Bachelor of Science in Nursing 2YC

NCMB210: BSN 2ND YEAR SUMMER MIDTERM 2022

Connection between the three:
Coverage for Midterm: Modules 1-5
- When you do research, it forms the education and clinical
• Historical Perspectives of Nursing and the Computer
practices. Kasi yung mga na di-discover natin sa research,
• Electronic Health Records from a Hospital Perspective we use that to improve the education and clinical practice.
• Computer Hardware
• Computer Software Health Informatics
• Computer System • Computer science – hardware (ex: stethoscope, BP apparatus,
pulse oximeter etc.) these are the tangible elements of health
INTRODUCTION OF NURSING INFORMATICS informatics. Physical.
Discussed by Prof. MJ Dino
• Information science – software that are installed in the
Nursing across the centuries hardware. (ex: Microsoft word, excel etc)
• 1830 – “Nurse the Comforter” • Health science – research – this are the results of research that
• 1860 – “Nurse the Behaviorist” – nurses are independent, are supporting the practice of nursing.
trustable member of healthcare team • Cognitive science – intelligence of humans. Every technology
• 1900 – “Technology Experts” should be paired with human intelligence
• 1918 – “Angel of Mercy”- nurses at war • Wisdom – ethics. Goodness and badness of human action.
• 1943 – “The Remedist”
Global nurse Nursing informatics
- Global nurse is someone that heals. - Specialty that integrates nursing science, computer science and
- H – healthcare partner information science to manage and communicate data,
- E – engaged professional information and knowledge in nursing practice.
- A – active researcher - Nursing informatics is more specifically or related to practice
- L – lifelong learner of the nursing profession.
- S – servant leader - Health informatics – malawak sya, pwede for medicine,
- Why do we need to use technology? pharmacy etc. Pero sa nursing informatics, solely related to
nursing concepts.
• Managing data easier
- Informatics – management and communication of reliable
• Convenient and accurate
information using technology and intelligence in compliance
• Consistency of standards.
• Saving time • INFO – information
• More organize files and information • R – reliable
• Communicate more effectively • MA – management
• Due to the age of technology, nurses must use the • T – technology
available technology for efficiency, to do tasks affectively
• I – intelligence
and to have high productivity.
• C – communication
Why use information technology?
1) Automation • S – standards
- Using technology for expediting the way we do things - Role of the nurse when it comes to informatics – data to
- “I will use technology to save time” information continuum
- Element of time
- Expediting – make the process faster Data to information continuum
2) Innovation - If u r the nurse, your task in informatics would be convert data
- Using technology for improving the way we do things into information.
- “I will use technology to guide my decisions”
- Element of quality
Typology of technologies in nursing
1) Clinical
- Hospital practices
- Tech – “health”
- Timely
2) Education
- Nursing schools
- Tech – “learn”
- Trendy
3) Research
- Studies
- Tech – “search”
- Trailblazing
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 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022

History of informatics in PH
• 1980s – tertiary facilities already using IBM machines
- Hospitals are already using computers.
- IBM International Business Machine – nagpoproduce ng
computers
• 1990s – PAMI was formed headed by Dr. Marte
- PAMI – Philippine Association of Medical Informatics
- The practice of informatics for healthcare started in the
field of medicine in Philippines
• 1990s – Establishment of MIU (Medical Informatics Units) in
UP
• 1990s – CHITS development (Community Health Information
Tracking System) – ginagamit sa mga barangay health centers
• 1997 – Launch of DOH website
- Before 1997, the manner on how we disseminate information
from DOH was through TV commercials
• 1997 – Action Agenda for the 21st century (IT21 – Information
Technology 21)
• 2004 – Master of Science in Health Informatics
• 2004 – Creation of Multipurpose community tele-center

- When u put data together, and u use your human intelligence

to interpret those data, information, and knowledge, it
becomes wisdom.
- When u get data, it doesn’t mean that you will give immediate
conclusion to the particular data. You collect several
information from diff sources, to come up with a good
diagnosis or decision = wisdom.
Nursing informatics
- Informatics competencies as global imperatives
- The need for research in nursing informatics
- Convert new knowledge to usable forms

- Western countries – global village e-internet research (isang

community connected na sya into internet)
- US – telemedicine/ telematics research In developed countries:
- Canada - telemedicine/ telematics research • Paperless system
- Asia – mHealth research (mobile health) • Use of EHR (Electronic Health Record) seems to be
- Philippines – education research inevitable in modern society (Collins & Wagner, 2005)
• Most hospitals in the developed countries are gradually
adopting the paperless system (Kukafka et al, 2007; Wen
et al, 2007)
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 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
The BIG paper-based health record problem:
• Illegible and incomplete
• Difficult to access in one place
• Not secured from unauthorized uses and users
Electronic health record VS Clinical information system
• Electronic health record
- A repository of electronically maintained information
about an individual’s lifetime health status and health care,
stored such that it can serve the multiple legitimate users
of the record.
- Pang matagalan, buong buhay mo may record, kung
kalian ka na surgery, na admit sa hospital etc.
- This should be initiative of the government.
- Kapag naaccess ng doctor un record mo, makikita lahat ng
record mo since the day u born.
• Clinical information system
- Computer cased system that is designed for collecting,
storing, manipulating and making available clinical
information important to the health care delivery process.
- Short term. Ex: naadmit ka sa hospital, yung time na
naadmit ka na yon, for temporary lng.
• Open Source Software – libre
- Ex: OpenEMR
- NMDS (Nursing Minimum Data Set) conceived in the
1970s; helps nurses better understand communicate and
quantify the care they provide.
HISTORICAL PERSPECTIVE OF NURSING
From Module 1
Computer
- It is a general term referring to Information Technology (IT)
and computer systems. In nursing, it is synonymous to
Nursing Information Systems (NIS), nursing computer
applications and Nursing Informatics (NI).
- Computers are used to manage information in patient care,
monitor quality of nursing care and evaluate care outcomes.
- Computers with networks are now used in communicating
data via the internet, accessing resources and interacting with
patients on the World Wide Web (WWW).
Nursing Informatics
- refers to the integration, of nursing, its information and
information management with information processing and
information technology to support the health of the people
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worldwide (International Medical Informatics Association,
1998).
- a specialty that integrates nursing, computer and information
science to manage and communicate data, information and
knowledge in nursing practice. It facilitates the integration of
data, information and knowledge to support patients, nurses
and other providers in their decision-making in all roles and
settings. This support is accomplished through the use of
information structures, processes and information technology
(American Nurses Association, 2006).
Clinical Information Systems
- this can be used interchangeably with Electronic Health
Information Systems (EHR-S), computerized patient record
and electronic medical record.
- refers to a set of components that form the mechanism by
which patient records are created, used, stored and retrieved
and usually located within a healthcare provider setting.
- It includes people, data, rules and procedures, processing and
storage devices, communication and support facilities
(Institute of Medicine, 1991).
Major Historical Perspectives of Nursing and Computers
- Computer technology emerged in nursing in response to the
changing and developing technologies in the healthcare
industry and in nursing practice. The major historical
perspectives of nursing and computers can be analyzed based
on the following themes:
o Six time periods (divided on time coverage prior to 1960s
to post 2000)
o Four major nursing areas (nursing practice, administration,
education and research)
o Standards initiatives (nursing practice, data, healthcare
data standards)
o Significant landmark events (chart)
Six Time Periods
Prior to 1960s - Simple Beginnings
- The use of computers in both computer and medical industry
grew on early 1950s. There were only few experts who formed
a cadre of pioneers that attempted to adapt computers to
healthcare and nursing. During this time, the image of nursing
profession is undergoing major changes: improving nursing
image, expansion of scope and complexity of nursing practice
and services and the increasing number of new nurses. Initially,
computers were used in health care facilities for basic business
office transactions. Some examples are punch cards to store
data and card readers for computer programs, sorting and
preparation of data for processing. They were linked together
and operated by paper tape and used teletypewriters to print
their output. As computer technology advanced, healthcare
technologies improved.
1960s - Issues and NI Researches
- The use of computer technology in healthcare settings began
to be questioned. Areas of debate are centered on the
application of computers and data that needs to be
computerized. Nursing standards were reviewed and resources
were analyzed. Studies were conducted to assess computer
technology and its effective utilization in the healthcare
industry. Nurses’ stations were considered as “hub” of
information exchange.
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
- The increasing number of healthcare facilities was paralleled
to the advancement in computer technology. The introduction
of new computer technologies such as the Cathode Ray Tubes
(CRT) added more dimensions to computer systems providing
more accessible and user-friendly machines.
- Hospital Information Systems (HISs) were primarily
developed to process financial transactions but few emerged to
document and process healthcare activities.
- Computer vendors were beginning to penetrate the healthcare
field but the progress was slow due to limitations in
technology, lack of standardization and diversity in paper-
based patient records.
1970s - Giant Leap for NI
- Nurses begin to recognize the value of the computer for their
profession. Giant steps were taken in both nursing and
computer technology. Nurses assisted in the design of HISs
and other environment that lead to the development of
forerunning software as bases of today’s systems. Computer
applications for financial and management functions of patient
care systems were perceived as cost-saving technologies.
Several states and large community health agencies in the US
developed and/or contracted for their own computer-based
Management Information Systems (MISs) which provide
statistical and financial information required local government
and federal agencies for specific program funds and
reimbursement of patient services such as Medicare, Medicaid
and other third-party payers.
1980s - Emergence of Informatics Field
- The field of Informatics emerged in the healthcare industry
and nursing. NI became an accepted specialty and many
nursing experts entered the field. Technology challenged
creative professionals and the use of computers in nursing
became revolutionary. The need for nursing software evolved
and nursing education identified the need to update practice
standards, determine data standards, vocabularies and
classification schemes that could be coded for Computer-based
Patient Record Systems (CPRSs).
- Many mainframe HISs emerged with nursing subsystems that
documented several aspects of the patient record including
Kardex, results reporting, vital signs and other system that
documented narrative nursing notes via word-processing
packages. Discharge planning systems were also developed
and used as referrals to community healthcare facilities in the
continuum of care.
- The microcomputer, widely known as the personal
computer (PCs) emerged that made computers more
accessible, affordable and usable by nurses. It served not only
terminals linked to mainframe PCs but also as stand-alone
systems or workstations.
1990s - Affirmation of Nursing Informatics as Specialty Field
- Computer technology became an integral part of healthcare
settings, nursing practice and nursing profession. Professional
organizations identified initiatives that addressed IT and
informatics. Policies and legislation were adopted promoting
computer technology in healthcare including nursing.
- The nursing profession became actively involved in promoting
NI. NI was approved by American Nurses Association (ANA)
as a new nursing specialty.
- The need for computer-based nursing practice standards, data
standards, nursing minimum data sets and national databases
emerged concurrent with the need for a unified nursing
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language including nomenclatures, vocabularies, taxonomies
and classification schemes. Nurse administrators demanded
that HISs should include nursing protocols and nurse
educators continued to require use of innovative technologies
for all levels and types of nursing and patient education. Nurse
researchers required knowledge presentation, decision support,
and expert systems based on aggregated data.
- The 1990s bring about development of smaller and faster
computers – laptops and notebooks, workstations, Local Area
Network (LANs) and Wide Area Networks (WANs). The
internet made it possible for the information and knowledge
databases to be integrated into bedside systems.
- The internet brought new cyberspace tools. By 1995, the
internet introduces electronic mail (e-mail), file transfer
protocol (FTP), Gopher, Telnet and WWW protocols. The
Web became the means for communicating online services
and resources.
Post 2000 - Rapid Growth and Development in NI
- Healthcare and nursing undergone developments such as
wireless point of care, open source solutions, regional database
projects and increased IT solutions on healthcare environment.
Clinical information systems became individualized in the
Electronic Patient Record (EPR) and patient specific systems
considered for the lifelong longitudinal record or the
Electronic Health Record (EHR). Mobile computing devices
were also introduced such as Personal Digital Assistants
(PDAs), Tablet computers and smart phones. The Voice over
Internet Protocol (VoIP) promises to provide cheap voice
communication for healthcare organizations. The prediction of
smart cards was realized in Europe (Germany).
- The internet has provided a means for development of clinical
applications. Critical care units are monitored remotely by
health providers. Telenursing, a recognized specialty since the
late 1990s, is increasing in popularity and providing patient
care in an efficient and expeditious fashion
- The Health Insurance Portability and Accountability Act
of 1996 (HIPAA) was enacted post year 2000 to streamline
health care transactions and reduce cost. Standardized
transaction and code sets were implemented in early 2004 to
protect security and ensure privacy and confidentiality of
healthcare data. The legislation recommended healthcare
providers to use Provider Identification Number (PIN).
Four Major Nursing Areas
- The historical perspectives on nursing that shaped the need for
computers, information technologies and informatics can be
describe through focusing on major areas in nursing
Nursing practice
- evolved and changed radically. It has become an integral part
of the EHR. Computer systems with nursing, and patient care
data, nursing care plans are no longer separate subsystems of
the computerized HISs, but rather integrated into one
interdisciplinary patient health record in the EHR. The need
for an interdisciplinary EHR resulted because of the many
initiatives proposed and promoted by the nursing profession as
well as by the other health care providers. They all require
patient care data to track the care process. Further nursing
practice data emerged with the introduction of several nursing
terminologies that were recognized by the ANA as coded
terminologies usable for the EHR. They are used to assess
problems, document care, and track the care process, and
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
measure outcomes. Thus, the electronic version of nursing
practice – the computer – has revolutionized and transformed
nursing practice.
- all about Nursing Care Plan
Nursing Administration
- Nursing administration in hospitals has also changed with the
introduction of the computer that links nursing departments
together. Most hospital policies and procedure manuals are
accessed and retrieved by computers. Furthermore, work load
measures, acuity systems and other nursing department
systems are online and integrated with the hospital or patient’s
EHR system or in separate nursing department systems. The
internet is being used by nurses to access digital libraries,
online resources, and research protocols at the bedside.
Nursing Education
- The computer has radically changed nursing education. Most
universities and schools of nursing offer computer-enhanced
courses, online courses (open university), and/or distance
education. Campus wide computer systems are available for
students to communicate via e-mail, transfer data files, access
digital libraries, and retrieve online resources of millions of
Internet sites. An email accounts is considered a gateway to
these possibilities.
- New educational strategies require different methods of
teaching. The advent of computers in educational technology
has greatly revolutionized teaching methodologies and
strategies. Today, most faculty members use the Internet to
teach courses via the Web and communicate with other
students via email. The students on the other hand have to be
more active and assume more responsibility for their education
that can be enhanced through the use of the Web. The WWW
facilitates student-centered instructional settings creating a
motivating and active learning environment. Finally, time,
distance and cost are no longer barriers to educational
programs.
Nursing Research
- Nursing research provides the impetus to use the computer for
analyzing computer data. Software programs are available for
processing both quantitative and qualitative research data.
With the advancement of computer technology databases
supporting nursing research emerged, principally for online
searching and retrieving information from the electronic
bibliographic information systems or other databases that
contain relevant healthcare content, such as drug data. The
internet also provides online access to millions of Web
resources around the world which have increased the
capabilities and expanded the field of nursing research
Standard Initiatives
- The third significant historical perspective concerns standard
initiatives focusing on nursing practice standards, nursing data
standards and healthcare data standards as well as federal
legislation that impact on the use of the computer into nursing:
Nursing Practice Standards
1) American Nurses Association (ANA)
- Considered as the official nursing organization that
contributes in the development and recommendation of
standards of nursing practice worldwide.
- In 1998, the ANA published the Standards of Clinical
Nursing Practice which focused not only on the
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organizing principles of clinical nursing practice but also
the standards of professional performance.
- They also recommend that the nursing process serve as
the conceptual framework for the documentation of
nursing practice.d
2) Joint Commission on Accreditation of Hospital
Organizations (JCAHO)
- focuses on the need for adequate records on patients in
hospitals and practice of standards for the documentation
of care by nurses. They also recommended acuity systems
to determine resource use as well as required care plans
for documenting nursing care. JCAHO described the
required contents of an EHR (example: collection and
organization of electronic data) though the publication of
their recent manual.
- In the Philippines, standardization of the nursing
profession was instigated by the Philippine Nurses
Association (PNA), as a member of the International
Council of Nurses, founded way back September 2, 1922
and the Board of Nursing which was empowered by the
Republic Act 9173.
Nursing Data Standards
- Nursing data standards has emerged as a new requirement for
the EHR. There are 13 nursing terminologies that have been
recognized by ANA such as the Critical Care Classification
(CCC), Nursing Outcomes Classification (NOC) and Nursing
Information Classification (NIC).
- The ANA is the worldwide organization responsible for the
recognition of the terminologies in nursing education. Other
organizations that contribute to the standardization of nursing
data are as follows:
1) American Society for Testing and Materials (ASTM)
- The ASTM facilitates student-centered instructional
settings creating a motivating and active learning
environment
2) High Level Seven (HL7)
- Health Level Seven is one of several American
National Standards Institute (ANSI) - accredited
Standards Developing Organizations (SDOs)
operating in the healthcare arena. Most SDOs
produce standards (sometimes called specifications or
protocols) for a particular healthcare domain such as
pharmacy, medical devices, imaging or insurance
(claims processing) transactions.
3) International Health Terminology Standards
Development Organization (IHTSDO)
- a not-for-profit association that develops and
promotes use of SNOMED CT to support safe and
effective health information exchange. SNOMED CT
is a clinical terminology and is considered to be the
most comprehensive, multilingual healthcare
terminology in the world.
4) National Committee on Vital and Health Statistics
(NCVHS)
- a statutory public advisory body to the Secretary of
Health and Human Services (HHS) that has a 57 year
history of advising HHS in the areas of health data,
health statistics, privacy and national health
information policy. The members are leaders and
experts in their fields, and the NCVHS has a
reputation for open, collaborative processes and
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
ability to deliver timely, thoughtful, and practical
recommendations.
Confidentiality & Security Standards
- Increasing access through electronic capture and exchange of
information raised concerns about the privacy and security of
personal health information (PHI).
• HITECH Act of 2009 – Included the provisions for
strengthening the original HIPAA legislation (patient
consent, organizations handling PHI, and increased
penalties for security breaches).
Significant Landmark Events
Healthcare Information and Management Systems
1961
Society (HIMSS) is founded
Development of one of the first Hospital Information
1965 System (HIS) at El Camino Hospital in Mountain View
California
First Invitation conference on Management Information
1973 Systems (MIS) for public/ community health agencies,
held in Fairfax Virginia
First research: state-of-the-art conference on Nursing
1977
Information Systems (NIS) held in Chicago
First military conference on computers in nursing in
1979
Washington DC
First workshop on computer usage in healthcare
1980
sponsored by the University of Akron Ohio
First national conference on computer technology and
1981 nursing held in Bethesda, MD
Nursing Information Systems Journal first published
First National Nursing Computer Technology
Conference, becoming an annual event, held in Newark,
New Jersey
1982
First international meeting: Working Conference on
Nursing Uses and Computers in Nursing held in London
First workshop on computers in nursing held in Boston
First nursing computer journal is published: Computers
in Nursing
1984 Counsel in Computer Applications in Nursing (CCAN)
formed in Kansan City
First Nursing Minimum Data Set (NMDS) meeting
Council on Nursing Informatics formed in New York
First invitational NMDS conference held
Essentials of Computer Electives initiated in graduate
1985 and undergraduate programs at Georgetown University
School of nursing
American Nurses Association recognizes NANDA as
the first taxonomy in nursing
Graduate program in Nursing Informatics introduced at
1989 Maryland University in Baltimore and University of
Utah
ANA Congress of Nursing Practice recognizes Nursing
1990
Informatics as a specialty area
International Classification of Nursing Practice (ICNP)
was initiated
1991 First Doctoral Specialty in Nursing Informatics
sponsored by Maryland University
American Nursing Informatics Association is initiated at
California, has since become international
1992
ANA recognizes taxonomies
ANA recognizes Nursing Informatics as a specialty by
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delineating the scope of practice
1993 Electronic Library goes online
First International Nursing Informatics, Teleconference
held in Melbourne, Australia, Auckland and New
1995 Zealand
Credentialing in Nursing Informatics initiated by
American Nurses Credentialing Center (ANCC)
First Harriet Werley Award for best nursing informatics
paper
1996
Online Journal of Nursing Informatics (OJNI) first
published
Nursing Information and Data Set Evaluation Center
1997 (NIDSEC) standards and scoring guidelines published to
address documentation of nursing care
1999 Nursing Vocabulary Summit Conference Held
Canadian Informatics Nurses Association received
2001 emerging group status from the Canadian Nurses
Association
JCAHO identified clinical information systems as a way
to improve safety and recommended that hospitals adopt
2002 technologies
Online MSN in Nursing Informatics offered by Duke
University
HIPAA deadline for electronic transaction standards
enacted in October
2003
President calls for widespread adaptation of Electronic
Health Record (EHR) in 10 years
The office of the National Health Information
2004
Coordinator established
ELECTRONIC HEALTH RECORDS
From module 2
Electronic Health Records
- An electronic record composed of health information
regarding an individual patient that exists as part of a complete
system designed to provide access to, and management of,
such information. The electronic health record (EHR) is
developed and managed by the health facility or provider. The
term Electronic Health Record has largely replaced the older
“Electronic Medical Record.”
- It is much more than an electronic replacement of existing
paper systems. The EHR can start to actively support clinical
care by providing a wide variety of information services.
However, it is hard to understand what information is really
important to clinical care and what is simply occasionally
desirable.
- The EHR bring uncountable advantages in primary health care
detaching such as the faster access to information, the updated
information, it allows having a clinical process with all the
patient clinical information and an easier access to information
(ex: allows the simultaneous access from different locations).
- Recognizable efforts in the development of EHR are
distinguished by the Nicholas E. Davis Awards of Excellence
Program whose history describes the improvement of EHR in
different settings.
Impacts of HER’s on Care
- Our world has been radically transformed by digital
technology – smart phones, tablets, and web-enabled devices
have transformed our daily lives and the way we communicate.
Medicine is an information-rich enterprise.
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
- A greater and more seamless flow of information within a
digital health care infrastructure, created by electronic health
The Nicholas E. Davies Awards of Excellence Program
- The Computer-Based Patient Record Institute (CPRI), founded
in 1992, was an organization representing all the stakeholders
in healthcare, focusing on the clinical applications of
information technology. It was among the first nationally
based organizations to initiate and coordinate activities to
facilitate and promote the routine use of Computer-Based
Patient Records (CPRs) throughout healthcare.
- The CPRI group on CPR Systems Evaluation developed the
CPR project evaluation criteria in 1993 which became the
basis in assessing accomplishments of CPR projects and
provided the Foundation of Nicholas E. Davies Awards
Excellence Program.
- The Program was named after Dr. Nicholas E. Davis, an
Atlanta-based physician, president elect of the American
College of Physicians, and member of Institute of Medicine
(IOM) committee in improving patient records. He was killed
in a plane crash just as the IOM report on CPRs was being
released.
- The HIMSS Nicholas E. Davies Awards of Excellence
recognize excellence in the implementation and use of health
information technology, specifically EHRs, for healthcare
organizations, private practices and public health systems.
- Nowadays the Nicholas E. Davies Awards Excellence
Program is managed by the Healthcare Information
Management Systems Society, and has the following program
objectives:
• Promote the vision of EHR systems through concrete
examples
• Understand and share documented value of EHR systems
• Provide visibility and recognition for high impact EHR
system
• Share successful EHR implementation strategies
• Encourages and recognizes excellence in the
implementation of EMREHR systems Implementation
- Implementation
- Strategy
- Planning
- Project Management and Governance – Strategy
The Healthcare Information Management Systems Society
(HIMSS)
- The Healthcare Information and Management Systems Society
(HIMSS) is the healthcare industry's membership organization
exclusively focused on providing global leadership for the
optimal use of healthcare information technology (IT) and
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management systems for the betterment of healthcare.
Founded in 1961 with offices in Chicago, Washington D.C.,
- Brussels, and other locations across the United States and
Europe, HIMSS represents more than 20,000 individual
members and over 300 corporate members that collectively
represent organizations employing millions of people. HIMSS
frames and leads healthcare public policy and industry
practices through its advocacy, educational and professional
development initiatives designed to promote information and
management systems' contributions to ensuring quality patient
care.
- HIMSS has the following mission and vision:
• HIMMS Vision – Advancing the best use of information
and management systems for the betterment of health care
• HIMMS Mission - To lead change in the healthcare
information and management systems field through
knowledge sharing, advocacy, collaboration, innovation,
and community affiliations
The Four Criteria
- The four major criteria in the initial assessment of awardees
identified by the CPRI Workgroup on CPR Systems are as
follows:
1) Management – the organizational aspects of EHR
implementation:
• Strategy
• Planning
• Project management
• Governance
2) Functionality - delivered by the EHR to meet the
organizational objectives and the needs of patients and
end-users
3) Technology - technical design and architecture that
enable the EHR to deliver the required functionality and
performance
4) Value - concrete return on investment as well as intrinsic
value derived from the implementation of the EHR
Application and Assessment Process
1) Applications scoring based on established objective criteria
updated regularly reflecting EHR adoption changes
2) Threshold application (11 pages) review to determine if
applicant meets initial screens
3) If threshold is met, full application of 50 pages is submitted
for evaluation
4) Sites visit for confirmation of application
Nicholas E. Davies Excellence Awardees
• Organizational Award – The first organizational award was
given on 1995. There are 20 recognized institutions. The list of
awardees from 1995-2004 is tabulated below
Year Organizations
Intermountain Health Care, Salt Lake City, UT
1995 Columbia Presbyterian Medical Center, NY
Department of Veterans Affairs
1996 Brigham and Women’s Hospital, Boston, MA
Kaiser Permanente of OHIO, Cleverland, OH North
1997 Mississippi Health Services, Tupelo, MS
Regenstreif Institute for Health Care, IL
Northwestern Memorial Hospital, Chicago, IL
1998
Kaiser Permanente Northwest, Portland, OR
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
Kaiser Permanente, CO
1999
Queens Medical Center Honolulu, HI
Harvard Vanguard Medical Associates, MA
2000 VA Puget Sound Healthcare System, Washington
St. Vincent’s Hospital, Westchester Country, NY
University of Illinois at Chicago Medical Center, OH
2001
The Ohio State Medical Center, Columbus OH
2003 Cincinnati Children’s Hospital Medical Center
2004 Evanston Northwestern Healthcare Evaston, IL
• Primary Care – The first primary care award was given on
2003. There are 7 recognized institutions. The list of 2003 –
2004 awardees are as follows:
Year Organizations
Cooper Pediatric, Duluth, GA
2003 Evans Medical Group, Evans, GA
Roswell Pediatrics, Alpharetta, GA
Pennsylvania National Electronics Disease Reporting
System, Harrisburg, PA
South Dakota Department of Health Electronic Vital
2004
Records and screening Systems, Pierre SD
Utah Statewide Immunization Information System, Salt
Lake City, UT
Common Characteristics of Nicholas E. Davis Excellence
awardees
- There are common characteristics noted in the previous
Nicholas E. Davis Excellence Awardees.
• Considered the Electronic Health Record (EHR) as a key
component in the strategic vision. They understand that
healthcare is an information business.
• The EHR implementation strategic vision is defined by
remarkably similar organizational goals.
• Provision of adequate funding and appropriate resources
needed for the project to realize success.
• Creation of governance of EHR System implementation
• Present short but concrete operational planning.
• Organize a documentation system for value for the
implementing organization
• Allocation of cost-effective budget.
Differences of Nicholas E. Davis Excellence Awardees
- On the other hand, Nicholas E. Davis Excellence awardees
show differences that make one distinct from the other.
• Variable years spent in EHR program development.
• Different external agenda and societal challenges.
• Application of new technologies and techniques.
COMPUTER HARDWARE
Discussed by Prof. MJ Dino
• It is a machine
• It is electronic
• It is automatic
• It can manipulate data
• It has memory
• It has logic functions
- A computer is defined as a machine that is capable of
performing a sequence of arithmetic and logic operations and
with the following characteristics:
J.A.K.E 8 of 18
- A computer system is capable of performing certain logical
operation, provide new time dimension, has the ability to store
and retrieve information, control error and check itself.
- On the other hand, it has limitations. A computer is dependent
on prepared instructions. It has no ability to derive meaning
from objects and cannot correct wrong instruction supporting
the idea “GIGO” which means “garbage in – garbage out”.
Classifications of Computers
• Analog
- Used for scientific, engineering and process-controlled
purposes.
- Analog technology records waveforms as they are.
- Uses physical characteristics of materials to show
measurement
- Ex: clock, thermometer, sphygmomanometer
• Digital
- Used for both business and scientific processing.
- Perform simple mathematical operations of greater
accuracy.
- Converts analog waveforms into set of numbers and
records them. The numbers are converted into voltage
stream for representation.
- Ex: digital clock, digital thermometer, digital
sphygmomanometer
• Hybrid
- Special purpose machine that combines the measuring
capabilities of analog and logical and control capabilities
of digital computers.
- Combines the measuring capabilities of analog and logical
and control capabilities of digital computers.
Components of a Computer System
• Hardware - It refers to the tangible parts of a computer
• Software - Refers to any sequence of instruction that make it
easier to communicate with computers. It also pertains to the
programs that govern the operation of a computer that make
the hardware productive.
• Peopleware/ Personnel - Refer to the user or people who
work with the computer so that it can be used to find solutions
to problems; it indirectly refers to the persons who use the
information generated by the computer. In medical and
nursing informatics, it refers to the members of the healthcare
team.
Classes of Computers
• Supercomputer
- machines with the capacities beyond large computer
systems with the speed of 100 million instructions per
second.
- Uses power to execute a few programs as fast as possible
• Mainframes
- the largest, fastest and most expensive type of computer
for processing, storing and retrieving data and can access
billions of characters of data.
- Powerful multi-user computer capable of supporting many
hundreds or thousands of users simultaneously.
- Uses power to execute more programs concurrently
• Microcomputers / Personal Computers
- a digital computer system under the control of a stored
program that uses a microprocessor, a programmable read
only memory (ROM) and random-access memory (RAM).
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022

• Minicomputers computers were developed, using a microprocessor to locate

- Multi-user computer capable of supporting up to hundreds much of the computer's processing abilities on a single (small)
of users simultaneously. chip. Coupled with one of Intel's inventions - the RAM chip
- Smaller version of mainframes or supercomputers (Kilobits of memory on a single chip) - the microprocessor
• Handheld Computers/ PDAs allowed fourth generation computers to be even smaller and
- a handy computer which can be brought from one place to faster than ever before. The 4004 was only capable of 60,000
another instructions per second, but later processors (such as the 8086
• Workstation that all of Intel's processors for the IBM PC and compatibles
- For engineering applications, publishing, software are based) brought ever increasing speed and power to the
development computers. Supercomputers of the era were immensely
- Moderately high power, but high quality graphics powerful, like the Cray-1 which could calculate 150 million
- High-res screen, large RAM, large mass storage device floating point operations per second. The microprocessor
- Single-user computer but typically linked together with allowed the development of microcomputers, personal
other workstation to form a local network computers that were small and cheap enough to be available to
History of Computers ordinary people. The first personal computer was the MITS
First Generation Computers Altair 8800, released at the end of 1974, but it was followed
- Modern computing can probably be traced back to the by computers such as the Apple I and II, Commodore PET and
'Harvard Mk I' and Colossus (both of 1943). Colossus was an eventually the original IBM PC in 1981.
electronic computer built in Britain at the end 1943 and - Although processing power and storage capacities have
designed to crack the German coding system - Lorenz cipher. increased beyond all recognition since the 1970s the
The 'Harvard Mk I' was a more general purpose electro- underlying technology of LSI (large scale integration) or VLSI
mechanical programmable computer built at Harvard (very large scale integration) microchips has remained
University with backing from IBM. These computers were basically the same, so it is widely regarded that most of today's
among the first of the 'first generation' computers. computers still belong to the fourth generation.
- First generation computers were normally based around wired Gen Year Circuitry Devices Processors
circuits containing vacuum valves and used punched cards as
ENIAC,
the main (non-volatile) storage medium. Another general
1939- Vacuum EDVAC,
purpose computer of this era was 'ENIAC' (Electronic 1ST Calculators
1954 Tubes UNIVAC,
Numerical Integrator and Computer) which was completed in
IBM
1946. It was typical of first generation computers, it weighed
1954- IBM
30 tonnes contained 18,000 electronic valves and consumed 2ND Transistor Mainframes
1959
around 25KW of electrical power. It was, however, capable of
PDP
an amazing 100,000 calculations a second. 1959- Integrated Mini-
3RD System/ 32
Second Generation Computers 1971 Circuit computers
System/ 36
- The next major step in the history of computing was the
Micro- Intel Pentium,
invention of the transistor in 1947.
processor, Micro- Motorola,
- This replaced the inefficient valves with a much smaller and
1971- Very Large computer, Zilog,
more reliable component. Transistorised computers are 4 TH
1991 Scale Personal ARM
normally referred to as 'Second Generation' and dominated the
Integration computer architecture
late 1950s and early 1960s.
(VLSI)
- Despite using transistors and printed circuits these computers
were still bulky and strictly the domain of universities and Super UNIX System,
governments. computers, Intel Pentium,
Third Generation Computers Mainframe, Celeron, Core
Small
Mini- Duo,
- The explosion in the use of computers began with 'Third Computer
Generation' computers. These relied Jack St. Claire Kilby's 1991- computers, Core 2 Duo,
5TH System
invention - the integrated circuit or microchip; the first present Personal Core 2, Quad,
Interface
integrated circuit was produced in September 1958 but Computers, i3, i5, i7,
(SCSI)
computers using them didn't begin to appear until 1963. While Mobile Atom, Xeon,
large ‘mainframes' such as the I.B.M. 360 increased storage Computers, AMD, Athlon,
Game consoles Duron, etc.
and processing capabilities further, the integrated circuit
allowed the development of Minicomputers that began to
bring computing into many smaller businesses. Large scale Basic Components
integration of circuits led to the development of very small Central processing unit (CPU)
processing units, an early example of this is the processor used - The CPU controls the computer processes and communicates
for analyzing flight data in the US Navy's F14A `TomCat' with the other components of a personal computer. A
fighter jet. This processor was developed by Steve Geller, Ray computer's CPU may be one of the most complicated parts of
Holt and a team from AiResearch and American Microsystems. the computer because of its intricacies.
Fourth Generation Computers (Modern) - If a computer is experiencing CPU issues, a computer
- On November 15th, 1971, Intel released the world's first technician may start by checking the fan and cleaning out any
commercial microprocessor, the 4004. Fourth generation dust or debris inside the machine. Another step a computer

J.A.K.E 9 of 18
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
technician may complete is verifying that power supply cables
work.
- A CPU will not function properly unless it receives a signal
from the power supply.
• Arithmetic and logic unit – Controls mathematical
function such as addition and subtraction and functions of
the test logic (Boolean) conditions
• Control unit – carries out the machine language functions
called fetch, execute, decode and store.
Motherboard
- The motherboard provides the structure for all other
components and connects them, while also providing a way to
distribute power, deliver information and connect to devices
such as a printer or mouse. It controls how data transfers and
what type of monitor or screen device to use, for example. It
houses the CPU, memory and secondary storage devices such
as hard drives.
- The first thing that a computer technician may do to
troubleshoot any motherboard issues is to take the PC apart
and inspect all the connections for corrosion. They may also
check the power supply and make sure the computer is
receiving electricity.
Random Access Memory (RAM)
- refers to working memory used for primary storage.
- Can be accessed, used, changed, and written on repeatedly.
- Contains data and instructions that are stored and processed by
computer programs called application programs.
- Content is lost whenever the power to the computer is turned
off.
- RAM is where data lives temporarily while it's being actively
used by programs, such as when a user launches a computer
application.
- A technician may know how to identify the type of RAM in a
computer, how to replace it if it's defective and how to
diagnose problems with copying data from one location in
memory to another.
- A technician should have knowledge about the different
RAMs that are available and they may also know what types
of errors might affect a computer's RAM operation.
- A technician may backup all computer files before fixing
RAM to avoid losing critical programs and documents.
- ROM
- A form of permanent storage which means that data and
programs at ROM can only be read by computer and
cannot be erased or altered.
- Contain the programs called firmware,
- not erased when computer is turned off.
- Register – A small number of very high-speed memory
locations. Data must be registered before it can be processed
16-bit, 32-bit, 64-bit
- Cache – Small memory storage area holding recently accessed
data
Video graphics array port
- A video graphics array (VGA) port is a video input that is
primarily used on PC monitors.
- Troubleshooting a VGA port could include verifying there
isn't a loose connection, faulty cable or a broken monitor.
- Another task a computer technician may do is use compressed
air to spray inside the VGA port to ensure it's free of dust.
Power supply
J.A.K.E 10 of 18
- A power supply provides electricity to all components of a
computer system. Typically, it's a power cord connected from
the back of a PC tower into an electricity socket. A technician
may troubleshoot the power supply by turning off the
computer, unplugging and detaching the power supply cord or
trying a new cord or outlet.
Cooling fan
- Cooling fans are a computer's system to decrease overheating.
Many computers have more than one cooling fan to help users
who run their computer heavily, such as video streaming or
gaming. A computer technician may need to fix a computer's
cooling fan if a user notices their computer overheating. They
may check for any damage to the blades and make sure that
they are free from debris. Replacing computer fans can be a
common troubleshooting solution for a technician.
Hard drive
- Hard drives are data storage devices used to store files,
programs or other information on a computer system. They
use magnetically coated discs called hard disks that store
digital representations of information. If a hard drive fails, a
computer technician may suspect a corrupt hard drive. They
may use data recovery software to repair the computer or may
replace the hard drive.
Monitor
- A computer monitor is an electronic device that displays
what's what programs are running on your computer so a user
can see. Some computer technicians may wear anti-static
gloves when handling computer monitors to avoid static
electricity. They may also troubleshoot monitor issues by
disconnecting it from the computer and trying a new power
cord.
Printer
- This is a machine that produces copies of text or images on
paper using ink. Popular printers include laser or inkjet and
computer technicians may be skilled in troubleshooting issues
across multiple brands and varieties. Computer technicians
may service printers including verifying power is running to
the machine. They may also check to see if the paper tray is
full and ready for printing. Technicians might replace or refill
any ink cartridges and toner.
- If the physical printer components are operating efficiently but
the machine still isn't working, a technician will then
troubleshoot software malfunctions that may occur in the
communication between the computer and the printer. This
requires more expertise to fix since it involves how the
systems interact with each other rather than physical
component failures on the printer itself.
Scanner
- A scanner is a device that digitally copies an image or and
makes it available as a file for access on a computer. If a
scanner malfunctions, a computer technician may remove the
cover and carefully check if it has any damage. If there are no
visible issues, then they may check the power connection
cable. Similar to a printer, there is computer software that
connects the scanner to the computer, so a technician will also
verify that the software is communicating to the scanner.
Computer mouse
- A computer mouse can have a wire or is wireless and is an
input device used to control a cursor on the computer monitor.
A wired computer mouse has a cord that connects to a USB
port on a computer while a wireless mouse has no physical
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
connection with a computer system. Instead, a wireless mouse
communicates using an adapter that is usually plugged into an
available USB port and runs off its own batteries using
Bluetooth technology.
- Computer technicians may troubleshoot computer mouse
issues by ensuring it's connected properly if it has a wire. If
the mouse is wireless, a technician can look to see if they need
batteries and that the wireless connection is working.
Computer technicians can clean both wired and wireless with
cloths to ensure there is no dust or debris on the sensor on the
bottom of a mouse. If there is, the mouse may not operate
correctly.
Input Devices – allows computer to receive data from outside
source
• Keyboard – set of typewriter –like keys that enables you
to enter data into the computer
• Mouse – hand-controlled device for interacting with the
computer/screen
• Touch Screen – interactive visual display; users touch the
screen to select options from a displayed menu
Capacitative/resistive
• Lightpen – light sensitive device shaped like pen, used to
draw on the computer screen to make selections
• Voice Input – uses microphone to access computer w/o
using keyboard or mouse
• Scanner – device that reads prints and converts it into a
graphic image on the computer
• Webcam – camera that records video
• Others: gamepad/controller, fingerprint/retinal/image
scanner, instruments
Output Devices – allows computer to report its results to
external world in a form of text, graphics, signals, sounds
• Monitors and Projectors – uses screen for visual display
of information
• Printer – makes images appear on a medium (paper)
• Earphones and Speakers – uses sound waves to be heard
by user
• Vibration/Haptic feedback – uses touch to communicate
with the user
Storage Media – devices where programs or data are stored for
recovery
• Hard Disk/ External Hard Disk – has very high speed and
density, main storage of computers
• Diskette – has round magnetic disk inside. Obsolete
• CD/DVD/Blu-ray – a rigid disk that holds more density
than diskettes therefore has more capacity.
• USB disk – small removable hard drive that is inserted
into the USB port. Synonymous to pen drive, thistle drive
and pocket disks
• Cloud (not hardware) – uses the internet to store data.
Definition of Computer Hardware
- The computer hardware is defined as all of the physical
components (objective) of the machine itself. The basic
hardware of the computer includes the electronic circuits,
microchips, processors and the motherboard itself encased in
the Central Processing Unit (CPU) box.
J.A.K.E 11 of 18
- In addition, hardware typically includes devices that are
peripheral to the main computer box such as input and output
device including keyboard, mouse, printer, fax and storage
components such as hard drives. The group of required and
optional hardware items that are linked together to make up a
computer system is called configuration.
- Computer hardware advances during the late 1990s have made
possible many changes to the healthcare industry. The first
operations to be modified were special administrative
functions such as finance, payroll and nurse staffing and
scheduling reports. Later, the computer allowed fantastic
changes in the practice of radiology and imaging, allowing
noninvasive visualization of the human body. Computers are
now pervasive throughout the healthcare industry.
Fundamentals of Computer Hardware
- A computer has four basic components, although most have
many add-on components. At its most basic, a computer must
consist of a CPU, input and output controllers and storage
media. Examples of basic components are as follows:
• Central Processing Unit – The Central Processing Unit
(CPU) is considered the brain of the computer that
primarily consists of the following:
• Arithmetic and Logic Unit – Controls mathematical
function such as addition and subtraction and functions of
the test logic (Boolean) conditions [e.g. is value x greater,
equal to or more than the y value]
• Control Unit – carries out the machine language
functions called fetch, execute, decode and store.
• Memory – includes the locations of the computer internal
or main working storage. It consists of registers (small
number of very high-speed memory locations), RAM,
ROM and cache (small memory storage area holding
recently accessed data).
Computer Power
- Computers do not process information as words or numbers.
They handle information as byte that is made up of 8 bits. The
term bits and bytes refer to how the machine stores
information at the lowest, or “closest to machine registers and
memory”, level. The following definitions and conversions are
necessary for the discussion:
• Bit – short for “binary digit” is a unit of data in the binary
number system. It means “two”, so a bit can assume any
of two positions. A bit is an on (value of 1) and off (value
of 0) switch.
• Byte – a group of 8 bits. Bits are grouped into collection
of eight (8), which then functions as a unit. There are 255
different combinations of 0 and 1 in an 8-character (or 1-
byte unit). Byte conversion table is presented below:
Frequency Unit Conversion
1 Bit 1 Character
1 Byte 8 Bits
1000 Byte 1 Kilobyte
1000 Kilobyte 1 Megabyte
1000 Megabyte 1 Gigabyte
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
Computer Speed
- The basic operations of the CPU are called cycles (fetch,
decode, execute and store cycles). It takes time to the
computer to perform these functions. The CPU speed is
measured in cycles per second. For example, the original IBM
PC introduced in 1981 had a clock speed of 4.77 MHz (4.77
million cycles per second). Nowadays, PC speeds are timed in
billion cycles per second or gigahertz (GHz).
COMPUTER SOFTWARE
From Module 4
- Software is a general term for the various kinds of programs
used to operate computers and related devices.
- Software can be thought of as the variable part of a computer.
- Software requires hardware, which is the physical substrate on
which software exists and runs, and hardware is useless
without software.
- The term software dates back to at least 1850. At that time, it
is referred to a type of garbage that would decompose, and
hardware referred to garbage that would not decompose. The
current usage dates back to at least 1958, when John W. Tukey,
a highly influential statistician who held posts at both
Princeton University and Bell Labs, used it in an article in the
January 1958 issue of American Mathematical Monthly. Titled
the Teaching of Concrete Mathematics, he described software
as the carefully planned interpretive routines, compilers, and
other aspects of automotive programming.
- Software purposes:
• Translate instructions created in human language into
machine language.
• Packaged or stored software is needed to make the
computer an economic work tool.
Types of Software
System Software
- System software is a program that manages and supports the
computer resources and operations of a computer system while
it executes various tasks such as processing data and
information, controlling hardware components, and allowing
users to use application software.
- That is, systems software functions as a bridge between
computer system hardware and the application software.
Basic Input and Output System (BIOS)
- The BIOS software has a number of different roles, but its
most important role is to load the operating system. When you
turn on your computer and the microprocessor tries to execute
its first instruction, it has to get that instruction from
somewhere. It cannot get it from the operating system because
the operating system is located on a hard disk, and the
microprocessor cannot get to it without some instructions that
tell it how. The BIOS provides those instructions.
Brief history of computer programming and software
Augusta Ada Byron (1815 – 1852)
- Countess of Lovelace
- Mathematician who described the concept of a stored
computer program.
- Loop Concept - Use of automatic repetitious arithmetic steps
that the analytical engine would follow to solve a problem.
- First programmer in computer history.
J.A.K.E 12 of 18
Charles Babbage (1792 – 1871)
- Invented (but never built) a device that he named the
analytical machine.
- It could perform mathematical functions and instructions
communicated the machine.
John Von Neumann (1903 – 1957)
- Proposed that both data and instructions could be stored in the
computer and that the instructions could be automatically
carried out.
- Stored program concept was subsequently implemented as a
major concept in the evolution of the computer.
August 2, 1790
- America’s founders decreed that a census be taken every 10
years and the first census was done.
1860
- Found out that manual method of processing census were
inadequate.
Joseph Jacquard
- A weaver from France and invented the Jacquard Loom
- Jacquard Loom - A device that uses blocks of wood with holes
drilled in such a way that the threads to be woven into cloth
could form a program to the loom.
- The program varied the way the cloth was worked by the loom
so that a particular design would be produces in the fabric.
Herman Hollerith (1860 – 1929)
- A weaver from France and invented the Jacquard Loom
- Jacquard Loom - A device that uses blocks of wood with holes
drilled in such a way that the threads to be woven into cloth
could form a program to the loom.
- The program varied the way the cloth was worked by the loom
so that a particular design would be produces in the fabric.
Rear Admiral Grace Murray Hopper
- Mother of Computing
- Worked with the first digital mainframe computers (Mark I
and Mark II)
- Developed many concepts and mathematical foundations of
computer programming science.
- Debugging – checking the program to ensure that the
computer is free of error.
- Recognized that obscure assembly and machine-like
programming languages limited access to the computer and
therefore the utility of the machines.
- Her work formed the foundation for the first truly English-like
language (COBOL)
- Had an early vision of computers working independently and
together so that more could be accomplished.
System software
Operating Systems
- Operating systems are the software component of a computer
system that is responsible for the management and
coordination of activities and the sharing of the resources of
the computer.
- The operating system acts as a host for applications that are
run on the machine. As a host, one of the purposes of an
operating system is to handle the details of the operation of the
hardware.
- This relieves application programs from having to manage
these details and makes it easier to write applications.
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
- Almost all computers, including handheld computers, desktop
computers, supercomputers, and even video game consoles,
use an operating system of some type.
- Common examples are Microsoft Windows and Linux / Unix.
Disk Operating System (DOS)
- DOS is the medium through which the user and external
devices attached to the system communicate with the system.
- DOS translate the command issued by the user in the format
that is understandable by the computer and instruct computer
to work accordingly.
- It also translates the result and any error message in the format
for the user to understand.
Graphical User Interface (GUI)
- GUIs are computer program that enables a person to
communicate with a computer through the use of symbols,
visual metaphors, and pointing devices.
- The GUI has replaced the arcane and difficult textual
interfaces of earlier computing with a relatively intuitive
system that has made computer operation not only easier to
learn but more pleasant and natural.
- The GUI is now the standard computer interface, and its
components have themselves become unmistakable cultural
artifacts.
Utility Programs
- A program that performs a specific task related to the
management of computer functions, resources, or files, as
password protection, memory management, virus protection,
and file compression.
- Common examples are Disk Defragmenters, Application
Launchers and Web Browsers.
Application Software
- Programs that specify the information processing activities
required for the completion of specific tasks of computer users.
Examples
Classification of Application Software
Word Processing Software
- Writing tasks previously done on typewriters with
considerable effort can now be easily completed with word-
processing software.
- Writing tasks such as keying in reports, letters, and tables, as
well as merging documents, can be performed easily.
- Documents can be easily edited and formatted.
- Revisions can be made by deleting (cutting), inserting, moving
(cutting and pasting), and copying data.
- Documents can be stored (saved) and opened again for
revisions and/or printing.
- Many styles and sizes of fonts are available to make the
document attractive.
Spreadsheet Software
- Spreadsheet software permits performance of an almost
endless variety of quantitative tasks such as budgeting,
keeping track of inventory, preparing financial reports, or
manipulating numbers in any fashion, such as averaging each
of ten departmental monthly sales over a six-month period.
- A spreadsheet contains cells, the intersection of rows and
columns. Each cell contains a value keyed in by the user. Cells
also contain formulas with many capabilities, such as adding,
multiplying, dividing, subtracting, averaging, or even counting.
An outstanding feature of the spreadsheets is its ability to
recalculate automatically.
J.A.K.E 13 of 18
- If one were preparing a budget, for example, and wanted to
change a variable such as an increase in salary or a change in
amount of car payments, the formulas would automatically
recalculate the affected items and the totals.
Data Base Software
- A database contains a list of information items that are similar
in format and/or nature. An example is a phone book that lists
a name, address, and phone number for each entry.
- Once stored in a database, information can be retrieved in
several ways, using reports and queries. For example, all the
names listed for a given area code could be printed out and
used for a commercial mailing to that area.
Desktop Publishing Software
- This software permits the user to prepare documents by using
both word-processing devices and graphics.
- Desktop publishing software uses word-processing software,
with all its ease of entering and revising data, and supplements
it with sophisticated visual features that stem from graphics
software.
- For example, one can enhance a printed message with virtually
any kind of illustration, such as drawings, paintings, and
photographs.
Presentation Software
- A speaker may use presentation software to organize a slide
show for an audience. Text, graphics, sound, and movies can
easily be included in the presentation. An added feature is that
the slide show may be enhanced by inclusion of handouts with
two to six slides printed on a page.
- The page may be organized to provide space for notes to be
written in by the audience as the presentation ensues.
- An example of this is Power Point. Preparation of the software
is simplified by the use of 'wizards' that walk the user through
the creation of the presentation.
Standard office software
- Most common software packages sold with computers
- Includes: Word processing, spreadsheet, presentation and
database management system programs
- Open Office, Free Office, Microsoft Office Suites
Content Access Software
• Web browsers
- Software application for retrieving, presenting, and
traversing information resources on the Worldwide Web
(www)
- Firefox, Google Chrome, Internet Explorer, Opera, Safari
• Media players
- For playing back multimedia files (music, videos or both)
Media Creation Software
• 3D Computer Graphics Software
- Programs used to create 3D computer-generated imagery.
- 3dsMax, Maya, SketchUp, Blender
• Animation Software
- Used for generating animated images by using computer
graphics
• Graphic Art Software
- Used for graphic design, multimedia development,
specialized image development, general image editing, or
simply to access graphic files
- Adobe Photoshop, Corel, GIMP
• Sound Editing Software
- Designed solely or primarily for recording, editing and
playing back digital audio.
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
- Finale, Sibelius, Audacity, Noteworthy Composer
• Game Development Tool
- A specialized software application that assists or
facilitates the making of a computer or video game.
- Game Maker, Unity, RPG Maker
Office Suite Software
- Office suite software puts together complete programs of
software. A typical suite package might include word
processing, spreadsheet, databases, and presentation software.
Depending on the jobs that need to be done, the suite provides
the tools to make professional-looking documents.
- Application programs are written in a particular programming
language.
Common Software/ Programs Utilized in the Nursing Practice
- In most hospitals, software used by nurses includes admission,
discharge and transfer (ADT) systems that help with patient
tracking and medication administration record (MAR)
software. Increasingly, hospitals have added charting software
that computerizes at least some parts of the nursing record.
- Nurses also utilize common software for communication
purposes. Some examples are as follows:
Chat Rooms
- Chat rooms are like electronic conference calls. Multiple users
can send and receive messages at the same time.
- Some chat rooms are public but private chat rooms require
password.
- Chat room technology is synchronous, that is, users can
connect in real time even at huge distances.
Social Network
- Social network refers to any number of web addresses
designed to create online communities.
- These communities can be focused around common interests,
goals, or simply away for people to interact.
Electronic Bulletin Board
- Electronic bulletin board is an early form of computer
conferencing but still popular nowadays.
- They may be called discussion boards or electronic forums.
Forums can be posted using administrative or user defined
categories.
- Electronic bulletin board is asynchronous which means users
can post messages at the time of their convenience.
Listservs
- Listservs are considered the least powerful version of the
electronic bulletin board. The software functions more like an
electronic mailing list. When a user post message to a board, it
is merely emailed to all members of the conference.
Programming Languages
- A programming language is a means of communicating with
the computer. The only language a CPU can understand is
binary or machine language.
- A computer executes a sequence of instructions (a program) in
order to perform some task. In spite of much written about
computers being electronic brains or having artificial
intelligence, it is still necessary for humans to convey this
sequence of instructions to the computer before the computer
can perform the task.
- The set of instructions and the order in which they have to be
performed is known as an algorithm.
J.A.K.E 14 of 18
- The result of expressing the algorithm in a programming
language is called a program.
- The process of writing the algorithm using a programming
language is called programming, and the person doing this is
the programmer.
Categories of Programming Languages
1st level
Machine Language
- Machine language belongs to low level programming
languages. They are the most basic and can be understand
directly by the computer and consist of binary numbers 1 and
0.
Symbolic Language
- Symbolic language, on the other hand, use convenient symbols
or mnemonics.
Assembly Language
- intermediate languages that are very close to machine
language and do not have the level of linguistic sophistication
exhibited by other high-level languages but must still be
translated into machine language.
2nd level
High Level Language
- High level languages are programming languages that must
first be translated into a machine language before they can be
understood and processed by a computer. They use traditional
mathematical symbols.
- Also called Compiler Languages, for these languages requires
a special program called a Compiler, which translates
programs written in particular languages into machine
language.
- Far more English-like language
- A single comma or letter out of place will cause the program
to crash.
- The style and sequence of a language are called its SYNTAX.
Non-procedural language
- Are specialized application programs that requires more
involvement of the user in directing the program to do the
necessary work.
- A user specifies what the program is to do, but not how the
program is to perform the task.
- The how is already programmed by the manufacturer of the
language program.
- Statistical Package for Social Sciences (SPSS) – A statistical
analysis program, the user enters a command that tells the
computer to compute a chi-square statistic on a particular
datasheet. The formula is already a part of the program; the
user does not have to tell SPSS how to calculate
High level procedural language (3rd Generation Language)
Fortran
- First high-level computer language and the progenitor of many
key high-level concepts, such as variables, expressions,
statements, iterative and conditional statements, separately
compiled subroutines, and formatted input/output.
Cobol
- First universal programming language. The first truly English-
like language.
- A language that can be run on any computer makes and
models.
- Designed for writing business programs with minimum of
time and effort
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
C thing to a standard programming
- It was named after an earlier prototype program called simply
B.
- Most popular computer language for writing new OS and other
system programs
C ++
- Used for a variety of applications, especially those that allows
users to interact with electronic companies through the
Internet.
JAVA
- Was developed by Sun Microsystems to be a relatively simple
language that would provide portability across differing
computer platforms and the security needed for use on a huge,
public network like the internet.
- Critical for any serious web developers
Visual Programming Languages
- Developed to facilitate program development in graphics-
based environments.
- Often taught to beginning programmers
Natural language
- The user tells the machine what to do in the user’s own natural
language or through use of a set of very English-like
commands.
- Any user could give understandable commands to the
computer in his or her own word style and accent is being
performed.
- Voice recognition technology is integrated with the language
so that voice commands are recognized and executed
Common Programming Languages
Beginner’s All-Purpose Symbolic Instruction Code (BASIC)
- BASIC is the first lingua franca of microcomputers, often
taught to beginning programmers because it is easy to use and
understand and because it contains the same major concepts as
many other languages, it is thought to be more difficult.
Common Business Oriented Language (COBOL)
- It is a language that can be run on any computer makes and
models. It was designed for writing business programs with
minimum of time and effort
- COBOL is a compiled language, are split into four divisions:
• Identification
• Environment
• Data
• Procedure
Formula Translation (FORTRAN)
- The first high-level computer language and the progenitor of
many key high-level concepts, such as variables, expressions,
statements, iterative and conditional statements, separately
compiled sub-routines, and formatted input/output.
Pascal
- Pascal is a compiled, structured language, built upon ALGOL,
simplifies syntax while adding data types and structures such
as sub ranges, enumerated data types, files, records, and sets
C
- C is considered by many to be more a machine-independent
assembly language than a high-level language, its close
association with the UNIX operating system, its enormous
popularity, and its standardization by the American National
Standards Institute (ANSI) have made it perhaps the closest
J.A.K.E 15 of 18
language in the
microcomputer/workstation marketplace
Computer Programming
- refers to the process of writing a computer program, which is a
series of instructions written in proper sequence to solve a
specific problem. A program encompasses the program
instructions and is generally written by a computer
programmer.
- There are five major steps in writing any computer
program:
• Problem Definition – involves the identification of the
problem to be solved regarded as the most crucial step in
programming
• Program Design – where the process designing takes
place
• Writing the Code and Program Documentation – includes
structure and narrative documentation
• Alpha Testing – also known as desk checking where
components are checked based on the intended purpose
and design
• Beta Testing and Program Documentation – involves
installation to actual user environment that signals
program implementation
Terms
• Software - a general term for the various kinds of programs
used to operate computers and related devices. Software can
be thought of as the variable part of a computer. Software
requires hardware, which is the physical substrate on which
software exists and runs, and hardware is useless without
software.
• Programming language - a means of communicating with the
computer. The only language a CPU can understand is binary
or machine language.
COMPUTER SYSTEM
From Module 5
- Every functioning computer is a system; that is, it is a complex
entity like the human body, consisting of an organized set of
interconnected components or functions that function together
as a unit to accomplish results that one part alone could not.
- The term computer system is used to describe the set of
peripherals, computer box, and the software that together
perform computing functions to achieve common goal.
- Health professionals use computer systems consisting of
multiple, interconnected computers that function to facilitate
the work of groups of providers and their support people in a
system called a network. The greatest range of functionality is
realized when computers are connected to other computers in a
network.
- A system by its nature is not random. It is orderly and
predictable in its functioning. The use of systems in computer
is based on systems theory.
Systems Theory
- Systems theory provides the conceptual basis for
understanding complex entities that consist of multiple
interrelated parts working together to achieve a desired result.
The key concepts of system theory are:
o Part
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
o Interaction
o Interdependency
o Input
o Output
o Processing
o Feedback
o Control
The primary propositions of the theory are the following:
• A system takes an input on which to perform processes
• The processes performed by a system on input result in
system output
• The processes in a system are subject to control forces
• Feedback is the key mechanism of control in a system
• A system’s parts interact in such a way that the parts are
interdependent with respect to the system’s process
• Impingement on one part in a system will produce effects
on the system’s processes and may produce distortions on
other parts of the system.
• Distortion in one part of a system may be a symptom of a
problem in another component (secondary malfunction)
• Correlation of a malfunctioning part will correct the
system functioning only if the malfunction was a primary
malfunction and not a secondary malfunction
• Effects on the system’s processing function will affect the
system’s output
• A system is more than the sum of its parts. If the parts of
the system will function independently, the system no
longer exists:
- The functioning of the system is different than the
functioning of its separate parts
- The output of each separate parts, even if combined,
does not equal the output of the system
- When combined into a system, the component parts
form an entirely new entity
Elements of the System
Interdependent parts
- Without the interaction of the parts, the system process could
not occur. In computer systems, the process involves
mathematical, logical or data transfer operations interacting
among its components.
Input
- Input is any feed from the system’s external environment.
- Input in a computer system may serve to initiate computer
functioning, as when the machine is turned on and the OS is
loaded into RAM.
Process
- Process is the activity of the system. A system perform
process on its inputs to produce outputs or some sort of results.
- Process in a computer system can be seen in the example of a
presentation graphic system.
Output
- Output is any end product or waste produced as a result of the
system process.
- The output in a presentation graphic system, for example,
might be an electronic file (softcopy) stored on D hard drive or
removable storage.
Control
- Control refers to any component or activity that serves to
prevent or correct problems or errors in a system’s input,
process, or output.
J.A.K.E 16 of 18
- A system must function with rules and procedures. In
computer systems, variety of control facilities exists within the
OS.
Feedback
- is the output from one part of the system process that serves as
input to another part of the system process.
- Feedback within system is typically used as part of a system’s
self-regulation function.
- In computer system, feedback components are important
functions of the OS and utility programs.
Systems Classification
Closed System
- defined as a system that exhibits several characteristics. A
closed system is clearly differentiated from all other systems
and factors in its environment. Its boundaries are clearly
defined and rigid. It has sealed boundaries that separate it from
the rest of the environment. Access to the closed system is
highly restricted, because the only inputs acceptable to the
system are from another part of itself.
- A closed system has to be self-sufficient, because any input
from the external environment is a threat to the integrity of a
closed system. It does not need an internal source to help rid of
its output or waste products.
- An example of a closed system in nursing is the chest tube
drainage system. The components of the system are dependent
to each other to achieve the common goal. If the integrity of
the tubes will be compromised, air (an external factor) will
enter the system and the desirable results will not be realized.
Open System
- a system that exhibits integration, fluid or fuzzy boundaries
and interaction with environments. They need not be self-
regulating although they might exhibit that characteristic. An
open system overlaps other systems and may be a subsystem
within a larger system. It is sometimes difficult to identify the
boundaries of an open system because boundaries are
permeable to external influences rather than sealed against
them.
- Intrauterine circulation of the fetus is an example of an open
system. Fetuses exhibit a certain degree of circulatory
independence but it needs interaction with the permeable
components of the maternal blood for nourishment, respiration
and excretion. Similarly, adults have basic needs (air, water,
food, medication) coming from an outside source.
Information Systems
- a set of people, procedures and resources that collects,
transforms and disseminates information in an organization; a
system that accepts data resources as input and processes them
into information products as output; a system that uses the
resources of hardware, software and people to perform input,
processing, output, storage and control activities (key pieces)
that transform data resources into information products; a
purposefully designed system that brings data, computers,
procedures, and people together to manage information
important to an organization's mission.
Types of Information Systems
Transaction Processing System (TPS)
- TPS records daily routine transactions such as diagnostic exam
requests from clients. TPS are vital for the organization, as
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022
they gather all the input necessary for other types of systems.
TPS provide the basic input to the company's database. A
failure in the TPS often means disaster for the organization.
Knowledge Work System (KWS)
- KWS supports highly skilled knowledge workers in the
creation and integration of new knowledge into the company.
Computer Aided Design (CAD) systems, for example, used by
product designers not only allow them to easily make
modifications without having to redraw the entire object (just
like word processors for documents), but also enable them to
test the product without having to build physical prototypes.
Office Automation System (OAS)
- OAS support general hospital work for handling and managing
documents and facilitating communication. Text and image
processing systems evolved from word processors to desktop
publishing, enabling the creation of professional documents
with graphics and special layout features.
- Spreadsheets, presentation packages like powerpoint, personal
database systems and note-taking systems (appointment book,
notepad, cardfile) are part of OAS.
Management Information System (MIS)
- MIS generates information for monitoring performance (e.g.
productivity information) and maintaining coordination (e.g.
between purchasing and accounts payable).
- MIS extract process and summarize data from the TPS and
provide periodic (weekly, monthly, quarterly) reports to
administrators (e.g. hospital managers, nurse managers).
Decision Support System (DSS)
- DSS supports analytical work in semi-structured or
unstructured situations. They enable managers to answer
"What if?" questions by providing powerful models and tools
(simulation, optimization) to evaluate alternatives (e.g.
evaluating alternative care plans).
- DSS are user-friendly and highly interactive. Although they
use data from the TPS and MIS, they also allow the inclusion
of new data, often from external sources, such as current share
prices or prices of competitors.
Executive Support System (ESS)
- provide a generalized computing and communication
environment to senior managers to support strategic decisions.
- They draw data from the MIS and allow communication with
external sources of information. But unlike DSS, they are not
designed to use analytical models for specific problem solving.
- ESS is designed to facilitate senior managers' access to
information quickly and effectively.
Bibliographic retrieval system
- Retrieval system that generally refers to bibliographic data,
document information, or literature.
Stand-alone, Dedicated, or Turnkey System
- A special purpose system designed for a single application or
set of functions.
Physiologic Monitoring System (PMS)
- monitor vital physiologic parameters so that clinicians can be
informed of changes in a patient's condition. They typically
consist of several distinct components, including a central
station, bedside monitors, and ambulatory telemetry
transmitters and receivers.
Decision support system
- Work with the user to support, but not replace, human
judgment in a decision-making situation.
J.A.K.E 17 of 18
Expert system
- Designed for users to stimulate cause and effect reasoning that
an expert would use if confronted with the same situation in a
real live environment.
Artificial Intelligence System
- Attempts to model human reasoning processes.
- Track the accuracy of is predictions and judgments and alter
its own decision-making rules, based on new knowledge it
generates for itself.
Natural Language System
- Used to recognize and process human speech (voice) and/ or
handwriting.
Hospital Information Systems
- Hospital information systems (HIS) is a computer system that
is designed to manage all the hospital’s medical and
administrative information in order to enable health
professional perform their jobs effectively and efficiently.
- Hospital information systems were first developed in the
1960s and have been an essential part in hospital information
management and administration.
- Early systems consisted of large central computers connected
to dumb terminals, which are now being replaced by
networked microcomputers. The systems were used to manage
patient finance and hospital inventory. An excellent example
of HIS is the new Microsoft Amalga.
Microsoft Amalga Hospital Information System (HIS)
- the new version of Hospital 2000, is a state-of-the-art,
integrated hospital information system designed to meet the
needs of developing and emerging markets. Amalga HIS
delivers a complete, agile hospital information system that is
flexible, affordable and intuitive. This scalable, integrated
HIS:
o Manages all hospital functions with one affordable,
integrated solution
o Helps improve operational efficiency, care quality and
patient experience by providing staff with a single,
customized view of healthcare information
o Helps improve care quality and the patient experience by
providing clinicians with a single, customizable view of
patient data across all encounters to enable more informed
decision-making and faster throughput.
Program Modules of HIS
- HIS offers variety of administrative applications. Clinical
support programs are increasingly being viewed as the
critically important modules in an HIS.
- Semi clinical Modules
Order-Entry System
- Its main function is to monitor and sometimes control the flow
of patients in a hospital from admission to discharge.
Order-Entry-Results Reporting Module (OE)
- OE is almost always available in all HIS. This enables the staff
to enter laboratory, pharmacy and radiology orders, results and
reports online.
Clinical Modules
Charting Systems
- Usually included are the medication reports, admission
assessment, shift assessment, special assessments and some
 NURSING INFORMATICS – BSN 2ND YEAR SUMMER MIDTERM 2022

elements of the nursing care plan. Charting systems are • Network - a set of interconnected computers that through the
variable due to lack of universally implemented standard hardware and software technology, work cooperatively for the
nursing language. purpose of information and application program interchange.
Point of Service Systems (POS)
- POS are special type of clinical system that uses hand-held or
bedside PC to ensure that the data are entered at the point at
which they are collected. Placement of POS workstations is an
issue among healthcare institutions.
Laboratory, Pharmacy and Radiology Modules
- Shows laboratory, pharmacy and radiology data. Some are
equipped with warnings and standards for comparison and
critical assessment.

Network Systems
- A network is a set of interconnected computers that through
the hardware and software technology, work cooperatively for
the purpose of information and application program
interchange.
- The central concept of network science is cooperation. All
computers in a network must function in an interdependent
way. Moreover, it must have software that can interpret the
signals it receives and a set of communication rules. The rules
are written into system software programs called protocols or
networking software.
- Network systems are keys to the effective functioning of most
hospital computer systems.
- Types of Networks:
• Local Area Network (LAN) - The computers are
geographically close together (that is, in the same
building).
• Wide Area Network (WAN) - The computers are farther
apart and are connected by telephone lines or radio waves.
• Campus Area Network (CAN) - The computers are within
a limited geographic area, such as a campus or military
base.
• Metropolitan Area Network (MAN) - A data network
designed for a town or city.
• Home Area Networks (HAN) - A network contained
within a user's home that connects a person's digital
devices.

Terms
• Computer System - is used to describe the set of peripherals,
computer box, and the software that together perform
computing functions to achieve common goal.
• Information Systems (IS) - a set of people, procedures and
resources that collects, transforms and disseminates
information in an organization; a system that accepts data
resources as input and processes them into information
products as output; a system that uses the resources of
hardware, software and people to perform input, processing,
output, storage and control activities (key pieces) that
transform data resources into information products; a
purposefully designed system that brings data, computers,
procedures, and people together to manage information
important to an organization's mission.
• Hospital information systems (HIS) - a computer system that
is designed to manage all the hospital’s medical and Copy paste lng galing modules at PPT un topics 4-5 ahhh mag
administrative information in order to enable health notes at making nlng kau maigi sa discussion ni doc MJ sa thurs.
professional perform their jobs effectively and efficiently. Review well and Good luck sa exam!! – Aki

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