LESSON 1: HISTORICAL PERSPECTIVE OF NURSING Consumer-centric Healthcare System

INFORMATICS 1. There is a shift to a consumer-centric healthcare

Overview system due to escalating costs
Nursing Informatics 2. Consumers are encouraged to be active partners in
Evolved from the French word “informatics" their care
Referred to the field of applied computer science 3. A variety of technologies have evolved to enable
Concerned with the processing of information such as consumers to have access to their health information
nursing information 4. Consumers can choose whether to share this across
healthcare providers and settings
Computers 5. Personal health records multiplied as either stand-
First introduced into healthcare facilities in the 1960s alone systems or those tethered to EHRs
For the processing of basic administrative tasks 6. Consumers are more literate regarding healthcare
The computer is an essential tool in HIT systems information literacy and expect to become more
involved in managing their own health
Health Information Technology (HIT)
1. HIT is an all-encompassing term LESSON 2: MAJOR HISTORICAL PERSPECTIVE OF
2. Refers to technology that: NURSING AND COMPUTERS- SEVEN TIME
Captures health information
PERIODS
Processes health information
SEVEN TIME PERIODS
Generates health information
1. Prior to the 1960s
3. Computerization affects all aspects of healthcare
Developed in the late 1930s and early 1940s 
delivery including:
Use in healthcare did not begin until the 1950s and
Provision and documentation of patient care
1960s 
Education of healthcare providers
A few experts formed a cadre to adapt computers to
Scientific research for advancing healthcare delivery
healthcare and nursing 
Administration of healthcare delivery services
Computers in healthcare were used for administrative
Reimbursement for patient care
and accounting functions
Legal and ethical implications
2. 1960s
Safety and quality issues
Use of computer technology began to be explored 
4. A shift toward:
Studies were conducted to determine how computer
Integrating multiple technologies and
technology could be utilized 
telecommunication devices
The nurses’ station was viewed as the most
Invisible storage devices such as cloud storage
appropriate center for the development of computer
User-friendly, menu-driven, touchscreen manipulation
applications 
methods
The mid-1960s presented nurses with new
5. Computers in nursing are used for:
opportunities for computer use 
Managing patient care information
Increased time devoted to documentation and a rise
Monitoring quality
in medication errors prompted the investigation of
Evaluating outcomes
emerging computer-based information systems
Communicating data and messaged via the Internet
Accessing resources
3. 1970s
Interacting with patients on the Web
During the late 1960s through the 1970s, hospitals
Documenting and processing real-time plans of care
began developing computer-based information
Supporting nursing research
systems which initially focused on (1) Physician order
Testing new systems
entry (2) Results reporting (3) Pharmacy (4)
Designing new knowledge databases
Laboratory (5) Radiology reports (6) Information for
Developing data warehouses
financial and managerial purposes (7) Physiologic
Advancing the role of nursing in the healthcare
monitoring systems in the intensive care units 
industry and nursing science
A few systems started to include (1) Care planning (2)
Decision support (3) Interdisciplinary problem
lists Nurses were often involved in implementing Legislative activity in the mid-1990s paved the way for
systems  electronic health records through the Health
Interest in computers and nursing began to emerge in Insurance Portability and Accountability Act (HIPAA)
public and home health and education  of 1996 (public-law 104-19) 
In the 1970s, conferences helped public and home The complexity of technology, workflow analysis, and
health nurses (1) Understand the importance of regulations shaped new roles in nursing 
nursing data and their relationship to new Medicare In 1992, the ANA recognized nursing informatics as a
and Medicaid legislation (2) Provide information on new nursing specialty separate Scope of Nursing
the usefulness of computers for capturing and Informatics Practice Standards, and also established a
aggregating home health and public health specific credentialing examination for it 
information  The demand for nursing informatics (NI) expertise
Hospitals and public health agencies embarked on increased 
investigating computers and nursing  The ANA developed the Nursing Information and Data
The opportunity to improve education using computer Set Evaluation Standards (NIDSEC) to evaluate and
technology also began  recognize nursing technology rapidly changed in
Early nursing networks helped to expand nursing the 1990s (1) PCs became smaller (2) Computer
awareness of computers and the impact HIT could notebooks became affordable (3) Computers were
have on practice  linked through networks (4) The Internet became
The Clinical Center at the National Institutes of Health mainstream (5) The World Wide Web (WWW)
implemented the Technicon Medical Information increased access to information 
System (TDS) computer system  The purpose of Information systems was to guide the
TDS one of the earliest clinical information systems development and selection of nursing systems that
(called Eclipsys & Allscripts)  included standardized nursing terminologies
TDS was the first system to include nursing practice integrated throughout the system
protocols 6. 2000s
4. 1980s More healthcare information became digitalized and
The field of nursing informatics exploded and became newer technologies emerged 
visible in the healthcare and nursing  In 2004 an Executive Order 13335 (1) Established the
The nursing profession needed to update its practice Office of the National Coordinator (ONC) for
standards and determine its data standards, Healthcare Information Technology (HIT) (2) Issued a
vocabularies, and classification schemes that could be recommendation calling for all healthcare providers to
used for the computer- based patient record systems  adopt interoperable electronic health records (EHRs)
Many mainframe healthcare information systems by 2014/2015 
(HISs) emerged with nursing subsystems  Wireless, point of care, regional database projects,
These systems documented several aspects of the and increased IT solutions proliferated 
patient record  The use of bar coding and radio-frequency
The microcomputer or personal computer (PC) identification (RFID) emerged as a useful technology 
emerged during this period  Smaller mobile devices with wireless or Internet
The first Nursing Special Interest Group on Computers access increased access to information for nurses
met for the first time during SCAMC (Symposium on within hospitals and in the community 
Computer Applications in Medical Care) in 1981  The development and refinement of voice over
In 1985, the ANA approved the formation of the Internet protocol (VoIP) provided voice cost-effective
Council on Computer Applications in Nursing (CCAN)  communication 
CCAN became a very powerful force in integrating The Internet provided a means for development of
computer applications into the nursing profession  clinical applications 
The first edition of this book published in 1986 The nursing informatics research agenda promoted
5. 1990s the integration of nursing care data in HIT systems
Advances in relational databases, client-server that would also generate data for analysis, reuse, and
architectures, and new programming methods  aggregation
Better application development at lower costs  7. 2010s
The impact of the Nursing Minimum Data Set (NMDS) 3. In 2001, that the Nursing Informatics Working Group
demonstrated that continued consensus and effort (NIWG) of the American Medical Informatics Association
was needed to bring to fruition the vision and (AMIA) became involved
implementation of minimum nursing data into clinical 4. The NI History Committee was established to take on
practice  this project
A new nursing informatics research agenda for 2008– 5. The committee solicited archival material from the
2018 emerged as critical for this specialty  known NI pioneers for a History of Nursing Informatics to
be housed in the NLM as part of its History Collection
The new agenda is built on one originally developed
6. In 2004, the rich stories of pioneers in nursing
and published by the National Institute for Nursing
informatics were captured through a project sponsored by
Research (NINR) in 1993 
the AMIA-NIWG
During 2010, the ONC convened two national
7. Pioneers were defined as those who “opened up” a new
committees: (1) National Committee on Health Policy area in nursing informatics and provided a sustained
(2) National Committee on Health Standards which contribution to the specialty
outlined and designed the focus for the “Meaningful 8. Through multiple contacts and review of the literature,
Use” (MU) legislation  145 pioneers and contributors were identified as having
Meaningful Use was designed to be implemented in at shaped nursing informatics since the 1950s
least three stages  9. Each identified pioneer was contacted to submit their
Consists of the regulations which built onto each nonpublished documents and/or historical materials to the
other with the ultimate goal of implementing a NLM to be indexed and archived for the Nursing
complete an interoperable EHR and/or HIT system in Informatics History Collection
all US hospitals  10. The catalogued document descriptions can be searched
In 2011/2012 MU Stage 1 was initiated focusing online: www.nlm.nih.gov/hmd/manuscripts/accessi
primarily on the Computerized Physician Order Entry ons.html
(CPOE) initiative for physicians  11. A convenience sample of pioneers was interviewed
In 2012/2013 MU Stage 2 was introduced focusing over a 4-year period at various nursing informatics
primarily on the implementation of Quality Indicators  meetings
The Quality Indicators are used to guide hospitals in 12. Videotaped stories from 33 pioneers were recorded
patient safety and if not implemented used as 13. The 33 videotaped stories are available on the AMIA
indicators subject to financial penalties website: www.amia.org/niwg-history-page
It is anticipated that MU Stage 3 will be implemented 14. The website also provides “use cases” for ideas about
how to use the information for teaching and learning more
in 2014/2015
about the pioneers
The Center for Medicare and Medicaid Services (CMS)
15. These resources are particularly useful for courses in
plans to increase reimbursement for the
informatics, leadership, and research
implementation of “MU” regulations in their HIT
16. They also are useful for nurses in the workforce who
and/or EHR systems through 2015 want to learn more about nursing informatics history
CMS may even penalize eligible providers and facilities 17. The early pioneers came from a variety of backgrounds
who do not meet the proposed MU criteria as nursing education in nursing informatics didn’t exist in
As the MU requirements increase they will impact on the 1960s
the role of the NI experts in hospitals 18. Almost all of the pioneers were educated as nurses,
MU requirements ultimately on the roles of all nurses though a few were not
in the inpatient facilities, making NI an integral 19. The pioneers had a vision that technology could make
component of all professional nursing services nursing practice better
20. The nursing pioneers influenced the evolution of
LESSON 3: NURSING INFORMATICS PIONEER informatics as a specialty from granular-level data through
History Project health policy and funding
1. In 1995, Saba initiated a history of NI at the National
Library of Medicine, which consisted of the collection of LESSON 4: NURSING STANDARDS INITIATIVES
archival documents from the NI pioneers Nursing Practice Standards
2. The history project was initiated based on a Nursing practice standards have been developed and
recommendation by Dr. Morris Collen recommended by the ANA
Nursing Scope and Standards of Practice that focused
a. On the organizing principles of clinical nursing practice 1. Increasing access through the electronic capture and
b. The standards of professional performance exchange of information raised concerns about the privacy
Nursing Informatics Scope and Standards of Practice builds and security of personal healthcare information (PHI)
on 2. Provisions for strengthening the original HIPAA
a. Clinical practice standards legislation were included in the 2009 HITECH Act
b. Outlines further the importance for implementing  
standardized content to support nursing practice by Electronic Health Records from a Historical Perspective
specialists in nursing informatics The Institute of Medicine (IOM)
In 1989, the Institute of Medicine (IOM) convened a
committee and asked the question, “Why is healthcare still
Nursing Education Standards predominantly using paper-based records when so many
1. Since the NLN’s Nursing Forum on Computers in new computer-based information technologies are
Healthcare and Nursing was formed in 1985, it has emerging?”
supported the integration of computer technology in the Two major conclusions resulted from the committee’s
nursing curriculum deliberations.
2. The American Association of Colleges of Nursing (AACN), a. First, computerized patient record (CPR) is an essential
revised The Essentials for Doctoral Education for Advanced technology for healthcare and is an integral tool for all
Nursing Practice and The Essentials of Baccalaureate professionals
Education for Professional Nursing Practice to require the b. Second, the committee after hearing from numerous
use of computers and informatics for both baccalaureate stakeholders recognized that there was no national
and graduate education coordination or champion for CPRs

The Computer-Based Patient Record Institute

Nursing Content Standards Created in 1992
1. The nursing process data elements in EHRs HITECH Act Given the mission to initiate and coordinate the urgently
of 2009 are essential for the exchange of nursing needed activities to develop, deploy, and routinely use
information across information systems and settings CPRs to achieve improved outcomes in healthcare quality,
2. Standardization of healthcare data began in 1893 with cost, and access
the List of International Causes of Death for the reporting Developed the CPR Project Evaluation Criteria in 1993
of morbidity cases worldwide modeled after the Baldridge Award
3. The standardization of nursing began with Florence a. These criteria formed the basis of a self-assessment that
Nightingale’s six cannons in her “Notes on Nursing” could be used by organizations and outside reviewers to
4. In 1955, Virginia Henderson published her 14 Daily measure and evaluate the accomplishments of CPR
Patterns of Living as the list of activities and conditions that projects
became the beginning of nursing practice standards in the b. The four major areas of the initial criteria (1)
United States Management (2) Functionality (3) Technology (4) Impact
5. In 1970, the ANA accepted the Nursing Process as the c. Provided a framework through which to view an
professional standards for nursing practice and which was implementation of computerized records
followed by the standardization of nursing content-data d. The criteria which provided the foundation for the
elements in 1973 Nicholas E. Davies Award of Excellence Program
6. Currently, the ANA has recognized 12 nursing The Davies Program evolved through multiple revisions
terminologies Under HIMSS management, the Davies Award of Excellence
7. The ANA selected six of the ANA recognized nursing is offered in four categories
languages for inclusion in the NLM’s Metathesaurus of the a. Enterprise (formerly Organizational or Acute Care), first
Unified Medical Language System (UMLS) and for inclusion offered in 1995
in the Systematized Nomenclature of Medicine—Clinical b. Ambulatory Care, started in 2003
Terms (SNOMED-CT) c. Public Health, initiated in 2004
8. There are a large number of standards organizations that d. Community Health Organizations (CHO), first presented
impact healthcare data content as well as healthcare in 2008
technology systems
CHAPTER 2: LESSON ABOUT HARDWARE
INTRODUCTION
Confidentiality and Security Standards Computer hardware
ü  defined as all of the physical components of a computer
ü  a machine that uses electronic components and ü  Computers are now pervasive throughout the healthcare
instructions to the components to perform industry
·         Calculations ü  Their applications are expected to continue to expand
·         Repetitive and complex procedures and thereby improve the quality of healthcare while at the
·         Process text same time reducing some costs
·         Manipulate data and signals ü  The applications of computers to healthcare will greatly
ü  Computer technology has evolved from huge, room- expand the diagnostic and therapeutic abilities of
sized electronic calculators developed with military funding practitioners and broaden the diagnostic and treatment
during World War II to palm-sized machines options available to recipients of healthcare
ü  The basic hardware of a computer composes the ü  Computers allow for distance visualization and
computer’s architecture, and includes: communication with patients in remote areas
·         Electronic circuits ü  None of these changes could have happened without
·         Microchips, processors tremendous advances in the machinery, the hardware, of
·         Random Access Memory (RAM) computers
·         Read-Only Memory (ROM)  
·         Graphic and sound cards REQUIRED HARDWARE COMPONENTS OF A COMPUTER
ü  These are attached to a component called 1. The box of any computer contains a motherboard:
a motherboard †        The motherboard is a thin, flat sheet made of a firm,
ü  The motherboard is a square or rectangular board with nonconducting material on which the internal components
circuits into which are plugged the main electronics of the — (printed circuits, chips, slots, and so on)—of the
computer computer are mounted
ü  Devices that may be inside the computer case but are †        The motherboard is made of
not part of the architecture include: a dielectric or nonconducting plastic material
·         Main storage device which is usually an internal hard †        The motherboard contains the microchips (including
drive the CPU), and the wiring, and slots for adding components
·         Cooling system †        The specific design of the components on the
·         Modem motherboard—especially the CPU and other
·         Ethernet connectors microprocessors—composes the foundation of the
·         Optical drives computer’s architecture
·         Universal Serial Bus (USB) connectors †        The motherboard’s storage media is called memory
·         Multi-format media card readers Memory
ü  Devices attached or linked to a computer that are Read-Only memory (ROM)
peripheral to the main computer box are part of ü  It is a form of permanent storage on the computer
the system’s hardware, these include: ü  It carries instructions that allow the computer to be
·         Input and output devices, including the keyboard, booted (started), and other essential machine instructions
touch screen, mouse, printer, and fax ü  Its programming is stored by the manufacturer and
·         Storage components such as external hard drives, cannot be changed by the user
thumb drives, floppy drives, tape drives, sound systems ü  Data and programs in ROM can only be read by the
(earphones, microphones, speakers, subwoofers) computer, and cannot be erased or altered by users
·         Computer monitor ü  Theoretically, ROM can be changed by the factory
ü  Computer systems are composed of many different ü  Effectively, the programs are permanently wired into the
component parts that enable the user to communicate memory
with the computer, and with other computers to produce ü  ROM generally contains the programs, called firmware,
work used by the control unit of the CPU to oversee computer
ü  The group of required and optional hardware items that functions
are linked together to make up a computer system is called ü  In microcomputers, this may also include the software
its configuration programs used to translate the computer’s high-level
ü  When computers are sold, many of the key components programming languages into machine language (binary
are placed inside a rigid plastic housing or case, which is code)
called the box ü  ROM storage is not erased when the computer is
ü  What can typically be seen from the outside is the box turned off
containing the internal components, and the peripherals
such as a keyboard, mouse, speakers, monitor, and printer Random access memory (RAM)
Additional: ü  Refers to working memory used for primary storage
ü  It is used as temporary storage
ü  Also known as main memory, RAM can be accessed, ü  A touch screen is actually both an input and output
used, changed, and written on repeatedly device combined
ü  RAM is the work area available to the CPU for all ü  Electronics allow the computer to “sense” when a
processing applications particular part of the screen is pressed or touched
ü  When a user clicks on a program icon, the computer ü  In this way, users input information into the computer
loads all or part of the program into RAM where it can be ü  The touchscreen displays information back to the user,
accessed very quickly just as does any computer monitor
ü  It saves work done through the programs until the user ü  A light pen is a device attached to the computer that has
formally saves the work on the hard drive or other special software that allows the computer to sense when
permanent storage the light pen is focused on a particular part of the screen
ü  RAM is a permanent part of the computer ü  It allows smaller screen location discriminations than
ü  RAM is called volatile memory because everything in does a touchscreen
RAM unloads (is lost) when the computer is turned off ü  For both the touch screen and light pen, software
ü  The computer programs that users install on their interprets the meaning of the user identified screen
computers to do work or play games are stored on media location to the program
such as on the hard drive are not permanent parts of the ü  Many other input devices exist
computer itself ü  Some devices are used for security and can detect users’
ü  Running programs from the hard drive would be a very fingerprints, retinal prints, voiceprints, or other personally
slow process, so parts of the programs are loaded and unique physical characteristics that identify users who have
unloaded from the much faster RAM as needed clearance to use the system
ü  They are unloaded when the user shuts the program Output devices
down or turns off the computer ü  These devices allow the computer to report its results to
ü  The contents of RAM are erased whenever the power to the external world
the computer is turned off ü  Defined as any equipment that translates the computer
ü  RAM is made ready for new programs when the information into something readable by people or other
computer is turned on again machines
Cache ü  Output can be in the form of text, data files, sound,
ü  A smaller form of RAM graphics, or signals to other devices
ü  Its purpose is to speed up processing by storing ü  The most obvious output devices are the monitor
frequently called items in a small, rapid access memory (display screen), and printer
location ü  Other commonly used output devices include storage
ü  Prior to the development of cache, all information had to devices such as the Universal Serial Bus (USB) drive (also
be fetched from the hard drive, and then stored in RAM known as flash or thumb drives), and optical media
ü  To handle all the work, the processor had to move STORAGE MEDIA
information into and out of RAM (and back to the hard Hard Drive
drive) in order to manage all the data from programs and ü  It is a peripheral that has very high speed and high-
their output density
ü  Given that RAM is large, it takes a bit of searching to find ü  It is a very fast means of storing and retrieving data as
just the pieces needed and is relatively slow well as having a large storage capacity in comparison with
ü  Fetching from cache takes much less time than from the other types of storage
RAM ü  The hard drive is the main storage device of a computer
ü  Keeping information that will be used frequently in ü  For small computers, it is typically inside the case or box
cache greatly reduces the amount of time needed to move that houses the CPR and other internal hardware
data around among the memory locations ü  Internal hard drives are not portable; they are plugged
ü  It is a relatively inexpensive way to increase the speed of directly into the motherboard
the computer ü  The storage capacity of hard drives has increased and
continues to increase exponentially every few years
INPUT AND OUTPUT ü  In 2014, most personal computers are sold with about a
Input devices terabyte of storage
ü  These devices allow the computer to receive information ü  In 1990 most personal computers came with about
from the outside world 500 megabytes
ü  The most common input devices are the keyboard and ü  On the biggest computers, storage is measured in
mouse petabytes, which is an almost unimaginably huge number
ü  Others commonly seen on nursing workstations include USB Flash Drive
the touch screen, light pen, voice detector, and scanner
ü  As demands for higher and higher density transportable ü  Even when paper backup copies were kept, loss of
storage rise, the popularity of the USB disk has also risen information on the hard drive was usually inconvenient at
ü  A USB flash drive is actually a form of a small, removable the least and a disaster at worst
hard drive that is inserted into the USB port of the ü  Diskettes could not store large amounts of data, so
computer people began to search for economical and speedy ways to
ü  There are many names for it, including pen drive, jump back up the information on their hard drive
drive, thistle drive, and pocket drive ü  Zip drives, which were mini magnetic tape devices, were
ü  This is a device that can store 4 gigabytes (GB) for a form of relatively fast (in their time) backup storage for
about $10 people’s data
ü  Flash drives can be very tiny, only about ½ in by 1 in ü  Thumb (USB) and external hard drives were faster than
ü  They can also be much bigger and can home 128 GB tape media and replaced it as the backup media of choice
or more ü  Today, many people purchase services that allow them
ü  The flash drive is highly reliable to back up their data online, which means it gets stored on
ü  Small enough to fit comfortably in a pants pocket or on a commercial computers that they have backup facilities
lanyard as a necklace, or on one’s keychain Cloud Storage
ü  The device plugs into one of the computer box’s USB ü  An extension of the online storage service offered by
ports and instead of saving to hard drive or CD-ROM or individual vendors
disk, the user simply saves to the flash drive ü  Data stored in the “Cloud” is still stored on commercial
ü  Can store so much data in a package so much smaller computers called servers
than a CD or DVD, the convenience makes it worth the ü  The “Cloud” refers to a distributed system of many
slightly higher price to many users commercial, networked servers that communicate through
ü  As its popularity increases, prices drop  the Internet, and work together so closely that they can
Optical Media essentially function as one large system
ü  Include Compact Disks (CDs), Digital Versatile Disks ü  Physically, enormous numbers of servers that store data
(DVDs), and Blu-Ray are located in buildings, many warehouse sized
ü  CD-ROMs and DVDs are rigid disks that hold a higher ü  These data storage sites are called data centers
density of information and have higher speed ü  Multiple data centers are linked together to create cloud
ü  Until the late 1990s, CD-ROMs were strictly input devices storage
ü  CD-ROMs were designed to store sound and data, and ü  The advantage to the customer is safety of the stored
held about 737 megabytes of information and large laser data
writers were required to store data on them ü  A key factor in cloud storage is redundancy
ü  CD-ROMs were read-only media ü  The storage vendors must maintain multiple copies of
ü  Technology developed in the 1980s by Philips the data they store
Corporation permitted the development of a new type of ü  If one server in a data center becomes inoperable,
CD that could be written on by the user copies of the data on that server are stored elsewhere and
ü  Those are called CD-RW for Compact Disc Read-Write thus the data are not lost
ü  As technology advanced and people wanted to store ü  They can be retrieved from another server
motion pictures on computer readable media, DVDs were ü  There are numerous vendors who offer individuals free
developed and they held approximately 4.3 gigabytes of cloud storage space for their personal files, such as photos
information, which will handle a regular 2 hour movie and music
ü  DVDs are too limited to handle high definition movies ü  They may also offer storage for a modest monthly or
and movies longer than 2 hours yearly fee
ü  Media moved to the even higher storage capacity of ü  Some continuously back up data, others back up data at
BluRay discs which store approximately 27 gigabytes of specified times, and typically the user can order files to be
information or the equivalent of a 2 hour high definition backed up whenever he or she wishes
movie ü  Cloud storage is far more secure and reliable than a
ü  Double layer Blu-Ray discs can store 54 gigabytes or personal hard drive or backup drives
4.5 hours of high definition motion picture media ü  Most users of smartphones, tablet computers, and other
ü  Blu-Ray is derived from the blue color of the laser that portable devices store their data in the Cloud, not only
writes on the media and ray for the optical ray that reads because of the security of the data, but because storage in
the media small devices is somewhat limited
Other Storage Devices ü  The Cloud allows more data storage than most
ü  As computers became more standard in offices during individuals need for personal use
the 1990s, more and more corporate and individual EVOLUTION OF COMPUTERS
information was stored solely on computers Major Types of Computers
Supercomputers ü  A mainframe is capable of processing and accessing
ü  The largest type of computer billions (GB) of characters of data or mathematical
ü  First developed by Seymour Cray in 1972 calculations per second
ü  The early supercomputer research, development, and ü  Mainframes can serve a large number (thousands) of
production was done by Cray Corporation or one of its users at the same time
affiliates (Cray, 2014) ü  In some settings, hundreds of workstations (input and
ü  A supercomputer is a computational-oriented computer output devices that may or may not have any processing
specially designed for scientific applications requiring a power of their own) are wired directly to the mainframe
gigantic amount of calculations which, to be useful, must for processing and communication speeds faster than can
be processed at superfast speeds be achieved with wireless communications
ü  The supercomputer is truly a world class “number ü  There are also wireless and telephone linkages into the
cruncher” computer so that remote users can gain access to the
ü  Designed primarily for analysis of scientific and mainframe
engineering problems and for tasks requiring millions or ü  As compared with a desktop PC, a mainframe has an
billions of computational operations and calculations extremely large memory capacity, fast operating and
ü  Are huge and expensive processing time, and it can process a large number of
ü  Supercomputers are used primarily in such work as functions (multiprocessing) at one time
defense and weaponry, weather forecasting, advanced  
engineering and physics, and other mathematically Microcomputers (Personal Computers or PCs)
intensive scientific research applications ü  While mainframe computers provide critical service to
ü  Provides computing power for the high-performance the healthcare industry, much smaller computers are also
computing and communication (HPCC) environment an essential part of healthcare computing systems
  ü  Computers designed to support a single user are called
Mainframes microcomputers or personal computers (PCs)
ü  The most common fast, large, and expensive type of ü  Much smaller and less powerful than a mainframe, PCs
computer used in large businesses (including hospitals and were designed to be used by one person at a time
other large healthcare facilities) for processing, storing, and ü  Microcomputers are also found in educational and
retrieving data research settings, where they are used to conduct a
ü  It is a large multiuser central computer that meets the multitude of special educational and scientific functions
computing needs large and medium sized public and ü  Desktops are replacing many of the mainframe
private organizations attributes
ü  Mainframes are used for processing the large amount of ü  Desktops can serve as stand-alone workstations and can
repetitive calculations involved in handling billing, payroll, be linked to a network system to increase their capabilities
inventory control, and business operations computing ü  This is advantageous, since software multiuser licensing
ü  The machines and software that process transactions in fees are usually less expensive per user than having each
high volume businesses are known as transaction user purchase his or her own copy
processing systems (TPS) ü  Computer size has steadily decreased since their
ü  Mainframes always have very high processing speeds invention while at the same time, power has grown
(calculated in millions of processes per second, or MIPS, or exponentially
in floating point operations per second, or FLOPS) ü  The components of desktop computer are typically
ü  Prior to the year 2000, mainframes were often defined housed in a hard case
almost entirely by their high processing speed ü  While the size of the case can vary considerably, one
ü  Today’s mainframes are more defined by the following common size is 2 ft long by 6 to 10 in wide
characteristics than merely processing speed: (1) Their ü  The case is most typically connected via wire or wireless
extensive input and output capabilities to support their technology to a keyboard, monitor, mouse, and printer
multiuser environment ü  Microcomputers are also available as portable or laptop
(2) Complex engineering to support long term stability with computers, and as notebook, tablet, and handheld
high reliability, allowing these machines to run computers
uninterrupted for decades ü  Laptop computers are highly portable because they are
(3) Their ability to process the massive throughput needed much are smaller than the standard desktop
for high volume business transactions and business office microcomputer
operations ü  Many are less than 2 in deep
  ü  There is huge variation in the length and width, but if a
15 in viewing screen is used, the case is usually about 16 in
by about 12 in
ü  Notebook computers are even smaller; one size system (owned by Google Corporation), and the Windows
marketed in 2014 is 8.5 in × 11 in operating system for smartphones and tablets from
ü  Tablet computers are smaller with a width of about 7 in Microsoft Corporation
and length of about 9 in, but are super thin as compared ü  The Android system is an open source operating system,
with the laptop and notebook computers the other two OS are closed and proprietary
ü  Less than an inch deep, they end up widened due to the ü  There are thousands of software applications (called
addition of a protective case that usually also serves as a apps) developed for all these platforms, many of them free
stand or sold at a very low price
  ü  Typically, the apps work on only the platform for which
Handheld Computers they were developed
ü  Small, special function computers, although a few “full ü  Quite a few will work on both smartphones and tablets
function” handheld computers were introduced in the late using that platform
1990s ü  For example, many apps that work on the iPad tablet will
ü  Some have claimed to have almost the same also work on the iPhone
functionality and processing capabilities as a laptop or  
notebook Connectivity, Compatibility, and Incompatibility Issues
ü  Limited in their expansion possibilities, their ability to 1. Communication among various hardware devices cannot
serve as full participants in the office network, and the be assumed.
peripherals they can support †        Given that departments within a single organization
ü  More popular are the palm-sized computers, including have often bought small systems designed to support their
personal digital assistants (PDAs), which are the smallest of work, a single hospital may have literally hundreds of
the handheld computers different computers and applications on those computers
ü  The PDA is a very small special function handheld †        Simply wiring incompatible machines so that power
computer which provides calendar, contacts, and note- can flow between them accomplishes nothing
taking functions, and may provide word processing, †        Often, computers cannot transfer data meaningfully
spreadsheet, and a variety of other functions among themselves
ü  Originally sold as isolated devices, today virtually all †        This makes it difficult to create a comprehensive
PDAs are combined with telephone functionality and sold medical record for individual patients
as smartphones †        Information stored somewhere in the facility may not
ü  Smartphones are ubiquitous be available when needed to the providers who need the
ü  Smartphones are owned by a huge number of people information to make good patient care decisions
worldwide, from the slums of South Africa to business †        As greater attention is placed on patient safety and
people in the most developed countries quality improvement, and on analysis of performance data
ü  Smartphones have replaced wristwatches, pocket for planning and evaluation, there is a need to acquire and
calendars, and other personal items people used to keep combine data from multiple patient care operations
their lives organized computers and systems
ü  Many people might be more comfortable leaving home  
without a coat in winter than without their smartphone. 2. Different computers have different architectures,
ü  These devices provide constant connectivity and access hardware configurations, and different storage schemes
to Internet and telephone functions †        Software must be specifically designed to
ü  They are particularly useful in that they can synchronize communicate with another program for the two to
with other technology and provide automatic support for communicate
such things as the user’s calendar †        Systems not designed specifically to work together
ü  The processors for most smartphones, tablet computers, cannot communicate information and processes to each
and other small but powerful devices are made by other without the addition of complex translation
Advanced RISC Machines Ltd. (ARM) programs (that usually don’t exist); that is, they are not
ü  A RISC processor is a “Reduced Instruction Set interoperable
Computer,” which means it is a special purpose processor  
ü  As of 2014, these processors are 32 bit microprocessors 3. As a result of the interoperability problems, it can be
that use the RISC architecture economically infeasible to move data across different
ü  There are a variety of hardware platforms and operating computers and programs.
systems for smartphones and tablet computers †        The interoperability problem limits the nurses’ ability
ü  The three most common are the Apple Corporation’s to obtain, combine and analyze data they need to provide
iPhone and iPad using the iOS operating system, high quality, safe patient care
smartphones, and tablets using the Android operating
†        Organization progress and performance is hampered †        By 2014, the size of main memory in computers sold
when data and information are not available to perform to the public had risen exponentially
the analysis required to identify problems, opportunities †        Most computers in 2014 are advertised with between
for improvement, safety risks, and to make projections 5 and 16 GB of main memory and computers with 20 GB or
about future needs more of main memory are available
†        Interoperability is necessary to meet the †        Cache has also become an important variable in
requirements of the Medicare and Medicaid EHR Incentive computer power and thus in advertising the power of
Programs (which provide financial incentives for the computers
“meaningful use” of certified EHR technology) as part of  
the HITECH Act of 2009 3. Another important selling point of a computer is the size
†        Interoperability usually requires interoperable of the hard drive that is installed in the box
software programs such as SNOMED CT and †        The first hard drives sold for microcomputers in the
  1970s were external devices that stored about 1,500
Computer Power kilobytes
1. Bits and Bytes †        At that time, home computers were not sold with
†        A bit (binary digit) is a unit of data in the binary internal hard drives
numbering system †        When the user turned on the computer, they had to
†        Binary means two, so a bit can assume one of two be sure the operating system (OS) diskette was in the disk
positions drive, or the computer could not work
†        A bit is an ON/OFF switch—ON equals the value of 1 †        This architecture severely limited the size and
and OFF equals 0 functionality of programs
†        Bits are grouped into collections of 8, which then †        Consumer demand for hard drives was such that their
function as a unit size grew exponentially while at the same time the cost of
†        That unit describes a single character in the hard drive storage decreased exponentially.
computer, such as the letter A or the number 3, and is †        By late 1999, home computers sold typically had
called a byte between 6 and 20 GB of space on the hard drive
†        There are 255 different combinations of 0 and 1 in an †        In 2010 the typical laptop computer was sold with a
8-character (or 1-byte) unit 300 to 500 GB hard drive
†        That forms the basic limit to the number of †        Desktops often came with hard drives that offered a
characters that can be directly expressed in the computer terabyte or more of storage
†        The basic character set hardwired into most PCs †        By 2014, most home and laptop computers were
contains 255 characters advertised with 1 to 2 terabyte hard drives
†        In the early days of PCs, this was a problem because it †        Hard drive space will undoubtedly continue to
severely limited the images that could be produced increase
†        With the advent of graphics cards and the additional †        Applications programs have become so large that
character sets and graphics that graphics cards allow, both the main memory and the hard drive storage space
virtually any character can be produced on a computer have had to increase exponentially
screen or printed on a printer
†        Even without graphics cards, additional character sets Computer Speed
can be created by means of programming techniques 1. The basic operations of the CPU are called cycles
†        The size of a variety of computer functions and †        The four types of cycles, or operations of a CPU,
components is measured by how many bytes they can include: (1) Fetch (2) Decode (3) Execute (4) Store
handle or store at one time †        It takes time for the computer to perform each of
  these functions or cycles
2. Main memory, which includes the ROM on the †        The CPU speed is measured in cycles per second,
motherboard in today’s computers, is very large as which is called the clock speed of the computer
compared with that of just a few years ago, and continues †        One million cycles per second is called 1 megahertz
to increase every year with new computers (MHz)
†        The size of memory is an important factor in the †        A billion cycles per second is called 1 gigahertz (GHz)
amount of work a computer can handle †        CPU speed is very fast because computers perform
†        Large main memory is another key measure in the many billions of cycles per second
power of a computer †        They can be slow if their processors have insufficient
†        In the mid-1970s, the PCs on the market were speed for the work they are required to process
typically sold with a main memory of between 48 and 64 K  
2. Clock speeds, like most other components, have greatly §  PCs and workstations on LANs typically contain a NIC
improved over time specifically designed for the LAN transmission technology,
†        For example, the original IBM PC introduced in 1981 such as Ethernet
had a clock speed of 4.77 MHz (4.77 million cycles per §  NICs provide a dedicated, full-time connection to a
second) network
†        In 2010, home computers commonly had speed of §  Most home and portable computers connect to the
1.8 to 3 GHz. In 2014, advertised computers in the $1000 Internet through modems on an as-needed dial-up
range have clock speeds of 2.5 to 3 GHz connection
†        The higher the clock speed possessed by the CPU, the §  The modem provides the connection interface to the
faster and (in one dimension) the more powerful the Internet service provider
computer §  The oldest network interface (or “adapter card”) is an
†        Clock rate can be misleading, since different kinds of Ethernet card
processors may perform a different amount of work in one §  Wireless network modems are used more often today
cycle §  There exist other options such as arcnet and serial-port
†        General purpose computers are known as complex boards
instruction set computers (CISCs) and their processors are §  The choice of NIC depends on the communication
prepared to perform a large number of different medium
instruction sets †        Communication medium (cabling)
†        A cycle in a CISC computer may take longer than that ü Distance. Relatively short distances are required for
for a specialized type of computer called a reduced wireless, compressed video and coaxial cable systems. For
instruction set computer (RISC) much longer distances, fiber-optics, telephone lines, and
†        Clock speed is one important measure of the power satellite transmission are used
of a computer ü Amount of data transfer. Large amounts of data
(especially video) are best handled with coaxial cables and
Network Hardware compressed video and through satellite communications
1. A network is a set of cooperative interconnected (satellite and compressed video are very
computers for the purpose of information interchange expensive). Smaller amounts of data or serial (nonvideo)
2. The networks of greatest interest include local area streams are best handled through the other wire types,
networks (LANs), wide area networks (WANs), and the such as twisted pair copper wire and optical fiber, and are
Internet, which is a network of networks less expensive.
†        A LAN usually supports the interconnected ü How often the transfer is needed. Coaxial works best for
computer needs of a single company or agency locally wired networks that are used constantly by a very
†        The computers are physically located close to each limited number of users. Telephone wires work well for the
other, and generally, only members of the company or relatively high usage public networks (like the Internet) but
agency have legitimate access to the information on the are more likely to get overloaded when many users try to
network use the system at the same time. Consider, for example,
†        †        WANs support geographically dispersed the busy Internet or phone lines getting clogged up when a
facilities, such as the individual grocery stores in a tornado or hurricane has struck a community
national chain ü Availability. Availability depends on cost, transmission
A subset of WANs includes the metropolitan area networks speed, number of users (who might clog up the system),
(MANs) that support and connect the many buildings of and weather conditions (satellites)
local governmental agencies or university campuses
 
3. The most important components of network hardware
are the adapter or interface card, cabling, and servers
4. The role of hardware in a network is to provide an
interconnection between computers
5. For a computer to participate on a network, it must have
at least two pieces of hardware:
†        Network adapter or network interface card
§  A network interface card (NIC) is a computer circuit
board or card that is installed in a computer so that it can
be connected to a network