Nursing Informatics History

8/12/2019 Nursing Informatics History

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NURSINGINFORMATICS

Valery C. Lim, MSN



Introduction:

> NI how it is started? NI was started through theEHR Decade (electronic health record)->

mandated by the President of the UnitedStates and the secretary of Health and HumanServices ( HHS)



NOW NI is…

> Moving to the forefront of the nursingprofession and nursing information technology

system Nurses are becoming and or computer literate

Nursing profession is implementing standards

for its clinical care and data for its nursinginformation technology systems.



What is the role of the nurses in NI?

Since nurses are the largest group of professionals thatprovide clinical care to patients and consumers advocate- nurses are qualified as INFORMATION SPECIALISTS- may serve as….

1. Administrator2. Researcher

3. Educators and

4. Community health care professionals or work as

5. Computer information officers (CIOs)6. Corporate executives in vendors companies

7. Implementers of information technology

8. Developers of systems and

9. Consultants



Definition of NI by ANANI is… A specialty that integrates nursing science, computer

science and information science to manage and

communicate DATA, INFORMATION andKNOWLEDGE in nursing practice. facilitates the integration of data, information and

knowledge to support patients, nurses and otherproviders in their decision making in all roles and

settings Represents the transition of data, and data

information and knowledge into action Also represents the practice, administration,

community health education and nursing researchapplication.



NI specialists emerged as a new specialty bythe ANA

Majority of nurses entering the profession is

computer literate Every health care setting ---acute care

hospital, academic school of nursing, largecommunity health agency or health care

setting where nurses function---will employ atleast one NI specialist and will implementsome type of a CIS (clinical informationsystem)



CIS designed to support nursing practice. Itrequires an understanding of professionalnursing practice process, technology that is

the application for the science to functionelectronically.

CIS that adequately support nursing practicehave not emerged over the past decades-- Major historical perspectives of nursing

and computers..



Major historical perspectives ofnursing and computers

Intro..

Computer technology emerged in nursing inresponse to the changing and developingtechnologies in health care industry and in nursingpractice. It is analyzed in the ff:

1.SIX TIME PERIODS

2. Four major nursing areas

3. Standards initiatives 4. Significant landmarks and;

5. Major landmarks milestone chart



Six Time Periods

1. Prior to 1960s (starting 1950s)

Nursing profession undergoing majorchanges.

Image of nursing was improving, nursingpractices and services were expanding inscope and complexity and number of nurseswas increasing these events provided for

the profession to embrace computers. Computers were initially used in health care

facilities for basic business office function.



1 Prior to the 1960’s

2. 1960s

3. 1970s

4. 1980s

5. 1990s

6. Post 2000



1.Prior to 1960s (1950)

There were only few experts that attempt to adapt computersto health care and nursing

Nursing profession was undergoing major changes.

Image of nursing was improving, nursing practices andservices were expanding in scope and complexity, thenumber of nurses were increasing.

Computers were initially used in health care facilities for basicoffice functions.

These early computers used punch cards to store data andcard readers to read computer programs, sort, and preparedata for processing. They were linked together and operatedby paper tape and used teletypewriters to print their output.



2.1960s

Used of computer technology in health caresetting began to be questioned. Why

computers? What should be computerized? - Nursing practice was reviewed and nursingresources were analyzed.

Studies were conducted to determine howcomputer technology could be utilizedeffectively in the health care industry and whatareas of nursing should be automated?



Nurses station the most appropriate centerfor the development of the computerapplications.

Computer technology advanced so as with thehealth care facilities increased.

Introduction of cathode ray tube (CRT)

terminals, online data communication, andreal- time processing—added importantdimensions to the computer system providing more accessible and ―user -friendly‖

machines.



Hospital Information Systems (HISs) weredeveloped primarily to process financialtransactions and serve as billing and

accounting system. However, few HISsemerge—document and process limitednumber of medical orders and nursing careactivities.



3. 1970s

Continued integration of computers into nursing.

Nurses began to recognize the value of the computer for theirprofession.

Nurses recognized the computer’s potential for improving thedocumentation of nursing practice, the quality of patient care,and the repetitive aspects of managing patient care.

Nurses assisted in the design and development of nursingapplications for the HISs and other environments wherenurses functioned.

Several states (in the USA) and large community healthagencies developed and/or contracted for their owncomputer-based management information systems (MISs)



MISs? For Public Health MISs provideinformation required by the local, state, andfederal agencies for specific program funds

MIS Home health agencies providedbilling and other financial information requiredfor reimbursement of patient services byMedicare, Medicaid, etc.



1980s

The field of informatics emerged in the healthcare industry and nursing.

NI became accepted specialty of nursing.

Use of computers in nursing becamerevolutionary

The need for nursing software evolved. Nursing profession needed not only to update

its practice standards but also to determine its

data standards, vocabularies and classification





PCs brought computing powers to theworkplace, more importantly to the point ofcare.

1990s Computer technology became an integral part

of health care settings, nursing practice, and

the nursing profession. Policies and legislation were adopted

promoting computer technology in health careincluding nursing.



Nursing profession became actively involvedin promoting NI.

1992 NI was approved ANA as new nursing

specialty- demand for NI expertise increasedgreatly in the workplace and other settingswhere nurses functioned.

Need? Computer –based nursing practicestandards, data standards, nursing minimumdata sets.



Smaller and faster computers laptops andnotebooks- to the bedside, and all of thepoint-ofcare settings.

Workstations and Local Area Networks (LAN)were developed for hospital nursing units

Wide Area Networks (WANs)- for linking care

across health care facilities Internet- started to be used for linking

across the different systems. made itpossible for information and knowledge

databases to be integrated into bedside



Internet

- for sophisticated information technologies.

1995 E-mail

Facilitates data exchange between CPRsacross the facilities and settings.

Web- became the means for communicating

online services and resources to the nursingcommunity.





Technology: wireless tablet computer,PDAs,and smart cellular phones, voice over internetprotocol (VoIP).

Internet provided a means for development ofclinical applications.

Critical care units are monitored remotely by

health care providers. Home health care increasingly partnered with

information technology for the provision ofpatient care.



Telenursing recognized as specialty 1990s increased in popularity and providing patientcare.



Four major nursing areas

That shaped the need for computers,information technologies and informatics.

1. Nursing Practice

2. Nursing administration

3. Nursing education

4. Nursing research



Nursing Practice

Became an integral part of the HER

Computer systems with nursing and patient care data, nursing careplans are no longer separate subsystems of the computerized HISs,

but rather integrated into one interdisciplinary patient health record(EHR).

Nursing practice data emerged with the introduction of severalnursing terminologies that were recognized by the ANA as codedterminologies usable for EHR used to assess problems,

document care, track the care process and measures outcome Electronic version of nursing practice.

Computer revolutionarized and transformed the nursing practice.



Nursing Administration

Changed with the introduction of the computerthat links nursing departments together.

Policy and procedure manuals are accessedand retrieved by computer.

Nurses have access to digital libraries, online

resources, and research protocols at thebedside.





Nursing Research

Software programs are available for bothquantitaive and qualitative research.

Online searching and retrieving informationfrom the electronic bibliographic literaturesystems.

Increased capabilities and expanded the fieldof nursing research.



Electronic Health Records

Introduction:

This presentation seeks to highlight thefoundation and purpose of Electronic Health

Records (EHR). This is a new way of storingand organizing patient’s medicalinformation.EHR patient files are divided intosections where health care providers and staffcan find the information they need to providepatient care.



CONTENT

Definition

Benefits of EHR

How secure is EHR in patient privacy

Who access patient information



is a digital format or documentation of anindividual’s medical history that is maintained

by health care providers or health institutions.

It includes information on patient’sdemographics progress notes, medicationproblems, vital signs, past history, diagnosticresults and vaccination.



Benefits of HER

1. 1. Medical errors

EHR enables patients’ safety by eliminating medical

error through illegible handwriting by physicians. Medical documentation in EHR appears to be clear

and legible and thus reduces legal implications. Fewerforms to fill out during a visit

Fewer repetitive questions – regarding past medicalhistory

alert system ensure proper dosage and drugs areadministered.



2. Improves patients quality of life

EHR assist in better disease management andclient education.

It also enhances communication amonghealthcare providers.

When patient are educated and healthcare

providers work collaboratively better patientoutcome is achieved.



3. Reduces cost of healthcare

EHR reduces transcription, re-filling andstorage cost. It saves time and cost through

eliminating redundant diagnostic testing, papercharting and decreasing storage and retrievalcost. This digital format enables healthcareprofessionals to communicate and track datafor specific patients



3. EHR maintains patient privacy

HIPAA law protects:

any information that your doctors, nurses, or

other health care providers put in the medicalrecord

conversations between doctors and others

about your familys care or treatment information about your family in the health

insurance carriers computer system

billing information



Who has access to information?

Access to information is done through hospitaldatabase that can be access through every

computer. To open a patients health record, health care

providers would log into the system with a

username and password or thumbprintidentification.

History of Electronic



History of ElectronicHealthRecords(EHR)

TIMELINE:

Mid 1960s Late 1960s 1972 19821965 Early1970s Early 1980sLate 1980s 1994 1996 1999

2002Early 1990s 1995 1997 Early 2000s20042007 2009 20112006 2008 2010 Mid-2011



Mid 1960s: Lockheed Unveils ClinicalDataManagement System

One of the earliest data processingsystems

focused specifically onmanaging clinical data – now called a hospital information system(HIS).

HIS is introduced at El Camino Hospital inMountain View, California



1965: National Library of Medicine Moves toComputer System

The National Library of Medicine converts

the Index Medicus – a comprehensive index ofthe worlds leading biomedical literature – tothe computer-based version later calledMedline, beginning the shift to electronic ratherthan paper-based information resources



Late 1960s: ―Problem-OrientedMedicalRecord‖ Introduced

Physician Larry Weed introduces the idea of

recording patient information electronically,aiming to generate a record that would allow athird party to independently verify thediagnosis.

Prior to this, a doctor only recorded hisdiagnoses and the treatment provided



Early 1970s: VistA Initiated to ManageVeterans Health Data

The predecessor to todays Agency for

Healthcare Research and Quality(AHRQ)initiates the concept behind Veterans Health

Information Systems and Technology

Architecture (VistA).

This marks the start of heavy governmentinvestments in VisTA and clinical IT



1972: First Electronic Medical Records SystemDeveloped

The Regenstreif Institute develops the first

electronic medical record system. Although the technology is widely regarded

as a major advancement for medical practices,

it does not attract many physicians



Early 1980s: VA Health Information SoftwareDeclared Public

The VistA information system is legally

declared available for unrestricted use withinthe public or private sectors.

This open-source collaboration marks the

evolution of VA health software. Majorhospitals in other countries adopt and modifyVistA and its information-driven care model



1982: Dragon Systems PioneersVoiceDictation Software

Early voice recognition prototype evolves

into Dragon Dictation, used today by morethan 150,000doctors and caregivers.

Its wide adoption illustrates that one early

key to success in healthcare IT was a designbuilt around doctors’ existing processes



Late 1980s: Emergence of Low-CostPCsSpurs Wide Adoption

Lower costs of personal computers(PCs)

make it an affordable way to automate corehealth care functions. Windows-basedsoftware emerge soon thereafter. Doctorsfollow the trend and buy PCs for their offices.

While EHRs weren’t widely adopted yet,practice management functions (billing andscheduling)started to move to computers



Early 1990s: Emergence of the WorldWideWeb

After Tim Berners-Lee established the World

WideWeb in 1990, new developments inbrowser interfaces – such as MicrosoftExplorer and Netscape Navigator – make itfaster and easier to access information online.

People begin to access health informationonline and the stage is set for web-basedEHRs



1994: Clinitec Sells Software to ConvertPaperRecords to EHRs

Two years after its birth the company is

bought by Quality Systems, Inc., a dentalsoftware company, which soon merges withMicromed, which provides front- and back-office practice management software.

In 2001, Clinitec and Micromed combine toform NextGen Healthcare InformationSystems, which becomesNextGen Healthcare.



1995: Eclypsis Corporation Founded

The company provides hospitals and otherhealthcare organizations with EMR,

computerized physician order entry, andrevenue cycle management software.

In 2008, the company acquires physicianpractice management software companyMediNotes.

Eclypsis merged with All scripts in August2010.



1996: Health Insurance Portability and Accountability Act

All software used to manage health

insurance claims must follow HIPAA’s newregulations on health record use, disclosureand confidentiality.

Software developers accurately predict oneconsequence of HIPAA will be a shift toelectronic health record (EHR),which cangreatly aid providers in complying with

confidentiality laws.



Veterans Health Administration Mandates Useof EHRs

The largest integrated health care system in

the United States, VHA, mandates use ofEHRs throughout all facilities. VHA quality ofcare shows significant improvement in thewake of these changes.

Later research indicates VHA care is betterthan that administered by Medicare, thegovernment social insurance program

administeredto Americans 65 and older.



1997: Allscripts Begins Focusing onHealthcareIT

The company a year later launches an

electronic prescribing solution for physicians,then acquires a series of ambulatory electronicmedical record companies.

By 2011 the product is used by over180,000physicians. Allscripts is now arguably thelargest EHR vendor





Early 2000s: Emergence of Web-basedSoftware

Salesforce.com and other web-based

companies emerge, proving that the software-as-a-service(SaaS) model is viable.

EHR vendors begin to offer remotely-hostedoptions, and new purely web-based vendorsstart to enter the market.



2002: GE Acquires MedicaLogic andMillbrook

The acquired solutions are later re-brandedCentricity with two applications, Centricity

EMR and Centricity Physician Office. Building on the momentum and experience

of MediaLogic and Millbrook, Centricityeventually emerges as the brand of 31healthcare IT solutions that form part of GEHealthcare, a division of General Electricvalued at $17 billion today.



2004: President George W. BushPromotes Adoption of EHRs

Demonstrating his commitment to

healthcare information technology, thePresident for health care IT demonstrationprojects to$100 million, creates a new sub-Cabinet position of National Health Information

Coordinator, and calls for widespread adoptionof EHRs by 2014, referring specifically tostandards for electronically transmitting X-rays,

lab results and electronic prescriptions. EHRs



2006: CCHIT Certifies Electronic HealthRecords Systems

Certification Commission for Health

Information Technology(CCHIT), a nonprofitaiming to accelerate adoption of secure andinteroperable health IT, begins certifyingelectronic health records systems to help

providers choose quality products.Controversy emerges later over CCHIT’s closeties to the board of trustees ofHealth care

Information and Management Systems



2007: VA and Kaiser Permanente CreateCONNECT

CONNECT- an open-source, cross-agency

software system –promotes sharing healthrecordsand aims to move the US towardnational interoperability. Health giant KaiserPermanente achieves inter operability with

VistA and uses many of its techniques



2008: Idea of Personal Health Record Reemerges

Growth in the Internet drives the idea of the

personal health record (PHR), a record wherean individual curates his/her own health dataonline or via an electronic device.

With the development of web technologies,the possibility of storing, exporting, andsharing patient-reported data makes sense.Google and Microsoft release PHR solutions



2009: HITECH Act Passes

Health Information Technology for Economicand Clinical Health(HITECH) Act passes as

part of President Obama’s American Recoveryand Reinvestment Act (ARRA) of 2009stimuluspackage. ARRA encourages the switch toelectronic records by providing Medicaid

rebates of up to$63,750 and Medicare rebatesof up to $44,000



2010: Apple’s iPad Spurs Widespread Use ofTablet Computers

The iPad ushers in the reemergence of the

tablet era to build on the features of the earlierTablet PC. Experts predict Gen Y and Z’ers willbe eager to engage with personal medicalrecords in part because of the high-tech,

interactive format.

Physicians start to demand the samesimplicity and convenience in the workplace

that they enjoy at home with their iPads.



2011: ONC-ATCB Certification ProgramCreated

The Office of the National Coordinator of the

HITECH Act creates a certification program inresponse to the need for clarity on what EHRsare capable of meeting meaningful use criteriaduring the first phase, or Stage 1, of adopting

EHRs. Specifically, the ONC announces whichthat 6 certification bodies, including CCHIT,are approved to verify meaningful use.



Mid-2011: HHS Proposes Accountable Care

To help providers better coordinate careacross settings for Medicare patients, new

regulations propose creating AccountableCare Organizations. ACOs that help reducehealthcare costs and meet performancestandards would be rewarded. This

represents a shift away from fee-for-servicemodel toward a focus on prevention – with theHER playing a key role in capturing patient

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Nursing Informatics History

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