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UNIT 1: NURSING INFORMATICS TECHNOLOGIES: Historical Perspective of Nursing

Informatics

1.0 Intended Learning Outcomes

1. Recognize a brief historical perspective of nursing informatics.

2. Define the key concepts in nursing informatics.
3. Identify and list the major landmark events and milestones of nursing informatics.
4. Discuss the purpose of nursing informatics.

1.1. Introduction

Nursing Informatics has evolved over the years to become a very important part of nursing practice.
The successful planning, implementation, management, and sustainability of such technologies
cannot be achieved without the unique contribution of” nurses.

Nurses “are expected to provide safe, competent, and compassionate care in an increasingly technical
and digital environment. Nursing Informatics combines knowledge and skills from nursing science,
computer science, information science, and cognitive science to design and implement automated
systems that support the nursing process in the delivery of health care services. (Joseph-Shehu, 2020)

Furthermore, Nursing informatics, despite its rich evolution and dynamic nature remains an emerging
field in the Philippines. With its inclusion as a critical content in the Bachelor of Science in Nursing
Curriculum, Policies, and Standards in 2008, various interpretations and adaptations were made
evident thereby influencing Philippine Nursing. Critical discussions, whether or not Nursing
Informatics affects the focus of nursing with the integration of information and communication
technologies into nursing service delivery systems continue to exist. It is imperative that a better
understanding of the contributions of Nursing Informatics to Philippine Nursing from a historical
perspective and declaring its implications for Philippine Nursing Practice initiated within a Caring
viewpoint are addressed and illuminated. (Faustorilla, 2022)

1.2 MAIN TOPIC

Description

The definition provided by the American Nurses Association (ANA) and recommended by HIMSS
has become widely referenced in response to the question, “What is nursing informatics?”

Nursing informatics "is the specialty that integrates nursing science with multiple information
and analytical sciences to identify, define, manage and communicate data, information,
knowledge and wisdom in nursing practice."

As a global advisor and thought leader in healthcare information and technology, HIMSS (Healthcare
Information and management Systems Society)has focused on this professional field for decades.
Understanding the integral role this specialty plays today in the healthcare workforce, we’ve
worked to amplify awareness by convening the experts and conducting extensive research on the
topic.

On the other hand, Nursing Informatics is a phrase that evolved from the French word “informatique”
which refers to the field of applied computer science concerned with the processing of information
such as nursing information. The computer was seen as a tool that could be used in many
environments.
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In the early 1960s, the computer was introduced into healthcare facilities for the processing of
basic administrative tasks. Thus the computer revolution in healthcare began and led to today’s
healthcare information technology (HIT) and/or electronic health record (EHR) systems.

The importance of the computer as an essential tool in HIT systems and the delivery of
contemporary healthcare is indisputable. HIT is an all-encompassing term referring to technology that
captures, processes, and generates healthcare information.

Computerization and/or electronic processing affect all aspects of healthcare delivery including
(a) provision and documentation of patient care,
(b) education of healthcare providers,
(c) scientific research for advancing healthcare delivery,
(d) administration of healthcare delivery services,
(e) reimbursement for patient care,
(f ) legal and ethical implications, as well as
(g) safety and quality issues.

Since the inception of the computer, there has been a shift from the use of mainframe, mini, or
microcomputers (PCs) to integrating multiple technologies and telecommunication devices such as
wireless, handheld, mobile computers, and smart (cell) phones designed to support the continuity of
care across healthcare settings and HIT systems. There has also been a shift from storage devices to
cloud storage.

*Cloud Storage is a mode of computer data storage in which digital data is stored on servers in off-
site locations. The servers are maintained by a third-party provider who is responsible for hosting,
managing, and securing data stored on its infrastructure.

Furthermore, there is less need to develop written instructions for software programs as today’s
applications are icon-based, user-friendly, and menu-driven. Additionally, video tutorials are
available for many programs. Touch-screen devices are replacing the need for a mouse.

Today, computers in nursing are used to manage patient care information, monitor quality, and
evaluate outcomes. Computers and networks are also being used for communicating (sending and
receiving) data and messages via the Internet, accessing resources, and interacting with patients on
the Web. Nurses are increasingly using systems for planning, budgeting, and policy-making for
patient care services. Computers are also used to document and process real-time plans of care,
support nursing research, test new systems, design new knowledge databases, develop data
warehouses, and advance the role of nursing in the healthcare industry and nursing science. Moreover,
computers are enhancing nursing education and distance learning with new media modalities.

The goal of Nursing Informatics:

To improve the health of populations, communities, families, and individuals by optimizing

information management and communication.

These activities include the design and use of informatics solutions and/or technology to support all
areas of nursing, including, but not limited to:

- the direct provision of care,

- establishing effective administrative systems,
- designing useful decision support systems,
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- managing and delivering educational experiences,

- enhancing supporting life-long learning, and
- supporting nursing research.

MAJOR HISTORICAL PERSPECTIVES OF NURSING AND COMPUTERS

Seven Time Periods

Prior to 1960s Computers were first developed in the late 1930s to early 1940s. As computers have
evolved, computing power has increased. This was attributed to the increasing number of transistors
or chips placed in an integrated circuit. In the mid-1960s Gordon Moore noted that the number
doubled approximately every two years. This argument has become known as Moore’s law
(Techopedia, 2019).

1960s. During the 1960s the uses of computer technology in healthcare settings began to be explored.
Questions such as “Why use computers?” and “What should be computerized?” were discussed.
Nursing practice standards were reviewed, and nursing resources were analyzed. Studies were
conducted to determine how computer technology could be utilized effectively in the healthcare
industry and what areas of nursing should be automated. The nurses’ station in the hospital was viewed
as the hub of information exchange; therefore, numerous initial computer applications were developed
and implemented in this location.

By the mid-1960s, clinical practice presented nurses with new opportunities for computer use.
Increasingly complex patient care requirements and the proliferation of intensive care units (ICUs)
required that nurses become super users of computer technology as nurses monitored patients’ status
via cardiac monitors and instituted treatment regimens through ventilators and other computerized
devices such as infusion pumps. A significant increase in time spent by nurses documenting patient
care, in some cases estimated at 40%, as well as a noted rise in medication administration errors
prompted the need to investigate emerging hospital computer-based information systems (Sherman,
1965; Wolkodoff, 1963).

1970s. During the late 1960s through the 1970s, hospitals began developing computer-based
information systems which initially focused on computerized physician order entry (CPOE) and
results reporting; pharmacy, laboratory, and radiology reports; information for financial and
managerial purposes; and physiologic monitoring systems in the intensive care units; and a few
systems started to include care planning, decision support, and interdisciplinary problem lists. While
the content contained in early hospital information systems frequently was not specific to nursing
practice, a few systems did provide a few pioneer nurses with a foundation on which to base future
nursing information systems (Blackmon et al., 1982; Collen, 1995; Ozbolt & Bakken, 2003; Romano,
McCormick, & McNeely, 1982). Regardless of the focus, which remained primarily on medical
practice, nurses often were involved in implementing health information technology (HIT) systems.
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1980s. In the 1980s, the field of nursing informatics exploded and became visible in the healthcare
industry and nursing. Technology challenged creative professionals in the use of computers in nursing.
As computer systems were implemented, the needs of nursing took on a cause-and-effect modality;
that is, as new computer technologies emerged and as computer architecture advanced, the need for
nursing software evolved. It became apparent that the nursing profession needed to update its practice
standards and determine specific data standards, vocabularies, and classification schemes that could
be used for the computer-based patient record systems.
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In the 1980s, the microcomputer or personal computer (PC) emerged. This revolutionary technology
made computers more accessible, affordable, and usable by nurses and other healthcare providers.
The PC brought computing power to the workplace and, more importantly, to the point of care. Also,
the PCs served as dumb terminals linked to the mainframe computers and as stand-alone systems
(workstations). The PCs were user-friendly and allowed nurses to design and program their own
applications. The influence of computer technology extended to the introduction of devices to improve
patient safety. For example, the automated dispensing cabinets (ADCs) were introduced in the 1980s
(Grissinger, 2012). The computer controlled ADCs replaced medication carts and drug floor stock.
Tracking of medications occurred at the point of care. The use of ADCs in the clinical setting has
resulted in the reduction of medication errors.
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1990s. By the 1990s, large integrated healthcare delivery systems evolved, further creating the need
for information across healthcare facilities within these large systems to standardize processes, control
costs, and assure the quality of care (Shortliffe, Perreault, Wiederhold, & Pagan, 2003). Advances in
relational databases, client-server architectures, and new programming methods created the
opportunity for better application development at lower costs. Legislative activity in the mid-1990s
paved the way for EHRs through the Health Insurance Portability and Accountability Act (HIPAA)
of 1996 (public-law 104-191), emphasizing standardized transactions, and privacy and security of
patient-identifiable information (Gallagher, 2010). The complexity of technology, workflow analysis,
and regulations shaped new roles for nursing.

In 1992, the ANA recognized nursing informatics as a new nursing specialty with a separate Scope of
Nursing Informatics Practice Standards, and also established a specific credentialing examination for
it (ANA, 2008). Numerous local, national, and international organizations provided a forum for
networking and continuing education for nurses involved with informatics (Sackett & Erdley, 2002).
The demand for NI expertise increased in the healthcare industry and other settings where nurses
functioned, and the technology revolution continued to impact the nursing profession.
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In 1997, the ANA developed the Nursing Information and Data Set Evaluation Center (NIDSEC) to
evaluate and recognize nursing information systems (ANA, 1997). The purpose was to guide the
development and selection of nursing systems that included standardized nursing terminologies
integrated throughout the system whenever it was appropriate.

There were four high-level standards:

(a) inclusion of ANA-recognized terminologies;
(b) linkages among concepts represented by the terminologies retained in a logical and
reusable manner;
(c) data included in a clinical data repository; and
(d) general system characteristics.

The Certification Commission for Health Information Technology (CCHIT) had similar
criteria for the EHR certification, which was later adopted by the Office of the National Coordinator
for Health Information Technology (ONC); however, nursing data was no longer included. ANA was
ahead of its time in its thinking and development. The criteria are now under revision by the ANA to
support nurses to advocate their requirements for the emerging HIT systems.
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2000s. A change occurred in the new millennium as more and more healthcare information became
digitalized and newer technologies emerged. In 2004 an executive order 13335 established the ONC
and issued a recommendation calling for all healthcare providers to adopt interoperable EHRs by at
least 2014 or 2015 (http://healthhit.gocv/topic/about-onc). This challenged nurses to get involved in
the design of systems to support their workflow as well as in the integration of information from
multiple sources to support nurses’ knowledge of technology. In the late 2000s, as hospitals became
“paperless,” they began employing new nurses who had never charted on paper.

2010s. During 2010, the ONC convened two national committees, National Committee on Health
Policy and National Committee on Health Standards, which outlined and designed to address the
HITECH Act of 2009. The committees designed the “Meaningful Use” (MU) program which was to
be implemented in three stages of legislation consisting of regulations which built onto each other
with the ultimate goal of implementing a complete and interoperable EHR and/or HIT system in all
U.S. hospitals. For each stage, regulations were proposed by the national committees, developed and
reviewed by the public before they were finalized, and submitted to Centers for Medicare and
Medicaid (CMS) and the healthcare facilities for implementation.
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In 2011–2012, MU Stage 1 was initiated focusing primarily on the CPOE initiative for physicians.
Hospitals that implemented this MU regulation successfully received federal funds for their HIT
systems. In 2013–2015, MU Stage 2 was introduced focusing primarily on the implementation of
quality indicators that required electronic data to be collected as an integral component in the HIT
systems.
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As of 2018, the CMS proposed policies to strengthen Interoperability. The ONC and CMS rebranded
MU to Promoting Interoperability. It is anticipated that the initiative will make use of new
technologies and for patients to aggregate their health information from multiple providers into a
single electronic application. In 2019, the ONC continued to implement the latest legislation as well
as Interoperability through summits, webinars, and public comment.

1.3. REFERENCES

Elizabeth M. Joseph-Shehu, NSC 508 Fundamentals of Nursing Informatics. National Open

University of Nigeria. 2020 by NOUN Press

HIMSS. “What is Nursing Informatics?”. Originally published May 14, 2019, updated February 27,
2023.HIMSS 350 Orleans St., Suite S10000, Chicago, IL 60654, Phone (312) 664-4467
https://www.himss.org/resources/what-nursing-informatics

Post University Vlog. Nursing Informatics: Where Nursing and Technology Coincide. Nursing,
Program Insights. February 3, 2022. https://post.edu/blog/what-is-nursing-informatics/

Saba, et al. Historical Perspective of Nursing Informatics. Nurse Key: Fastest Nurse Insight Engine.
July 29, 2021/Posted by Admin in Nursing. https://nursekey.com/historical-perspectives-of-nursing-
informatics/

1.4 ACKNOWLEDGMENT

The images, tables, figures, and information contained in this module were taken from the
references cited above.

Prepared by:

MARY ANN D. APACIBLE, MAN EdD (CAR)

Clinical Instructor-Instructor I
College of Nursing - Samar State University