Computers in Nursing: History

• Computer technology emerged in nursing because of changing technologies in the health care industry and in nursing practice.
• There are six time periods in this topic.

Prior to the 1960s

• The use of computers in the health care industry increased.
• Computers were initially used for essential business office functions in healthcare facilities.
• Punch cards were used to store data, and reader cards were used to read computer programs, sort, and prepare data for processing.

1960s

• Uses of computer technology in the healthcare setting began to be questioned

• The nurses’ station in the hospital was the center of information exchange.

• The introduction of cathode ray tubes (CRT), online data communication, and real-time processing, added important dimensions to the computer system.

• Hospital information systems (HIS) were developed to process financial issues and were used as billing and accounting systems.

1970's

• Nurses began to recognize computers' value for the profession.
• Several mainframe HISs were designed and developed; a few served as forerunners of today’s systems.
• Several states and large community health agencies developed and contracted computer-based management information systems (MISS).
• MISS provided statistical information required by local, state, and federal agencies for specific program funds.
• Home health agencies provided billing and financial information for reimbursement of patient services by Medicare, Medicaid, and other third-party payers.

1980s

• Nursing informatics (NI) became an accepted specialty, and many nursing experts entered the field.
• Mainframe HISs recorded documents, patient records, Kardex, vital signs, online sources, nurses' notes, and discharge plans.
• Microcomputers, or personal computers, emerged.
• Microcomputers were user-friendly and allowed nurses to create their applications.

1990s

• Computer technology was essential to healthcare, nursing practice, and the nursing profession.
• NI was approved by the American Nurses Association (ANA) as a new specialty.
• Smaller and faster computers, laptops, and notebooks were developed.
• Workstations and local area networks (LANs) were developed for hospital nursing units.
• Wide area networks were developed to link care across healthcare facilities.
• The internet started to link across different systems.

Post 2000

• Wireless point-of-care development.
• Clinical information systems became individualized in Electronic Patient Record (EPR).
• Electronic Health Record (EHR) is a life longitudinal record.
• Personal Digital Assistant (PDA)
• Voice over Internet Protocol (VoIP).
• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted.
• Critical Care Units are monitored remotely by healthcare providers (eICU).

Four Major Nursing Areas

• Four major nursing areas are being discussed.

Nursing Practice

• Nursing practice is integral to Electronic Health Records (EHR).
• EHR is used to assess problems, document care, track the care process, and measure outcomes.
• EHR has revolutionized and transformed nursing practice.

Nursing Administration

• Workload measures, acuity systems, and other nursing department systems are online and integrated with the hospital for patient's EHR systems or in separate nursing department systems.

Nursing Education

• Campus-wide computer systems are available for students to communicate via email, transfer data files, access digital libraries, and retrieve online resources of millions of internet websites.

Nursing Research

• Nursing research provides impetus to use the computer for analyzing data.

Standard Initiatives

• Initiatives influenced the nursing profession and the need for computer systems, information technology, and terminologies to gain acceptance among healthcare policy makers.

Nursing Practice Standards

• Nursing Practice Standards have been developed and recommended by the ANA.
• Nursing Practice Standards also have been set by the Joint Commission on Accreditation of Hospital Organizations (JCAHO).
• Standards include EHR contents, such as what data should be collected and how the data should be organized in the electronic database.

Nursing Data Standards

• Nursing Data Standards emerged as a new requirement for the EHR.
• The ANA is responsible for the recognition of the terminologies and determining if they meet the criteria to be included in the National Library of Medicine.

Health Care Data Standards Organizations

• American National Standards Institute (ANSI)
• American Society for Testing and Materials (ASTM)
• SNOMED
• National Committee on Vital and Health Statistics (NCVHS)

Early Computer-Based Nursing Applications

• Applications were Developed before the mid-1970s as part of larger HISs.
• Applications focused on documenting nursing practice and managing patient care.
• Applications were designed for hospitals, ambulatory care settings, and agencies for community health.

Landmark Events in Nursing and Computers

• Landmark events were first introduced into the nursing profession over 35 years ago.
• Major milestones of nursing are interwoven with the advancement of computer and information technologies, increased need for nursing data, development of nursing applications, and changes making the nursing profession an autonomous discipline.