Historical Perspectives on Nursing Informatics

nursing informatics

a title from French word “informatics” which referred to the field of applied computer science concerned with the processing of information such as nursing information

early 1960s

the year when the computer was introduced into HC facilities for the processing of basic administrative tasks

HIT

healthcare information technology

EHR

electronic health record systems

computer evolution that occurred after the 1960s

healthcare information technology and electronic health records system

HIT

an all-encompassing term referring to technology that captures, processes, and generates healthcare information

computerization and/or electronic processing that affect all aspects of HC

• provision and documentation of patient care

• education of healthcare providers

• administration of healthcare delivery services

• reimbursement for patient care

• legal and ethical implications

• safety and quality issues

significant events influencing the growth of NI as a nursing specialty are analyzed accdg. to

• 1) Seven Time Periods

• 2) a synthesis of lessons learned from 33 videotaped interviews with Nursing Informatics Pioneers

• 3) Nursing Standards Initiatives including nursing practice and education, nursing content standards, and confidentiality and security standards

• 4) Electronic Health Records from a Historical Perspective

• 5) Landmark Events in Nursing and Computers

prior to the 1960s

• computers were developed in the late 1930s and early 1940s

• use in healthcare did not begin did not begin until the 1950s and 1960s

• The image of nursing was evolving, the number of education program and nurses increasing, and nursing practices and services were expanding in scope, autonomy, and complexity from physicians’ handmaidens to professional status

Punch cards

Used by early computers to store data

Card readers

Used by early computers to read computer programs, sort, and prepare data for processing

1960s

• use of computer technology began

• studies were conducted to determine how computer technology could be utilized

• the nurse’s station was viewed as the most appropriate center for the development of computer applications

• presented nurse with new opportunities for computer use

• Increased time devoted to documentation as well as noted rise in medication errors prompted the investigation of emerging computer-based information systems

1970s

• during the late 1960s thru 1970s, hospitals began developing computer-based information systems which focused on:

  • physician order entry

  • Result opening

  • Pharmacy

  • Laboratory

  • Radiology reports

  • Information for financial and managerial purposes

  • Physiologic monitoring systems in the ICU

A few systems started to include these in their computer-based information systems in the 70s

• care planning

• decision support

• interdisciplinary problem lists

1970s

• Nurses were often involved in implementing Health Information Technology (HIT) systems

• Interest in computers and nursing began to emerge in public and home health services

• The opportunity to improve education using computer technology has also began

• conferences sponsored by the Division of Nursing (DN), Public Health Service (PHS), and the National League for Nursing (NLN) helped public and home health

  nurses:

  • Understand the importance of nursing data and their relationship to new Medicare and Medicaid legislation

  • Provided information on the usefulness of computers for capturing and aggregating home health and public health information

PLATO

computerized teaching system that was implemented to teach classes in off-campus sites as an alternative to traditional classroom education

Technicon Data Systems (TDS)

• In the 70s the Clinical Center at the National Institutes of Health implemented this computer system

• one of the earliest clinical information systems (called Eclipsys and now Allscripts) was the first system to include nursing practice protocols

1980s

• The field of NI exploded and became visible in the healthcare industry and nursing

• new computer technologies emerged and as computer architecture advanced, the need for nursing software evolved

• invitational conferences were conducted at universities to

  introduce this new specialty into nursing education

• During this period, many mainframe healthcare information systems (HIs) emerged w/ nursing subsystems

healthcare information systems in the 80s documented several aspects of the patient record including

• provider order entry and results opening

• Kardex reporting

• Vital signs

• other systems-documented narrative nursing notes using word processing software packages

Discharge planning systems

Were developed in the 80s and used as referrals to community, public, and home healthcare facilities for continuum care

Microcomputers or personal computers

Emerged in the 1980s which made computers more accessible, affordable, and usable by nurses and other HC providers

Personal computer

• brought computing power to the workplace and, more importantly, to the point of care

• served as dumb terminal linked to the mainframe computers and as stand-alone systems

• were user friendly and allowed nurses to begin to design and program their own applications

Nursing Special Interest Group

Nurses began presenting at multidisciplinary conferences and formed their own working groups within HIT organizations w/c met for the first time during SCAMC (Symposium on Computer Applications in Medical Care) in 1981

Council on Computer Applications in Nursing (CCAN)

• Organization approved by the ANA in 1985

• Became a very powerful force in integrating computer applications in the nursing profession

• Developed a yearly Computer Nurse Directory on the nurses involved in the field, conducted computer applications demonstrations at the ANA Annual conferences

• shared information with their growing members in the first organization newsletter Input-Output

1990s

• Large integrated healthcare delivery systems evolved further creating the need for information across healthcare facilities

• Advances in relational databases, client-server architectures, and new programming methods = better application development at lower cost

• Legislative activity during this time period paved the way for EHRs through Health Insurance Portability and Accountability Act (HIPAA) of 1966 (public-law 104-191)

Health Insurance Portability and Accountability Act 1966

Public law that emphasizes standardized transactions and privacy and security of patient-identifiable information

1992

Year when ANA recognized Nursing Informatics as a new nursing specialty with a separate Scope of Nursing Informatics Practice Standards and established a specific credentialing examination for it

1997

• Year when ANA developed the Nursing Information and Data Set Evaluation Center (NIDSEC) to evaluate and nursing information systems

• guides the development and selection of nursing systems that included standardized nursing terminologies integrated throughout the system whenever it was appropriate

Four high-level standards of NIDSEC

• inclusion of ANA-recognized terminologies

• linkages among concepts rep

2010s

• A historical analysis of the impact of Nursing Minimum Data Set (NMDS) demonstrated that continued consensus and effort was needed to bring fruition of the vision and implementation of minimum nursing data into clinical practice

Meaningful Use

Was designed to be implemented in at least 3 stages each consisting of regulations which built onto each other with the ultimate goal of implementing a complete and interoperable EHR and/ or HIT systems in all US hospital

2011-2012 MU Stage 1

• Initiated focusing primarily on the CPOE or computerized physician order entry initiative for physicians

• Hospitals that implemented this received federal funds for their HIT systems

2012-2013 MU Stage 2

• Focused on the implementation of Quality Indicator that required electronic data to be collected, measured, and usef to demonstrate that a specific quality indicator was an integral component on the HIT systems

Quality Indicators

Used to guide hospitals in patient safety and if not implemented used as indicators subject to financial penalties

2015-2016 MU Stage 3

Primarily focused on care Outcome Measures and tentatively proposed Care Plans that encompass clinical specialty plans of care such as Nursing and Treatment Plans

Consumer-centric Healthcare System

• Enables consumers to be active partners in managing their own health

• Consumers have acces to their health information and choose whether to share this across HC providers and settings

2 committees created by ONC for MU legislation

• National Committee on Health Policy

• National Committee on Health Standards