
generation) is natural language.
Machine Language – consists only of the binary
number 1 and 0, representing the on and off
electrical impulse. All data – numbers, letters, and
symbols – are represented by combinations of
binary digits. Ex. 3 is represented by binary
numbers 00000011 48

Assembler Language – far more English-like, but it is

still very close to machine language
Assembler Language
PRINT_ASCII PROC
MOV DL, 00H
DL MOV CX, 255
PRINT_LOOP:
CALL WRITE_CHAR
INC DL
LOOP PRINT_LOOP
MOV AH, 4CH
INT 21h ;21h
PRINT ASCIIENDP

Third Generation Language – include procedural

languages -require the programmer to specify both what
the computer is to do and the procedure for how to do it.
MUMPS (Massachussetts General Hospital Utility Multi-
49
Programming System) - developed to support medical
records applications.
Visual Programming Language – program development in
graphics-based environment

Fourth Generation Languages – are specialized application

programs that require more involvement of the user in
directing the program to do the necessary work.

Fifth Generation Languages (third level languages)

- are called natural language. In these types of programs, the
user tells the machine what to do in the user's own natural
language or through the use of a set of very English-like
commands.

Common Software Useful to Nurses

- admission, discharge, and transter (ADT) system
- medication administration record (MAR) software 50

- computer physician order entry (CPOE) system

admission, discharge, and transter (ADT) system

51
medication administration record (MAR) software

52
computer physician order entry (CPOE) system

53
Visual Programming Language – program development in
graphics-based environment

Fourth Generation Languages – are specialized application

programs that require more involvement of the user in
directing the program to do the necessary work.

Fifth Generation Languages (third level languages)

- are called natural language. In these types of programs, the
user tells the machine what to do in the user's own natural
language or through the use of a set of very English-like
commands.

Common Software Useful to Nurses

- admission, discharge, and transter (ADT) system
- medication administration record (MAR) software 54

- computer physician order entry (CPOE) system

Chat Rooms – are like electronic conference calls. Multiple users
can send and receive messages at the same time.

Electronic Bulletin Boards – This technology creates space where

users can post a message.

List Servs – least powerful version of electronic bulletin board.

When a user posts a message to the board, it is merely e-
mailed to all members of the conference.

Computer Programming
5 Major Steps
1. Problem definition (functional specifications)
2. Program Design Specifications
3. Writing the code and program documentation
4. Alpha testing – to see if all the processes appear to be
functioning 55

5. Beta Testing and program documentation – program is installed

in actual user environment
Computer System – Every functioning computer is a system;
that is, it is a complex entity, consisting of an organized set of
interconnected components or factors that function together
as a unit to accomplish results that one part alone could not.

System Theory – The use of systems in computer technology is

based on system theory.

Six System Elements

1. System's set of interdependent parts
2. Input to the system
3. System processes
4. Output of the system
5. System control
6. Feedback
56
Classification of System

Closed System – Its boundaries are clearly defined and rigid.

Ex.: intravenous hypertension control system
Measure
Blood pressure every BP too
30 High?
minutes

Administer
ordered dose
of
antihypertensive
57
Open System – systems that exhibit integration, fluid or fuzzy
boundaries, and interaction with their environment

State Post-
health surgical
Outcomes Infectious
Database & in
Benchmark Hospital
file database
CDC
infectious
Disease
database
CDC co-
Hospital
funded
Consorti
University
um
study
Databas
of incidence of
e
Infections in 5- 58
state
region
Information System
- is the collection and integration of various pieces of hardware and
sortware and the human resources that meet the date collection,
storage, processing and report generation needs of an
organization.

Management Information System (MIS) - provides managers

information about their business operations. A MIS is defined as
an organized system for managing the flow of information in an
organization in a timely manner.

Bibliographic Retrieval Systems – is a retrieval system that

generally refers to bibliographic data, document information, or
literature.

Stand-Alone, Dedicated, or Turnkey System – is a special

59
purpose. It is developed for a single application or set of
functions. A patient classification system is an example of a
stand-alone system.
Transaction Systems – used to process predefined transactions and
produce predefined reports. It is designed for repeated operations
using fixed list.

Physiologic Monitoring Systems – are widely used in hospital patient

care units, in surgery, and more and more commonly, in private
homes. The heart monitor was one of the first physiologic monitors
used by nurses.

Decision Support Systems – is a computer system that supports

some aspect of the human decision-making process. Decision
support system work with the user to support, but not to replace,
human judgement in a decision-making situation.

Expert System – is a computer system containing the information and

decision-making strategies of an expert to assist nonexperts in
decision-making. An expert system is designed for users 60 to
simulate the cause and effect reasoning that an expert would use if
confronted with the same situation in a real live environment.
Artificial Intelligence Systems(AI) – is a system that attempts to
model human reasoning processes. The field is concerned with
symbolic inference and knowledge representation. Symbolic
inference in concerned with deriving new knowledge from
known facts and the use of logical inference rules. An example
of an inference rule is “if A > B and B > C, then A must be
greater that C.”

Natural Language Systems – is a system that can understand and

process commands given in the user's own natural, spoken
language.

Hospital Information Systems – sometime called a medical

information system (MIS) or patient care systems (PCS),
provides support for a wide variety of both administrative and
61
clinical functions.The purpose of an HIS is to manage
information needed to facilitate daily hospital operations by all
health care personnel.
Hospital Information Systems – sometime called a medical information
system (MIS) or patient care systems (PCS), provides support for a wide
variety of both administrative and clinical functions.The purpose of an HIS
is to manage information needed to facilitate daily hospital operations by
all health care personnel.

62
HIS Configuration – The most common configuration uses a
mainframe computer with hardwired terminals or workstations.
Another, and increasingly popular, configuration employs a local
area network (LAN).

Program Modules Available in an HIS

Semiclinical Modules – Example are Admission, Discharge, and

Transfer (ADT) and order-entry-results-reporting (OE) module.

Clinical Support Modules

Charting Systems – Usually included are the medication

administration reports, admission assessment, shift
assessments, special assessments (e.g., neurolofic
assessments and labor records), at least some elements of the
63
nursing care plan, vital signs records, wound care, and hygienic
care records.
Point-of-Service Systems (POS) – or point-of-care system is a special
type of clinical system. A POS system uses a hand-held or bedside
PC to ensure that data are entered at the point at which they are
collected.

Laboratory, Pharmacy, and Radiology Modules – A typical laboratory

system, for example, includes a laboratory test request, generates
the specimen labels, tracks the specimen through the various
laboratory stages, generates the results, and communicates the
findings to patient's medical record. Pharmacy systems track
medication orders and changes in orders. Radiology systems are
usually separate products developed by companies that specialize
in diagnostic computer imaging systems.

Network Systems

A Network is a set of interconnected computers that, through 64

hardware and software technology, work cooperatively for the
purpose of information and application program interchange.
Network Functios
1. file transfer (from one computer to another)
2. information availability (e.g., data and text files can be
simultaneously received by more than one recipient at the same
time)
3. resoure sharing
4. online transactions
5. Provision of a powerful communication medium
6. interactive environment
7. education and entertainment
8. e-mail

Network Security
Firewalls – specialized routers, carefully inspect each incoming
packet or information, looking for authorized source addresses and
rejecting any unknown addresses or even suspicious packets.
65
Encryption – means that data are converted into a cipher, or code of
some kind.
Examples of Search Engines
1. Altavista
2. Yahoo!
3. Google
4. 37.com
5. Go2net

Web Browsers – program that is used to visit Web pages.

Examples
1. Netscape Navigator
2. Microsoft Internet Explorer

World Wide Web (WWW) – is a hypertext-based, distributed

information system created by a team of researchers led by Dr.
Tim Berners-Lee at CERN in switzerland.

Hypertext Markup Language (HTML) – is the language used

66 to
create hypertext documents.
Open Software and Free Software

Most nurses use OSS/FS (Open source software/free software) on

a daily basis, but without even realizing it. Everybody who sends
e-mail or uses the Web uses OSS/FS most of the time, as the
majority of the hardware and software that allows the Internet to
function (Web servers, file transmission protocol (FTP) servers,
and mail system) are OSS/FS.

Free software is defined by the Free Software Foundation in terms

of four freedoms for the software user, i.e. to have the freedom
to use, study, redistribute, and improve the software in any they
wish.

67
Open Software Source and Free Software Health Care Applications

OpenEHR (http://www.openehr.org)
The openEHR foundation is an international, not-forprofit organization
that is working toward the development of interoperable, lifelong
EHRs (Electronic Health Records).

FreeMED (http://www.freemed.org)
FreeMED is the flagship product of the FreeMED Software
Foundation. It is the result of many years of work in developing an
OSS/FS electronic medical record (EMR) and billing system, which
focuses on the needs of physicians and health care providers.

OpenEMR (http://www.openemr.net)
OpenEMR is a free, open source medical clinic practice management
(PM) and EMR application. OpenEMR offers a range of functions,
including Practice Management features for patient scheduling and
68
patient demographics; online EMRs; prescription writing capability
with ability to e-mail or print prescriptions.
CARE2X
http://www.care2x.com
CARE2X is one of the few OSS/FS projects
to have been originated by a nurse (Elpidio
Latorilla, a surgery nurse). It aims to
develop a practical, integrated healthcare
information system (HIS), and is designed
to integrate the different information system
existing in health care organizations into
one single effficient system.
69
DATA PROCESSING

Data – are raw uninterrupted facts that are without meaning. For
example, a patient's weight is recorded as 140 lb, without
additional information this fact or datum cannot be interpreted.

Database – is an organized collection of related data. Placing notes

in folders and folders in file cabinets is one example of creating a
database; however, a database can be organized and stored in
many different formats.

Database Management Systems

DBMSs are computer programs used to input, store, modify, process,
and access data in a database. A functioning DBMS consists of
three interacting parts. These are the data, the DBMS configured
software program, and the query language used to access the
data. Some examples of DBMS in everyday life include
computerized library systems, automated teller machines,70 and
flight reservation systems.
Types of Files

Processing Files

Executable files consist of a computer program or set of instructions

that, when executed, causes the computer to open or start a
specific computer program or function. These are the files that tell
a computer what actions the computer should perform when
running a program. For example, running a SET-UP.EXE file will
tell the computer to begin installing the related computer program
on the computer.

Data Files

Data files contain data that have been captured and stored on a
computer using a software program. Many times the extension for
the file identifies the software program used to create the file. For
71
example, a document created in Microsoft Word will have the
extension DOC.
The Internet: A Nursing Resource

The Domain Name System – In order for the computers on the

internet to perform the tasks required, they have to have a way of
identifying each other. The Internet's DNS permits us to give
globally unique “names” to networks and computers.

Top-Level Domains (TLDs)

.AERO For the air transport industry

.BIZ For businesses
.COM Commercial/bussiness organizations
.EDU Restricted to 4-year degree granting institutions in North
America
.GOV Restricted to the U.S. Federal government
.INFO For all users
.INT Restricted to organizations that were established
72
by international treaty
.MIL Restricted to the U.S.military
.MUSEUM For museums
.NAME For individuals
.NET For network resources
.ORG For nonprofit organizations
.PRO For professions

E-mail

One of the most popular use for the Internet remains the ability to
send and receive electronic mail or e-mail.

User ID Name of Computer Domain Name

Clara.Barton@RedCross.org

73
The World Wide Web
How the World Wide Web Functions

The Web is built on the client/server model common to most networks. A software
program called a browser allows any computer to be a Web client. A computer that
functions as a server has special software that allows it to receive, interpret, and send
to the client computer the requested file. The Web's use of HTTP enables the
transmitting and interpretation of all types of files, not just text.

All computer and servers on the Internet have a specific IP (Internet Protocol)
address. This address for a website is called an URL (Universal Resource Locator).
An URL contains the name of the computer where the document you are seeking is
located along with other specifics to locate it.

74
PDA and Wireless Devices

PDA (Personal Digital Assistant) – is an example of a handheld

computer. A PDA comes with a miniature keyboard and a stylus for data
entry.

Wireless Devices

For a computer to connect wirelessly there must be a physical

component added to the device to enable wireless communication.

75
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77
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