LES 1.1: Historical Perspective of NI (Overview & Seven Time Periods)

French word “informatics”

Nursing Informatics is a title that evolved from what?

Informatics

Referred to the field of applied computer science concerned with the processing of information such as nursing information

Early 1960s

Year when the computer was introduced into healthcare facilities for the processing of basic administrative tasks

When computer revolution in healthcare began

• Healthcare Information Technology (HIT)

• Electronic Health Record (EHR)

What did the 1960s computer revolution in healthcare lead to?

Health Information Technology (HIT)

An all-encompassing term referring to technology that captures, processes, and generates healthcare info

PERRLAS

Acronym for Computerization and/or Electronic Processing affect all aspects of healthcare delivery including:

1. Provision and documentation of patient care

2. Education of healthcare providers

3. Scientific Research for advancing healthcare delivery

4. Reimbursement of patient care

5. Legal and ethical services

6. Administration of healthcare delivery services

7. Safety and quality issues

Computerization and/or Electronic Processing affect all aspects of healthcare delivery including:

1. 7 Time Periods

2. 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

Significant Events Influencing the Growth of NI as a Nursing Specialty

Later 1930s and early 1940s

Computers were developed in ___

1950s and 1960s

Use of computers in healthcare did not begin until the ___

Prior to 1960s

Identify the Time Period of the following:

A few experts formed a cadre to adapt computers to healthcare and nursing

Prior to 1960s

Identify the Time Period of the following:

Computers in healthcare were used for basic office administrative and financial accounting functions

Prior to 1960s

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Image of nurse evolved from handmaiden to professional status

1960s

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Use of computer technology began to be explored

1960s

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Studies were conducted to determine how computer technology could be utilized

1960s

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Nurses’ station was viewed as the most appropriate center for the development of computer applications

Mid-1960s

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Presented nurses with new opportunities for computer use

Due to increased complex patient care requirements and proliferations of ICUs, nurses needed to monitor patient status via ventilators and other computer devices

1960s

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Increased time devoted to documentation and a noted rise in medication errors prompted the investigation of emerging computer-based info systems

1970s

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Hospitals began developing computer-based information systems which initially focused on:

1. Physician Order Entry

2. Results Reporting

3. Pharmacy

4. Laboratory

5. Radiology Reports

6. Information for Financial Managerial Purposes

7. Physiologic Monitoring Systems in the ICUs

1. Physician Order

2. Physiologic Monitoring Systems in ICUs

3. Pharmacy

4. Laboratory

5. Radiology Reports

6. Results Reporting

7. Information for Financial Managerial Purposes

In the 1970s, hospitals began developing computer-based information systems which initially focused on the following:

1970s

Identify the Time Period of the following:

A few systems started to include:

1. Care Planning

2. Decision Support

3. Interdisciplinary Problem List

1. Care Planning

2. Decision Support

3. Interdisciplinary Problem List

In the 1970s, a few systems started to include:

1970s

Identify the Time Period of the following:

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

1970s

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Interest in computers and nursing began to emerge in public and home health and education

1970s

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Conferences helped public and home health nurses:

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

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

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

2. Provide information on the usefulness of computers for capturing and aggregating home health and public health info

In the 1970s, conferences helped public and home health nurses:

1970s

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Hospitals and agencies embarked on investigating computers and nursing

1970s

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Opportunity to improve education using computer technology also began

1970s

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Early nursing networks helped to expand nursing awareness of computers and the impact HIT could have on practice

1970s

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The Clinical Center at the National Institutes of Health implemented the Technicon Data Systems (TDS) computer system.

Clinical Center at the National Institutes of Health

In the 1970s, who implemented the Technicon Data Systems (TDS) computer system?

Technicon Data Systems (TDS)

In the 1970s, what did the Clinical Center at the National Institutes of Health implement?

Technicon Data Systems (TDS)

Was the first system to include nursing practice protocols

1970s

Identify the Time Period of the following:

One of the earliest clinical information system of the TDS was developed, called Eclipsys and now Allscripts

Eclipsys (now Allscripts)

In the 1970s, ,what was one of the earliest clinical info system of the TDS?

1980s

Identify the Time Period of the following:

Field of NI exploded and became visible in the healthcare and nursing

1980s

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Nursing profession needed to update its practice standards and determine its data standards, vocabularies, and classification schemes that could be used for the computer-based patient record system

1981

Identify the Year of the following:

National and international conferences and workshops were conducted by a few nursing pioneers to help nurses understand and get involved in this new emerging nursing specialty

1980s

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Many mainframe healthcare information systems (HISs) emerged with nursing subsystems

Healthcare Information Systems (HISs)

In the 1980s, many mainframe what emerged with nursing subsystems?

1980s

Identify the Time Period of the following:

HISs documented several aspects of the patient record namely:

1. Provider order entry

2. Results reporting

3. Kardex reporting

4. Vital signs

5. Other systems-documented narrative nursing notes using word processing software packages

1. Provider order entry

2. Results reporting

3. Kardex reporting

4. Vital signs

5. Other systems-documented narrative nursing notes using word processing software packages

In the 1980s, Healthcare Information Systems (HISs) documented several aspects of the patient record namely:

1980s

Identify the Time Period of the following:

The microcomputer or personal computer (PC) emerged during this period

1981

Identify the Year of the following:

The first Nursing Special Interest Group on Computers met for the first time during Symposium on Computer Applications in Medical Care (SCAMC)

Symposium on Computer Applications in Medical Care (SCAMC)

In 1981, the first Nursing Special Interest Group on Computers met for the first time during _____.

1985

Identify the Year of the following:

The ANA approved the information of the Council on Computer Application in Nursing (CCAN).

Council on Computer Application in Nursing (CCAN)

In 1985, the ANA approved the information of the ____

1980s

Identify the Time Period of the following:

CCAN became a very powerful force in integrating computer applications into the nursing profession

1980s

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CCAN board developed a yearly Computer Nurse Directory on the known nurses involved in the field, conducted computer applications demonstrations at the ANA Annual conferences, and shared information with their growing members in the first CCAN newsletter Input-Output.

Input-Output

In the 1980s, what was the first CCAN newsletter?

1986

Identify the Year of the following:

The first edition of this book was published.

1990s

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Advances in relational databases, client-server architectures, and new programming methods

1990s

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Better application developments at lower costs

Mid-1990s

Identify the Time Period of the following:

Legislative activity paved the way for electronic health records through the Health Insurance Portability and Accountability Act (HIPAA) of 1966 (Public Law 104 - 191)

Emphasizing standardized transactions, and privacy and security of patient-identifiable information

Health Insurance Portability and Accountability Act (HIPAA) of 1966

Mid-1990s, legislative activity paved the way for electronic health records through what, which emphasized standardized transactions, and privacy and security of patient-identifiable information?

1990s

Identify the Time Period of the following:

The complexity of technology, workflow analysis, and regulations shaped new roles in nursing.

1992

Identify the Year of the following:

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.

Scope of Nursing Informatics Practice Standards

In 1992, the ANA recognized nursing informatics as a new nursing specialty with a separate what?

1990s

Identify the Time Period of the following:

The demand of NI expertise increased.

1990s

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The ANA developed the Nursing Information and Data Set Evaluation Standards (NIDSEC) to evaluate and recognize nursing information systems.

Nursing Information and Data Set Evaluation Standards (NIDSEC)

In the 1990s, the ANA developed what to evaluate and recognize nursing information systems and guide the development and selection of nursing systems that included standardized nursing terminologies integrated throughout the system whenever it was appropriate?

1990s

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Technology rapidly changed increasing its use within and across nursing units, as well as across healthcare facilities

1990s

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PCs became smaller

1990s

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Computer notebooks became affordable

1990s

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Computers were linked through networks both within hospitals and health systems

1990s

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The internet became mainstream

1990s

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The World Wide Web (WWW) increased access to information

2004

Identify the Year of the following:

An Executive Order 13335:

• Established the Office of the National Coordinator (ONC) for HIT

• Issued a recommendation calling for all healthcare providers to adopt interoperable electronic health records (EHRs) by 2014-2015

Executive Order 13335

What did the following:

• Established the Office of the National Coordinator (ONC) for HIT

• Issued a recommendation calling for all healthcare providers to adopt interoperable electronic health records (EHRs) by 2014-2015

EO 13335 (2004)

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.

Office of the National Coordinator (ONC)

In 2004, Executive Order 13335 established what for HIT?

Interoperable electronic health records (EHRs) by 2014-2015

In 2004, Executive Order 13335 issued a recommendation calling for all healthcare providers to adopt what by what year?

2000s

Identify the Time Period of the following:

More and more healthcare information became digitalized and newer technologies emerged.

2000s

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Wireless, point of care, regional database projects, and increased IT solution proliferated

2000s

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The use of bar coding and radiofrequency identification (RFID) emerged as a useful technology.

Radiofrequency Identification (RFID)

In the 2000s, what helped ensure right patient with the right medication and helped nurses find equipment or scan patients to assure all surgical equipment is removed from inside before surgical sites are closed?

2000s

Identify the Time Period of the following:

Smaller mobile devices with wireless or Internet access increased access to information for nurses within hospitals and in the community.

2000s

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The development and refinement of Voice over Internet Protocol (VoIP) provided voice cost-effective communication, which uses internet rather than landline.

Voice over Internet Protocol (VoIP)

In the 2000s, the development and refinement of what provided voice cost-effective communication?

• Skype

• Teams

• Messenger

What are examples of VoIP?

2000s

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The Internet provided a means for development of clinical applications (e.g. telemedicines)

2000s

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The nursing informatics research agenda promoted the integration of nursing care data in HIT systems that would also generate data for analysis, reuse, and aggregation.

2010s

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

Nursing Minimum Data Set (NMDS)

In the 2010s, the impact of the ____ demonstrated that continued consensus and effort was needed to bring to fruition the vision and implementation of minimum nursing data into clinical practice.

2010s

Identify the Time Period of the following:

A new nursing informatics research agenda for 2008-2018 emerged as critical for this specialty.

The new agenda is built on one originally developed and published by the National Institute of Nursing Research (NINR) in 1993.

2008-2018; National Institute of Nursing Research (NINR)

For ____, a new nursing informatics research agenda was built on one originally developed and published by the ___ in 1993.

2010s

Identify the Time Period of the following:

A combination of the economic recession along with the escalating cost of healthcare results in the

• American Recovery and Reinvestment Act of 2009 (ARRA) and the

• Healthcare Information Technology for Economic and Clinical Health (HITECH) Act of 2009

with funding to implement HIT and/or EHR systems, support healthcare information exchange, enhance community and university-based informatics education, and support leading edge research to improve the use of HIT.

• American Recovery and Reinvestment Act of 2009 (ARRA) and the

• Healthcare Information Technology for Economic and Clinical Health (HITECH) Act of 2009

In the 2010s, a combination of the economic recession along with the escalating cost of healthcare results in what legislations, which leads to funding to implement HIT and/or EHR systems, support healthcare information exchange, enhance community and university-based informatics education, and support leading edge research to improve the use of HIT?

2010

Identify the Year of the following:

The Office of the National Coordinator (ONC) convened two national committees:

• National Committee on Health Policy

• National Committee on Health Standards, which outlined and designed the focus for the Meaningful Use (MU) Legislation

1. National Committee on Health Policy

2. National Committee on Health Standards

In 2010, what were the two national committees convened by the Office of the National Coordinator (ONC)?

National Committee on Health Standards

Which national committee convened by the ONC outline and design the focus for the Meaningful Use legislation?

Meaningful Use (MU)

• Use of EHR to improve patient care

• Set of standards health care providers must make to receive incentive payments

Meaningful Use

Designed to be implemented in at least three stages, with the ultimate goal of implementing a complete and interoperable EHR and/or HIT system in all US hospitals.

Centers for Medicaid and Medicare Services (CMS)

For each stage of Meaningful Use, regulations were proposed by the national committees, and developed and reviewed by the public before they were finalized by ____.

Philippine Health Insurance Corporation/PhilHealth

What is the Philippine equivalent of the Centers for Medicaid and Medicare (CMS)?

Physician Order Entry

In 2011-2012, MU Stage 1 was initiated focusing primarily on the computerized what?

Quality Indicators

In 2012-2013, MU Stage 2 was introduced focusing primarily on the implementation of what?

Quality Indicators

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

Care Outcome Measures and tentatively proposed Care Plans

In 2015-2016, MU Stage 3 will primarily focus on what?

2010s

Identify the Time Period:

Nurses are involved with all phases of MU, from implementation to assuring usage and adaptation. Majority of hospitals have HIT depts and employed at least 1 nurse to serve as an NI expert to assist in implementation of MU requirements.