COMPUTERS AND NURSING

NCM 221 - NURSING INFORMATICS (LEC)

BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

Introduction
● Nurses are becoming computer literate and
the nursing profession is implementing
practice standards for its clinical care and
data standards for its nursing information
technology system.
● NI represents the transition of data and data
information and knowledge into action.
● NI represents the practice, administration,
community health, nursing education, and
Organizing Framework for Clinical
nursing research applications.
Information System (CIS)
● Demonstrate how IT supports nurses to
improve quality, ensure safety, measure ● Provides an organizing framework and
outcomes and determine costs identifies some of the system components,
influencing factors, and relationships that
Overview
have not been fully considered in describing
Nursing Informatics is defined by American Nurses the complexity of nursing, a profession that
Association (ANA, 2001): relies so heavily on evidence, knowledge,
● A specialty that integrates nursing science, and critical thinking.
computer science, and information science to ● Consequently the requisite detailed analysis
manage and communicate data, information, and design processes have never begun or
and knowledge in nursing practice. Nursing have failed to generate the appropriate and
informatics facilitates the integration of data, diverse information system components
information, and knowledge to support necessary for successful support for nurses
patients, nurses, and other providers in their and nursing practice (Androwich et al,. 2003).
decision-making in all roles and settings. This ● The increased interest in NI occurred
support is accomplished through the use of because of the concerted efforts of several
information structure, information processes, groups that promoted nursing as an integral
and information technology part of the EHR systems being implemented
● A CIS is designed to support clinical nursing in healthcare.
practice. It requires not only an ● Individual nurses began to demand CIS to
understanding of professional nursing document their care, regardless of where
practice process but also technology that is they worked and the vendors of the EHR
the application for the science to function systems began to include nursing care
electronically components in their systems

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COMPUTERS AND NURSING
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

Historical Perspectives of
Nursing and the Computer Six Time Periods
● 1950
Overview ○ Computers and computerized
● The computer is the most powerful equipment were becoming an
technological tool to transform the nursing important part of the health care and
profession prior to the new century. began influencing the nursing
● Computer is an all encompassing term profession (Saba, 2001).
referring to information technology (IT), ● 1960
computer systems, and when they are used ○ Computers, while rudimentary, were
in nursing, refer to nursing informatics beginning to be used in healthcare.
systems, nursing applications. For example, the United States
● Computer in nursing are used to manage began to use computer systems to
information in patient care, monitor the process standardized
quality of care, and evaluate the outcomes of reimbursement forms with the
care. passage of the Medicare legislation
● Computers are also used to support nursing in 1966 (Saba, 2001).
research, test new systems, design new ○ The nursing profession began to
knowledge databases, and advance the role embrace and utilize informatics
of nursing in the health care industry. principles. During the 1960's a
nurse created an obstetrical
Major Historical Perspectives of Nursing and computer assisted nursing
Computers simulation exercise
● 1970
● six time periods ○ Informatics was coined in the 1970’s
○ prior to the 1960s, the 1960s, the from the French term informatique
1970s, the 1980s, the 1990s and in reference to advancing computer
post2000 technology (Saba, 2001). The
● four major nursing areas "informatics movement" was felt
○ nursing practice, administration, throughout all disciplines of health
education, and research care both nationally and
internationally (Saba, 2001, p. 178).
● standards initiatives ○ Nursing stations were studied and
○ nursing practice, nursing data, and identified to be central to patient
health care data standards care and deemed fundamental in
● significant landmarks events the creation of health information
● major landmark milestones chart listing those systems (HIS) (Saba, 2001).
events that influenced the introduction of ○ The adoption of some of the first
computers into the nursing profession HIS and Electronic Medical Records
including the key “computer/informatics” (EMR) occurred in the 1970's
nurse that directed the activity (Thede, 2012).

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COMPUTERS AND NURSING
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

○ By 1974 the first nursing informatics Brittain, 2012; Saba, 2001). And by
papers were presented at the 1985, computer technology classes
Medical Informatics Conference in were being offered at undergraduate
Sweden (Saba, 2001). and graduate levels (Saba, 2001).
○ Five papers were presented on a ○ The Computers in Nursing journal
variety of topics including: general was founded (Saba, 2001).
description of informatics impact, ○ International Medical Informatics
computer education of health care Association (IMIA) formally
workers, the design of nursing care recognized nursing as integral and
protocols for hospital information in 1982 the IMIA-Nursing
systems (HIS), advancing real-time Informatics Special Interest Group
cardiac monitors, and computerized (IMIA/NISIG) was formed (Saba,
medication systems (Saba, 2001). 2001). IMIA/NI-SIG holds
○ In the early 1970's, workshops were conferences every 3 years with the
being offered on how to use mandate to promote informatics
computer systems in home care education, collaboration, and
(Saba, 2001). In the US, computers support of NI development (Saba,
were used to calculate the cost of 2001).
home care visit (Saba, 2001). ○ 1980’s most Canadian hospitals had
○ Canadian Organization for the some form of computer information
Advancement of Computers in system for entering data (Kaminski,
Health (COACH) was found in 1975 2011).
(Kaminski, 2011). COACH works to ○ 1989 the International Council of
develop professional guidelines for Nurses (ICN) approved an initiative
utilizing computers in health care to develop a common NI language
(Kaminski, 2011). (Saba, 2001).
● 1980 ● 1990
○ The size of personal computers ○ In 1992 the American Nursing
(PC) became smaller while their Association (ANA) recognized
capabilities increased (Saba, 2001). nursing informatics as nursing
These technological advancements specialty (Saba, 2001). An by 1995
created high expectations for the the first NI credentialing exam was
benefits of nursing informatics offered by the ANA (Saba, 2001).
(Thede, 2012). ○ In 1998 the Canadian Nurses
○ Nursing informatics originated in Association (CNA) created the
1980’s to refer to computer National Nursing Informatics Project
technology, computer system, data which sought to develop Canadian
processing (Saba, 2001). competencies and strategies
○ During the 1980’s there were (Kaminski, 2011).
significant financial investments and ○ Nursing Minimal Data Set was
a big educational push to educate created as a way to ensure nursing
nurses in informatics (Norris & data was included within the

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COMPUTERS AND NURSING
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

Canadian Institute of Health ● The Internet is being used by nurses to

Information (CIHI) national database access digital libraries, online resources and
(Kaminski, 2011). research protocols.
○ In 1999 the International Council of Nursing Education
Nurses (ICN) created a program to ● Campus-wide computer systems are
expand the scope of practice and available for students to communicate via
advance nursing knowledge e-mail, transfer data files, access the digital
worldwide (Saba, 2001). libraries, and retrieve online resources of
● 2000 millions of Internet WWW sites.
○ During the 2000's the CNA ● Time, distance and cost are no longer
continued to support informatics barriers to educational programs.
development through the publication
Nursing Research
of documents
● Provides the impetus to use the computer for
● 2001
analyzing nursing data.
○ In 2001 the Canadian Nursing
● Software programs are available for
Informatics Association (CNIA) was
processing both quantitative and qualitative
founded with the aspiration to be the
research data.
voice for Nursing Informatics in
Canada (CNIA, 2012).
Standards Initiatives
● 2003
○ In 2003, CIHI published the Nursing practice standards
Roadmap Initiative (CIHI, 2003) ● American Nurses Association (ANA)
● 2006 ○ The official professional nursing
○ In 2006, the CNA launched education
NurseONE to develop a national ○ Published The Standards of Clinical
strategy for nursing informatics Nursing Practice which focused not
(Kaminski, 2011) only on the organizing principles of
clinical nursing practice but also the
Four Major Nursing Areas standards of professional
performance.
Nursing Practice
○ Has been set by the Joint
● Computer systems with nursing and patient
Commission on Accreditation of
care data are integrated into one
Hospital Organizations (JCAHO)
interdisciplinary patient health record in EHR.
which stressed the need for
● Nursing practice data emerged that were
adequate records on patients in
recognized by ANA and used in EHR.
hospitals and practice standards for
● The electronic version of nursing practice-the
the documentation of care by nurse.
computer-has revolutionized and transformed
● Nursing Data Standards
nursing practice.
○ 13 nursing terminologies that have
Nursing Administration been recognized by the ANA in
● Most policy and procedure manuals are which it was developed at different
accessed and retrieved by computer. times, has different characteristics

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COMPUTERS AND NURSING
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

and is used for documenting dependent healthcare-oriented

different aspects of nursing practice. information systems
○ ANA is responsible for the ○ SNOMED International is another
recognition of the terminologies and organization that servers as an
for determining if they have met the umbrella of the structured
criteria to be included in the nomenclatures and its merger with
National Library of Medicine (NLM) the Read Codes from the National
Unified Medical Language Systems Health Service in UK. SNOMED CT
(UMLS). the newly named that serves as the
● Health care data standards coding strategy and has become a
○ American National Standards national standard for EHR aspects
Institute (ANSI)a private nonprofit ○ The National Committee on Vital
membership organization. and Health Statistics(NCVHS)
○ ANSI was combined with the Health Workgroup on Computer-based
Care Informatics Standards Patient Records was created to help
Board(HISB) to form ANSI-HISB to the Department of Health and
fulfill a request by the European Human Services (DOHHS)
standards coordinating organization investigate and approve health care
to represent the U.S. standards standards for the federal
effort government to use to implement
○ The ANSI-HISB organization acts federal legislation.
as one linking to the two major
organizing in Europe Landmark Events in Nursing and Computers
■ European Standardization
● Early conferences, meetings
Committee(CEN)
● Early academic initiatives
■ International Standard
● Initial ANA initiatives
Organization (ISO)
● Initial National League for Nursing (NLN)
○ American Society for Testing and
initiatives
Materials (ASTM): ASTM E-31
● Early international initiatives
Committee on Healthcare
● Initial educational resources
Informatics is an accredited
● Significant collaborative events
committee that develops standards
for health information and HISs
designed to assist vendors, users,
and anyone interested in
systematizing health information
○ Health Level Seven(HL7) an
organization accredited by the
ANSI, which was created to develop
standards for the electronic
interchange of clinical, financial and
administrative information among

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COMPUTER HARDWARE
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

○ ROM (Read Only Memory)

COMPUTER HARDWARE ○ RAM (Random Access Memory)
● Defined as all of the physical components of READ ONLY MEMORY (ROM)
the machine itself.
● Basic hardware: ● A form of permanent storage
○ Electronic circuits ● Generally contains the programs called
○ Microchips firmware, used by the control unit of the CPU
○ Processors to oversee computer functions
○ Motherboard ○ *ROM storage is not erased when
● Includes devices that are peripheral to the the computer is turned off.
main computer box such as input and output
RANDOM ACCESS MEMORY (RAM)
devices.
● Refers to working memory used for primary
COMPUTER HARDWARE FUNDAMENTALS: storage.
MOTHERBOARD ● A volatile and used as temporary storage -
can be accessed, used, change and written
● A thin, flat sheet made of a firm, non on repeatedly
conducting material on which the internal ● Contains data and instructions that are
components-printed circuits, chips, slots and stored and processed by computer programs
so on- of the computer are mounted. called applications programs
● Made of dielectric or non conducting plastic ● The work area available to the CPU for all
material and the electric conductions are processing applications
etched or soldered onto the bottom of the ● The contents are lost whenever the power of
board. the computer is turned off.
● Has holes or perforations through which
components can be affixed. COMPUTER HARDWARE FUNDAMENTALS:
INPUT AND OUTPUT
COMPUTER HARDWARE FUNDAMENTALS:
CENTRAL PROCESSING UNIT (CPU) ● Input devices – allow the computer to receive
information from the outside world.
● The “brains” of the computer ○ e.g. keyboard, mouse, touch
● Consists of at least one arithmetic and logic screen, light pen, voice and scanner
unit and memory.
○ the arithmetic and logic units control INPUT DEVICES
mathematical functions
● Touch screen – both input and output device
○ the control unit carries out the
combined.
machine language functions called
● Light pen – a device attached to the
fetch, execute, decode and store
computer that has special software that
COMPUTER HARDWARE FUNDAMENTALS: allows the computer to sense when the light
MEMORY pen is focused on a particular part of the
screen.
● 2 types:

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COMPUTER HARDWARE
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

● Voice system – allow the nurse to speak into ○ it allows the user to transport data &
a microphone to record data. programs from one computer site to
○ Some devices are used for security another
and can detect user’s finger prints,
retinal prints, voice prints or other CD ROMs AND USB DISK
personally unique physical ● CD-ROM
characteristics that identify users ○ a rigid disk that holds a much higher
who have clearance to use the density of information than a
system. diskette & has a much higher speed
● USB disk
OUTPUT DEVICES
○ a small removable hard drive that is
● Allow the computer to report its results to the inserted into the USB port of the
external world computer
● Can be in the form of text, data files, sound, ○ a read-write device like floppies &
graphics or signals to other devices e.g. small enough to transport
monitor and printer comfortably in a pants pocket

COMPUTER HARDWARE FUNDAMENTALS: COMPUTER HARDWARE FUNDAMENTALS:

STORAGE MEDIA OTHER OUTPUT DEVICES
● Common storage devices: ● Magnetic tape drives
○ Magnetic storage media ○ In 1980 & early 1990s were a
■ Hard drive popular way to back up hard drive
■ Diskettes data
○ Optical storage ● Zip drives
■ CD-ROMs ○ More similar to ordinary floppy disks
○ Optical media are read by a laser but are of higher capacity
“eye” rather than a magnet
○ COMPUTER POWER

HARD DRIVE AND DISKETTES ● Bits & bytes refer to how the machine stores
information at the lowest or closest to
● Hard Drive machine registers & memory level.
○ a peripheral that has very high ● bit (binary digit)
speed and high density ○ a unit of data in the binary
○ a very fast means of storing & numbering system; on= 1; off= 0
retrieving data as well as having a ○ an on/off switch
large storage capacity in ● Byte – made up of 8 bits
comparison with the other types of
storage COMPUTER SPEED
● Diskettes
○ a round magnetic disk encased in a ● The CPU speed is measured in cycles per
flexible or rigid case second which one called the clock speed of
the computer.

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COMPUTER HARDWARE
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

● 1 million cycles per second is called 1 applications requiring gigantic

megahertz(MHz). amounts of calculations view image

CLASSES OF COMPUTERS: ANALOG TYPES OF COMPUTERS: MAINFRAMES

COMPUTERS ● Fastest, largest & most expensive type of
computer used for processing, storing, &
● Operates on continuous physical or electrical
retrieving data.
magnitudes, measuring on going continuous
analog quantities such as voltage, current,
temperature & pressure.
● Accepts input/output signals e.g. heart
monitors & fetal monitors TYPES OF COMPUTERS: MICROCOMPUTERS

CLASSES OF COMPUTERS: DIGITAL ● Microcomputers (Personal Computer or PCs)

COMPUTERS ○ can serve stand-alone workstations
& can be linked to a network system
● • Operates on discrete discontinuous to increase their capabilities view
numeral digits using the binary numbering image
● Data are represented by numbers, letters &
symbols rather than by waveforms TYPES OF COMPUTERS: HANDHELD
COMPUTERS
CLASSES OF COMPUTERS: HYBRID
● Small, special function computer
COMPUTERS
○ e.g. PDAs – can have calendar,
● Features of both the analog & the digital contacts, note- taking, word
computer processing, spread sheet, dictionary
● Used for specific application such as view image
complex signal processing & other
engineering oriented applications COMMON HARDWARE PERIPHERALS
● e.g. physiologic monitors that are able to ● Keyboard
capture the heart waveform & also to ● Monitor
measure the core body temperature at ● Mouse & trackball
specific times i.e. ECG,EEG ● Floppy disks & diskettes
● Touchpad & mouse button
TYPES OF COMPUTERS: SUPERCOMPUTERS ● Light pen or touch screen
● Each type was developed as the computer ● OCR
industry evolved & each was developed for a ● MICR
different purpose. ● Printers
● Supercomputers (high-end computers) ● Modems
○ largest type of computer
BASICS OF COMPUTER NETWORK HARDWARE
○ computational-oriented computer
specially design for specific

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COMPUTER HARDWARE
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

● Network - a set of cooperative interconnected

computer for the purpose of information CABLE MODEM AND SERVERS
interchange. ● Cable Modem
○ includes : LAN, WAN, MAN ○ Uses the same type of connection
● The most important components of network that cable uses
hardware are the adapter or interface card, ○ The interesting thing is that TV uses
cabling & server very little of the bandwidth of a
● The most important concepts in network cable connection, so the same
hardware are architecture & topology. cable that brings a user cable TV
can
NETWORK HARDWARE
● Servers
● The role of hardware in a network is to ○ One computer is the core or server
provide an interconnection between computer that receives request from
computers. It must have at least 2 pieces of the client computer and fulfill there
hardware: request.
● NIC – Network Adapter or Network Interface
○ a computer circuit board or card that ARCHITECTURE
is installed in a computer so that it ● Refers to overall physical structure,
can be connected to a network. peripherals, interconnections within the
● Communication medium (cabling) computer & its system software especially
○ the means by which actual transfer the operating system.
of data from one site to another ● Can be divided into five fundamental
takes place components:
● Choice of communication medium is based ○ Input/output
on the following: ○ Storage
○ Distance ○ Communication
○ Amount of data transfer ○ Control üprocessing
○ How often the transfer is needed ● Two types of network architecture:
○ Availability ● Broadcast
○ done by transmitting the same
TELEPHONE LINES COMMUNICATION
information to all computers in the
● Specialized phone lines called integrated network
services digital network (ISDN) lines are ○ typically used in LANs
used to carry communication across phone ● Point-to-point
lines. ○ the computer for w/c information is
● ISDN – set of communication standards for intended is identified first, & the
optical fibers that carry voice, digital & video communication is only to that
signals across phone lines. particular computer.
○ typically used in “dial-up” networking

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COMPUTER HARDWARE
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

TOPOLOGY

● Defines how the network components in a

LAN are interconnected within a physical
area & describes their physical
interconnection.
● Different topology:
○ Bus – all the node computers are
directly attached to a line.
○ Star – centralized structure where
all computers are connected
through a central computer called
the server.
○ Ring
■ all LAN computers were
connected in a ring fashion
with wires or cables that
directly connected all the
computers together.
○ Forms:
■ Hub – consists of a
“backbone” or main circuit,
attached to a number of
outgoing lines
■ Arcnet – uses a “token
bus” system managing line
sharing among all the
users on the network

5
COMPUTER SOFTWARE AND SYSTEMS
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

SOFTWARE UTILITIES / UTILITY PROGRAM

● Is the general term applied to the instructions ● Software that performs specific task, usually
that direct the computer’s hardware to related to managing your computer, its
perform work. devices, or its programs.
● Its consist of instructions communicated
electronically to the hardware. USER INTERFACE
● Is a part of the software with which you
TYPES OF SOFTWARE: SYSTEM SOFTWARE
interact; it controls how data and instructions
● Boots up the computer system; controls are entered and how information is presented
input, output and storage; and controls the on the screen.
operations of the application software; ● Types of User Interface
● Consist of programs that controls the ○ Command Line Interface
operation of the computer and its devices. ○ Graphical User Interface (GUI)

TYPES OF SOFTWARE: APPLICATION TYPES OF USER INTERFACE: COMMAND LINE

SOFTWARE INTERFACE
● Includes the various programs that users ● You type keywords or press special keys
require to perform day to- day tasks from the keyboard to enter data and
instructions.
TYPES OF SOFTWARE: OPERATING SYSTEM ● Command language – are set of commands
● A set of programs containing instructions that you use to interact with the computer.
coordinate all the activities among computer
TYPES OF USER INTERFACE: GRAPHICAL USER
hardware resources.
● “A computer cannot function without an INTERFACE
operating system”. ● Allows you to use menus and visual images
such as icons.
SYSTEM SOFTWARE VS OPERATING SYSTEM
● Icons are small images that represents a
program, instructions or information.

LANGUAGE TRANSLATION UTILITIES

● Translation programs are needed to convert
instructions written in English-like language
into binary.
● These translation programs are called
assemblers, compilers or interpreters.

1
COMPUTER SOFTWARE AND SYSTEMS
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

APPLICATION SOFTWARE ASSEMBLER LANGUAGE

● Types of Application Software ● Its far more English-like language but it is still
○ Word processor very close to machine language
○ Spreadsheet ● Assemble language instructions have a
○ DBMS (Database Management one-to-one correspondence with a machine
System) language instructions.
○ Graphics ● Sample Code:
○ Games ○ PRINT_ASCII PROC
○ Accounting Package MOV DL, 00h
DL MOV CX, 255
PROGRAMMING LANGUAGE ○ PRINT_LOOP:
CALL WRITE_CHAR
● Is a means of communicating with the
INC DL LOOP
computer.
PRINT_LOOP
● Is a set of words, symbols, and codes that
MOV AH, 4CH
enables a programmer to communicate a
INT 21H ;21H
solution algorithm to computer.
○ PRINT ASCII
GENERATIONS AND LEVEL OF PROGRAMMING ○ ENDP
LANGUAGE
THIRD GENERATION LANGUAGE
● The term “level” refers to how close the
● Procedural language – requires the
language is to the actual machine.
programmer to specify both what the
● First level includes the first two generations
computer is to do and the procedure on how
of programming language: Machine language
to do it.
and assembly language
● The programmer must master the language's
● Second level includes high-level procedural
recognized words and utilize them in a
and nonprocedural language
specific order. Misplaced commas and letters
● Third level (fifth generation) is natural
cause software failure.
language.
● Syntax- the style and sequence of a
language
MACHINE LANGUAGE
○ Example: FORTRAN and COBOL
● Is the true language of the computer. ● MUMPS (Massachusetts General Hospital
● Its consists only of binary numbers 1’s and Utility Multi- Programming System)
0’s, representing the ON and OFF electrical ○ A third generation language written
impulses. specifically for use in healthcare
● All data- numbers, letters and symbols- are settings
represented by combinations of binary digits.
○ For example the no.3 is represented
by 00000011, and 6 is represented
by 00000110

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COMPUTER SOFTWARE AND SYSTEMS
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

○ Nurses use this to charge IVs,

FOURTH GENERATION LANGUAGE dressings, and other supplies.
● Specialized application programs that require ○ Laboratory systems
more involvement of the user in directing the ○ Used to order and report lab tests.
program to do necessary work. ○ Computer physician order entry
● Procedural languages include programs such (CPOE)
as spreadsheets, statistical analysis ○ For physician to document their
programs, and database query languages. medical orders
○ Example: Statistical Package for
Social Sciences (SPSS) – a SOFTWARE USEFUL TO NURSES
statistical analysis program ● Computer based systems for radiology
Structured Query Language (SQL)- orders
a language designed for ● Charting Software
management and query operations ● Computerized patient acuity system
on a relational database ● Used to help with nurse staff allocation
● Hospital email system
FIFTH GENERATION LANGUAGE ● Used for at least some hospital
● Are also called natural language. communications
● The user tells the machine what to do in the ● Chat rooms
user’s own natural language or through use ● Electronic bulletin boards
of a set of very English-like commands. ● Conferencing systems
● Natural language recognition, in which any ● Listservs
user could give understandable commands
to the computer in his or her own word style COMPUTER SYSTEMS
and accent. ● Consists of multiple, interconnected
computers that function and facilitate the
SOFTWARE PACKAGES work of groups of providers and their support
● Is designed to meet the needs of a wide people in a system called a network.
variety of users, not just a single user or ● Common types of computer networks
company. ○ Point-to-point
● Is sometimes called commercial-off-the shelf ○ Local area networks (LAN)
software. ○ Wide area network (WAN)
○ Metropolitan area network (MAN)
SOFTWARE USEFUL TO NURSES
POINT-TO-POINT NETWORK
● It includes :
○ Admission, discharge and transfer ● A very small network in which all parts of the
(ADT) systems system are directly connected via wires or
○ Help with patient tracking wireless (typically provided by a router in a
○ Medication administration record single- building)
(MAR) software
○ Supplies inventory systems

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COMPUTER SOFTWARE AND SYSTEMS
NCM 221 - NURSING INFORMATICS (LEC)
BS Nursing - N21 | LAURENCE DAINE EGUNA | 2ND SEMESTER

LANs, WANs AND MANs

● Sequentially larger and given the number of
users they require communications
architecture to ensure all users on the
network are served.
● If the network capacity is too small, some
users will experience very long waits or
perhaps the system will crash from overload
(i.e., stop working and have to be restarted)

4
 NCM 221– DATA AND DATA PROCESSING • As noted, without context it is difficult to make judgments on
data alone.

It is because of this that data are presented here as a collection

of data processes for the storage, curation, retrieval, and
interpretation of data with the end goal being to gain wisdom

Data States

When discussing digital data, it is important to discuss the

three states of data— data at rest, data in motion, and data in
use (Rouse & Fitzgibbons, 2019)

Data at rest

• Refer to data on storage devices such as a removable one

such as a USB thumb drive, a hard drive, a file server, a cloud
server, or offsite backup servers.

• This is archived data that rarely change.

E.g. Patient’s past medical records data

• These data are subject to security protocols to protect the

confidential nature of these data

Data in use

• Refer to data that the information system is currently

updating, accessing, reading, or processing.

• This is its most vulnerable state as it becomes open to access

or change by others.

The Nelson Data to Wisdom Continuum. Revised Data - Some of these data may contain sensitive data-like social
Information Knowledge Wisdom (DIKW) Model-2013 Version security numbers, birth dates, health insurance numbers,
results of diagnostic tests, and so forth.
• Data - raw uninterrupted facts that are without meaning
• One can attempt to secure these data in use through
E.g. the following series of numbers are data, with no meaning: passwords and user IDs, but these are only as secure as the
98, 116, 58, 68, 18 person’s ability to keep that information private, and the
• Reordered and labeled as vital signs they have meaning and nature of the encryption technology used.
now represent information
Data in motion
temperature 98.0, pulse 58, respirations 18, and blood
• Data moving between applications, between locations within
pressure116/68
a computer system (RAM to hard drive, files are moved or
• Using the nurse’s knowledge this information is then copied from one folder to another), over the network, or over
interpreted. The nurse fits these data into a pattern of prior the Internet.
knowledge about vital signs.
• Data in motion are an increasing concern in healthcare
E.g. if the nurse records these vital signs as part of a physical because streaming data are now available from sensors,
for a high school athlete, they are in the normal range; monitoring devices, mobile devices, and so forth.
however, if these same numbers were part of an assessment
• It is important that one encrypts these data before moving
on an elderly patient with congestive heart failure, the low
and while moving to these devices.
pulse and blood pressure could suggest a problem
• While data in motion entail security risks, they also provide
• When the nurse uses knowledge to make appropriate
opportunities that we never imagined.
decisions and acts on those decisions the nurse exhibits
wisdom. - For example, monitoring patients in real time in their homes
can lead to improved patient care and compliance.
In other words, the nurse demonstrates wisdom when the
nurse synthesizes and appropriately uses a variety of Data Sources—Including Patient-Generated Data and
knowledge types within nursing actions to meet human needs. Population Health Data
Generating data: Data Definition—Context • Before digitization, handwritten nurses’ and doctors’ notes,
charts, and drawings provided insight when making decisions
• Data is “a fact represented as an item or event out of context”
about health and health trends.
(Mullins, 2013, p. 686).
• The advent of computer technology powerful enough to
• Data alone do not provide insights.
store and analyze data has changed the way that we gather,
curate, analyze, and present data in order to make the best
decisions about patient health.

DATA REPOSITORIES (STORING DATA)

Database Management Systems

• A database by definition is an organized collection of data.

• A database management system (DBMS) is software that

contains the database as well as a collection or set of programs
for accessing and processing these data in the database
Four factors in finding information in the database: thereby identifying relationships between the data.

• The data naming (indexing) and organizational schemes Advantages of Database Management Systems

• The size and complexity of the database • The main advantage of a DBMS is that it imposes a structure
onto the data that allows interaction between the end user and
• The type of data within the database the data.
• The database search methodology • In general, a DBMS allows the storage, curation, and retrieval
necessary to turn data without context into data that can be
Information systems are used to process data and produce
used to generate information and knowledge useful in making
information
wise patient care decisions
The systematic approach used to name, organize & store data
• The two main components of a DBMS are a “front-end”
in a database has a major impact on how easy it is to find
which provides an application in which a user can view,
information in the database.
manipulate, and interpret data and a “back-end” which is
where the data area stored.
Types of Data
One thing to notice is that data flow between both the front
• Two primary approaches in classifying data in a database end and the back end.
system:

- classified in terms of how these data will be used by the user

• e.g. financial data, patient data or human resource

data

- classified by their computerized data type This DBMS structure includes the ability to store data in a
• e.g. data can be numbers or letters or combination central repository as well as the ability to manage the data in
of both a central location thereby reducing data redundancy,
increasing data consistency, and improving access to data
Conceptual Data Types (Mullins, 2013).

• Reflect how users view data Data redundancy occurs when one stores the same data in the
database more than once or stores it in more than one
• Based on the source of the data interrelated database.
• Based on the event that the data are attempting to capture. •Patients may work with numerous doctors, each of whom
keeps patient records in their own database, inaccessible to
e.g. image data from x-ray, lab data, assessment data,
other doctors or facilities, necessitating patients to re-enter
intervention data and outcome data
information or request records from the other doctor or
Computer-Based Data facility.

Types •The patient's active medication list may be in the primary

provider's electronic medical record, a pharmacy's electronic
• alphanumeric data – includes letters & numbers in any record, or a healthcare institution's electronic record. A well-
combination designed automated database links and updates these records
- e.g. address, social security number, memo – a specific type in one place, allowing users to access it from anywhere.
of alphanumeric data
Data inconsistency results as each user working with different
• numeric data are used to perform numeric functions
databases updates or changes the data.
- format options – the number of digits after the decimal or the
presence of commas in a number • For example, when a doctor admits a patient to the hospital,
- it can be long integer, currency, scientific different caregivers will ask the patient about their home
- date & time are special types of numeric data
medications. The patient may just include prescription Database Models
medications or may also mention over-the-counter meds. A
patient may forget to bring a medication. Inconsistency
happens when caregivers record items in separate sections of
the medical record.

An additional problem occurs if one uses different terms for

the same data.

• For example, sometimes one might use a generic name while

other times one might use the brand name for that drug.

This is why standards such as standard languages (i.e.,

Conceptual Data Models
SNOMED) are key to the design of EHRs.

An automated database design that uses recognized

standards as well as consistent input and access to data is
imperative to creating databases necessary for the efficient
and effective delivery of quality healthcare

Fields, Records, and Files

• Field attribute is the specific datum for that field for that
record.

• Each row represents a record.

• Each row is assigned a primary identifier.

• A primary identifier is unique to that record. Logical Models

• A file is defined as a set of related records that have the same

data fields.

To summary, a database is made up of files, files are made up

of records, records are made up of fields, and fields contain
data

Types of Files: Processing Files

• Executable files consists of a computer program or set of

instructions that, when executed, causes the computer to open
or start a specific computer program or function • This model describes the data in more detail without paying
• These are the files that tell a computer what actions a attention to the actual physical implementation or design of
computer should perform when running a program. the database.

• Defines the structure of the whole database in terms of the

Types of Files: Command Files
attributes of the entities (data elements), their relationships, a
• Command files are a set of instructions that perform a set of primary key for each entity and so forth.
functions as opposed to running a whole program.
Physical Data Model
• A batch file contains a set of operating system commands
• Includes each of the data elements and the relationship
E.g. SET UP. EXE, AUTOEXEC.BAT,CONFIG.SYS between data elements, as they will be actually physically
stored on the computer.
• Data Files - contain data that have been captured and stored
on a computer using a software program • Four primary approaches to the development of a physical
data model
E.g. document created in MS Word with the extension .DOC
Hierarchical
Network
Relational
Object Oriented
 Hierarchical Data Object- Oriented Model

Have been compared to inverted trees. Developed because the relational model has a limited ability
to deal with binary large objects or BLOBS
All access to data starts at the top of the hierarchy or at the
root. • BLOBS are complex data types such as images, sounds,
spreadsheets, or text messages.
The table at the root will have pointers called branches that will
point to tables with data that relate hierarchically to the root The entity and the attributes are stored within an object.

Hierarchical Database Model • Amoxicillin, for example, is an antibiotic. Each antibiotic

possesses unique properties or activities. Because amoxicillin
is an antibiotic, it can be kept in the antibiotic object and inherit
all of the antibiotic's properties. For instance, because all
antibiotics can cause diarrhea, diarrhea may occur as a side
effect of amoxicillin.

Database Life Cycle

Network Model

The development and use of a DBMS follow a systematic

process called the life cycle of a database system
• Developed from hierarchical models, the child note is not
limited to one parent making it possible for a network model Initiation
to represent many-tomany relationships.
Occurs when a need or problem is identified and the
Relational Database Models (RDM) development of a DBMS is seen as a potential solution

• Consists of a series of files set up as tables. Planning and Analysis

• Each column represents an attribute, and each row is a record • The step begins with an assessment of the users view and the
or tuple. development of the conceptual model.

• The intersection of the row and the column is a cell. • what information…?
• how does…?
• The datum in the cell is the manifestation of the attribute for
that record. • Diagrams and narrative reports will be used to describe the
data elements, their attributes, and the overall ideal
- Each cell may contain only one piece of datum.
information flow in the conceptual model
- The datum must be atomic or broken down into its smallest
form. Detailed Systems Design and Development

E.g. blood pressure reading would be broken into the systolic • It begins with the selection of the physical model.
and diastolic reading.
• entry screens & the format for all output reports will be
carefully designed.
• Revisions are to be expected
Implementation

• Includes training the users, testing the system, developing a

procedure manual for use of the system

Evaluation and Maintenance

• The 1st evaluations should be informal & focus more on

troubleshooting specific problems.
 Common Data Operations Functions of a Warehouse

• Data input • Must be able to extract data from various computer systems
and import that data into the data warehouse.
• Data processing
• Must function as a database able to store and process all of
• Data output
the data in the database.
Data Input Operations • Must be able to deliver the data in the warehouse back to the
users on the form of information
Since data come from a variety of sources and devices, it is
important to note that one of the most important aspects of It support a number of activities:
data processing is to carefully define the healthcare processes
that relate to the input of data.

• For example, manually entered data especially in an

emergency situation are at much higher risk of random data
entry errors.

Data input operations, both technical and non-technical, are

important because they ensure that the data going into the
system are explicitly defined.

According to Kemp, “It is this capturing of ever-greater

volume, velocity and variety of data that, if harnessed
effectively, provides the organization with its Big Data
Data Analysis and Presentation
opportunity” (Kemp, 2014, p. 23)
Analytics
Data Processing
• The process one uses to make realistic, quality decisions
• DBMS directed actions that the computer performs on the using the available data.
data once entered into the system
- This means that data and their analysis guide the decision-
e.g. OLTP (Online transaction processing) that supports day-to- making process.
day operation of the institution
• Analysis involves a systematic examination and evaluation of
Data Output Operations data to uncover interrelationships within data, thereby
producing new insights and information
• Includes online and written reports
- The process usually involves breaking the data into smaller
- Reports that are clear and concise help the reader see the
parts to better understand the area of concern.
information in the data. On the other hand, poorly designed
reports can mislead and confuse the reader. Dashboards

• The development of a database system within a department • … is a visual display of the most important information
serves 2 important purposes: needed to achieve one or more objectives, consolidated and
arranged on a single screen so the information can be
a. Both the developers & the users create a new level of
monitored at-a-glance” (iDashboard, 2013, p.3)
knowledge and skills
• Available for clinical performance indicators such as unit
b. As individual departments develop databases, institutional
census, length of stay, and so forth,
data are being created
- For hospital performance indicators such as admissions,
Data Warehouses
income, and utilization
• Is defined as a large collection of data imported from several - For patient performance indicators such as average length of
different systems within one database. stay and drug error rates
- smaller collections of data are referred to as data marts. - For physician performance indicators such as number of
- Bill Immon, the father of the data warehouse concept, patients seen; and
defined a data warehouse as a subject-oriented, integrated, - For nursing performance indicators such as pain assessment,
time variant, nonvolatile collection of data used to support the staff turnover rates, educational levels, and pressure ulcer
management decision-making process. prevalence
Purposes of a Data Warehouse Data Quality
• A data warehouse makes it possible to separate the analytical Data Stewardship
and operational processing.
• The aspect of data governance that focuses on providing the
• With this separation the architectural design of the data appropriate access to users, helping users to understand the
warehouse is designed to support decisional information data, and taking ownership of data quality. Without
needs. appropriate stewardship, even the best infrastructures
become underutilized and poorly understood by knowledge Data/ Information to Knowledge (KDD)
workers who could be generating value with the data every
day” (Just, 2013, p.4.) • A traditional approach to the KDD development includes a
seven-step process:
• A data steward does not own the data but ensures its quality.
1. Task analysis
- The data steward is the “keeper of the data”, not the “owner 2. Data selection
of the data 3. Data cleaning
4. Data transformation
Big Data 5. Data mining
6. Pattern interpretation and evaluation
7. Deployment

Data Mining

• This means to apply computational techniques to find the

patterns and trends.

E.g. of data mining techniques include rule set classifiers like IF

conditions, THEN conclusion, decision tree algorithms, logistic
It is estimated that patients generate about 80 MB of data per
regression analysis, neuro-fuzzy techniques, and memory-
year and that healthcare data is the source of 30% of the
based reasoning
world’s data production (Huesch & Mosher, 2017).
Benchmarking
• The industry often defines Big Data in terms of the 4 Vs coined
by IBM. They are (1) Volume, (2), Variety, (3) Velocity, and (4) • A process where one compares outcome measures with
Veracity (IBM, 2018). More recently two more Vs were industry averages
added—Value and Variability (AndreuPerez, Poon, Merrifield,
Wong, & Yang, 2015; Rouse, 2018). • To determine the goal or objectives, define appropriate
indicators, collect data, and determine results.
Volume
- Structure measures examine the organization and whether a
• When speaking about the volume of big data, this means the structure is in place that will facilitate quality, cost-effective
amount of data created on a given day. It is estimated that 2.5 care.
Quintillion bytes of data are being created each day.
- Process measures such things as screening, diagnosing, and
Variety managing patient care, addressing how things are done.
• A second aspect of big data is the variety of data being - Outcomes track results.
produced and combined in order to gain insights. In terms of
healthcare, this variety of data could be handwritten doctor’s Outcome Probabilities
notes that have been digitized, lab results, medical imaging,
social media posts, etc • Is built on the statistical concept of probability.

Velocity • If one would toss a fair coin in the air 100 times, one would
expect that 50% of the time the coin would come up heads.
• The third aspect of big data as defined by IBM is the velocity
of data. In short, the velocity aspect of big data describes the • In nursing, question become, “What is the probability that a
trend toward gathering data from sensors or other real-time certain intervention will result in a certain outcome?”
data sources, such as Fitbits, that are streaming information
Wisdom
directly into our data repository

Veracity

• One of the potential pitfalls of relying on big data is that the

veracity of the data is often not verified. As will be discussed in
the next section, massive amounts of data are often being
collected, but these data are not being cleaned or curated over
time.

Value

• The fifth aspect of big data is clinically relevant data that bring
value to both the patient and healthcare systems. The value of
big data is that it can lead to value based patient centric care
and reduced costs.

Variability

• Variability addresses the extent and speed that the structure

of the data are changing as well as the frequency of the change.
In healthcare, seasonal variations in flu strains and outbreaks
of epidemics demonstrate the variability of illnesses.
 Knowledge Application

• A proposed theory of nursing knowledge/ wisdom uses the

formula NKW (IB)= P, where NK is nursing knowledge, W is
wisdom, “IB is the individual nurse’s integration and synthesis
of nursing knowledge through cognitive, psychomotor, and
affective/ spiritual domain of self” and P represents the
breadth and depth of practice

Expert Support/ Systems

• Represents the present and future vanguard of nursing

informatics.

• These systems aim to help make the nurse “more intelligent”

in providing quality care based on evidence.

• Uses artificial intelligence (AI) to model the decisions an

expert nurse would make.

• Provide the “best decision” recommendations based on what

an expert nurse would do unlike decision support systems that
provide several options from which nurse selects

Advantages of expert systems

Provide a solution more quickly than humans

Reduce waste and cut costs

Improve patient care by sharing the knowledge and wisdom of

human experts

Expert systems four main components