NUSING INFORMATICS

Computer Systems

DEFINITION OF TERMS

Definition of Computer
Machine that uses electronic components and instructions to the component to perform calculations and repetitive and complex procedures, process texts, and manipulate data and signals.

Computer Hardware
Definition: All of the physical components of the machine itself. Example: Electronic circuits Microchips Processors Motherboard Keyboard

Computer Hardware Fundamentals

Motherboard
Thin, flat sheet made of a firm, non-conducting material on which the internal components (printed circuits, chips, slots, etc.) of the computer is mounted.

Central Processing Unit

Brains of computer. the Consist of at least one arithmetic and logic unit, a control unit, and memory.

CPU> Parts
1. Arithmetic and Logic Unit
Control mathematic functions and functions that test logic conditions.

2. Control Unit

Carries out the machine language functions called fetch, execute, decode, and store.

CPU> Parts
3. Memory
Includes the locations of computers internal and main working storage.

CPU> Memory> Types

Read Only Memory
Permanent storage. Data and programs can only be read by the computer. Cannot be erased or altered. Generally contains (firmware). the programs

Not erased when computer is turned off.

CPU> Memory> Types

Random Access Memory
Working Memory Changeable and Temporary Can be accessed, used, changed and written on repeatedly.

Contains application.
Lost when computer is turned off.

Input Device
Allow the computer to receive information from the outside world.

Input Device> Mouse

Hand controlled mechanical device that electronically instructs the cursor to move across the video display screen.

Input Device> Keyboard

Most common input device.

Similar keyboard typewriter.

to of

Input Device> Touch Screen

Involve use of a special filter on a monitor screen that allows the screen to sense the pressure of the users finger on a particular position on the screen.

Input Device> Light Pen

photosensitive device that responds to light images when placed against a monitor screen.

Input Device> Optical Character Recognition

specialized computer input medium that allows data to be read directly from a form or document.

Input Device> Voice/Speech Synthesizer

allows user to input data into the computer by speaking into a connected microphone.

Output Device
Allow the computer to report its result to the external world.

Output Device> Monitor

display screen component of a terminal that allows the user to see images, programs, commands the user sends to the computer, and results of computers work (output).

Output Device> Printer

most important output device, Converts information produced by the computer system into printed form, rendering data in the binary code into readable English.

Storage Media
Includes the main memory but also the external devices on which the programs and data are stored.

Storage Media> Hard Drive

Peripheral that has a very high speed and high density. It is a very fast means of storing and retrieving data as well as having a large storage capacity.

Storage Media> Diskettes

Allows input and output from a diskette, which is a round magnetic disk encased in a flexible or rigid case. Allows the user to transport data and programs from one computer to another.

Storage Media> CD ROM

A rigid disk that hold a much higher density of information than a diskette and has a much higher speed.

Storage Media> USB Disk

Form of a small, removable hard drive that is inserted into the port of the computer.

HISTORY OF COMPUTERS

First Generation Computers

1943 First true digital computer (Colossus Mark I) was made. Bell Laboratories was working on the development of a computer as were two scientists at the University of Pennsylavia, J. Presper Eckert and John Mauchly, later founders of EckertMauchly Corporation.

1950 Remington Rand Corporation bought Eckert and Mauchlys company and 1 year later began to market the first large scale commercial computer system, UNIVAC-I (Anonymous, 2004).

1955 Sperry Corporation merged with Remington Rand forming the giant Sperry Rand Corporation. The first commercial application was run when General Electric processed its payroll on a UNIVAC computer. Age of business computing was born.

Second Generation Computer

Introduced in the late 1950s Included IBM 1401 and 1620 Used transistors instead of vacuum tubes Less heat, improved reliability, and much greater speeds Measured in millionths rather than thousandths of second (microseconds) Transistor were smaller and more durable

Third Generation Computer

Introduced in mid 1960s Use micro-miniature solid state components Measures billionths of a second (nanoseconds) Ex: IBM 360 and 370

Rise of Modern Personal Computers

1972 Intel Corporation introduced the first commercial microprocessor called Intel 8008 (Maxfield and Brown, 1997). Made the PC or microcomputer possible Steve Jobs and Steve Wozniak bought microprocessor for $25 and built a very simple computer they called Apple

1976 Steves began building machines in Steve Jobs garage Introduced their first computer at a meeting of the Homebrew Computer Club, at which Paul Terryl, president of the Byte Shop chain, ordered 50 computers.

Fourth Generation Computers

Introduced by IBM, IBM 370. First mainframe family that had printed circuits. Measured in millions of instructions per second (MIPS).

CLASSES OF COMPUTERS

Analog Computer
Operates on continuous physical or electronic magnitudes, measuring ongoing continuous analog quantities such as voltage, current, temperature, and pressure. Handles data in continuously variable quantities rather than breaking the data down into discrete digital representations. Example: heart monitors, fetal monitors

Digital Computer
Operates on discrete discontinuous numerical digits using the binary system. It represents using discrete values for all data. Its data is represented by numbers, letters, and symbols rather than waveforms. Example: Heart monitor

Hybrid Computer
Contains feature of both analog and digital computer. Used for specific applications such as complex signal processing and other engineering-oriented applications. Example: ECG, EEG

TYPES OF COMPUTERS

Supercomputers
Largest type of computer. Computational-oriented computer specifically designed for its scientific applications requiring gigantic amounts of calculations. Designed primarily for analysis of scientific and engineering problems and for tasks requiring millions or billions of computational operations and calculations.

Mainframes
Fastest, largest, and most expensive type of computer used in corporate America for processing, storing, and retrieving data. Large multiuser central computer that meets the computing needs, especially the large amount of repetitive calculations of bills, payroll, and the like, of a large organization. Capable of processing billions of information per second and accessing billions (GB) of characters of data.

Microcomputer (Personal Computer / PC)

Being used for number of independent applications as well as serving as a desktop link to the programs of the mainframe. Available as desktop computer, portable laptop, notebook. Uses in the hospital:
Patient classification Nurse staffing and scheduling Personnel management applications

Handheld Computers
Small, special function computers. Example: PDAs

 Is a set of cooperative interconnected computers for the purpose of information interchange.

 Usually supports the interconnected computer needs of a single company or agency. Computers are physically close to each other and members of the company have legitimate access.

 Supports geographically dispersed facilities. Subset include MAN (Metropolitan Area Network), that support interconnected buildings like university.

COMPONENT OF COMPUTER HARDWARE

Network Hardware
Provide interconnection between computers.

Network Hardware> Parts

Network adapter or Network interface card Computer circuit or card that installed in a computer so that it will be connected to a network. Provide a dedicated full time connection to a network. Most commonly used is Ethernet card,

Communication Medium (Cabling) Means by which actual transfer of data from one site to another takes place. Examples: twisted pair cable, coaxial cable, fiber-optics, telephone lines, satellites, compressed video.

Coaxial wire

Twisted Pair Cable

Fiber Optics

Telephone Line Communications ISDN (Integrated Services Digital Network) Used to carry communications across phone lines Set of communication standards for optical fibers that carry voice, digital, video signals across phone lines.

Bandwidth Controls how fast the signals can be transmitted across phone lines. Measured in Mbps
1. DSo (digital standard-zeroth level) The first one used That transmitted at 64 kilobytes per second. 2. T-Lines Replace DS0 Used to handle the high speed transmission needed for network communications

DS0

T-Line

Servers Computer program that provides to other computer programs in the same computer or in other networks. Client-server approach One computer is the core or server computer that receives requests from the client computer and fulfills those requests.

Architecture Refers to overall physical structure, peripherals, interconnections within the computer, and its software system. Refers to how communication among the various computers in the network is accomplished.

Five fundamental components (Computer Subsystem) 1. Input/Output 2. Storage 3. Communication 4. Control 5. Processing

Types: 1. Broadcast Communication is done by transmitting the same information to all computers in the network that are expected to respond to it. Typically used in LANs 2. Point-to-Point Used in dial up networking.

Topology Defines how the network computers in LAN are interconnected within a physical area and describes their physical interconnection.

Types 1. Bus Network topology or circuit arrangement in which all the node computers are directly attached to a line. Expansion slot on mother board.

2. Star Centralized structure where all computers are connected through central computer (server)

3. Ring Connection with wires or cables that directly connected to computers together. 3.1 Hub Consist of backbone or main circuit attached to outgoing lines. Used for relatively small number of connected workstation. All computers are connected to a hub processor that contains networking software and provides for communication among the various computers on the network. 3.2 Arcnet Token bus system for managing line sharing among all users on the network.

COMPUTER SOFTWARE

Computer Software
Instructions that direct the computers hardware to perform work. Purposes: Computers do not directly understand human language and software is needed for translate instructions created into human language into machine language. Needed to make the computer an economical work tool.

Brief History of Programming

Augusta Ada Byron Countess of Lovelace First described the concept of stored computer program. Theorized the use of automatic repetitious arithmetic steps that the analytical engine will follow to solve a problem (loop concept) First programmer

Charles Babbage Babbage built an analytical machine.

Robert Von Newmann Proposed both data and instructions could be stored in computer and that the instructions could be automatically carried out.

Babbage machine

Joseph Jacquard Weaver from France Invented the Jacquard loom (device that used blocks of wood with holes drilled in such a way that threads to be woven into cloth could form a program or set of instructions.

Jacquards Loom

Herman Hollerith Developed a machine that could read punched cards and tabulate results. (1884) Formed company called Tabulating Machine which became International Business Machine (IBM)

Holleriths Machine

Rear Admiral Grace Murray Hopper The mother of computing. Worked with the first digital computer (Mark I) and its successor (Mark II) Coined the term debugging which means checking the program to ensure that it is free of error. Did the Common Business-Oriented Language (COBOL) which was considered the first universal programming language

Mark I

Mark II

TYPES OF SOFTWARE

System Software
Consists of variety of programs that initialize or boot up computer when it first turned on and thereafter control all functions of the computer hardware and application hardware.

System Software> Basic Input Output System (BIOS)

First level of system control Consist of set of instructions permanently burned onto computer chip is truly a combination of software and hardware.

System Software> Operating System

Actual software, loaded from the hard drive into RAM as soon as the computer is turned on. OS can be upgraded or completely changed without changing the hardware chip. Manages the interface to peripheral hardware, schedule tasks, allocates storage in memory and on disks, and provides an interface between the machine and the user. Example: Windows 7

User Interfaces 1. Disk Operating System (DOS) Present a blank screen to the user and the user submits typed commands. First designed for mainframe computers and replicated the procedure programmers and under manual OSs.

2. Graphical User Interface Computer for everybody and PC market exploded. Supports use of graphic images called icons to represent commands to the computer. Support the operation of menus. Example: Macintosh by Steve Jobs

3. Utility Programs Designed to enhance the functions of OS or perhaps to add facilities that basic OS does not offer. 3.1 Language Translation Utilities Convert instructions written in Englishlike language into binary Also known as assemblers, compilers, interpreters 3.2 Worldwide Web (www) Network system utility program for the Internet. Provides a protocol for documents across the Internet

3.3 Web Browser Utility program that allows the user to access the Web and the material available through the web. Example: Opera, Google Chrome, Internet Explorer

Application Software
Includes the various programs people use to do work, process data, play games, communicate with others, or watch multimedia programs on a computer.

COMMON SOFTWARE USEFUL TO NURSE

Chat Rooms

Electronic Bulletin Boards

Listservs

COMPUTER PROGRAMMING
Process of writing a computer program, which is a series of instructions written in proper sequence to solve a specific problem.

Step 1: Problem or function definition

Most critical step in programming Requires the problem or task be precisely defined and the procedures to be performed by program, be perfectly understood. Ex: Calculate cost of nursing visit C by totaling cost of nurse A and cost of supplies B.

Step 2: Program Design Specification

Set of functional specification that identifies all the functions the program is to perform. It includes narrative description of the functions the system and a graphical representation of the systems process flow. Second set is called design specification, these are instructions given to the programmer. Maybe highly technical and are not typically viewed by customers.

Step 3: Program Preparation

The actual writing or coding of programs, entails translating the design specifications into programming language to be used. Program language (algorithms) must be coded in detail and in logical sequence so that the program can process data correctly.

Step 4: Documentation
Two types of documentation that must be produced: Program Documentation includes narrative manual of instructions to system administrators who will have to maintain the program after the initial programming is completed. Users Manual provides clear directions and examples of how to make the program work as intended.

Step 5: Program Testing

Alpha Testing programming team and system analyst carefully desk check the program to see if all the processes appear to be functioning as specified in flowcharts, functional specifications, and design specs. Also known as desk checking. Beta Testing program is installed in the actual user environment, and further programming of screen formats and other user interface functions is performed. Some users are trained to use the system

Step 6: Program Implementation

Final step in programming where in program is implemented throughout a beta site.

System Elements

Interdependent Parts
Most defining attribute of a system, it

interacts to conduct processes.

Input
Any factor from the external environment

that is taken into the system. May serve to initiate system functioning.

Process
Activity of the system. Input to create some outputs or results.

Output
Any product or waste produced as a result of

system process.

Controls
Refer to any component or activity that serve

to prevent or correct problems or errors in the systems input, process or output.

Feedbacks
Output from one part of a system process

that serve as input or part of another part of the system process. Used as part of a systems self regulation function.

Classification of Systems

Closed System
Also known as Self-containment or Selfregulation Defined as a system with the following characteristics: differentiation, isolation, independence, self sufficiency. Boundaries are clearly defined and rigid. Access if highly restricted because only inputs acceptable are inputs from another part of itself.

Open System
System that exhibit integration, fluid or fuzzy boundaries and interaction with their environments. Overlaps other system and maybe a subsystem within a larger system.

Information System
Is the collection and integration of various pieces of hardware and software and the human resources that meet data collection, storage, processing, and report generation needs of organization.

Information System Types

Management Information System Provides managers information about their business operations. Organized system for managing the flow of information in an organization in a timely manner. Primary use is assisting in decision making processes. Support strategic planning, management control, operations support.

Bibliographic Retrieval System Retrieval system that generally refers to bibliographic data, document information, or literature primarily used to store and retrieve data and not to conduct any computations per se. Example: CINAHL MEDLINE (http://igm.nlm.nih.gov)

Stand-Alone, Dedicated, Turnkey System Special purpose system, developed for a single application or set of functions. Example: Patient Classification System

Transaction System Used to process predefined transactions and produce predefined reports. It is designed for repeated operations using a fixed list. Example: Inventory System, Admission/Discharge/Transfer system

Physiologic Monitoring System Widely used in hospital patient care units Example: Heart monitor

Decision Support System Computer system that supports some aspect of the human decision making process. Work with user to support, but not replace, human judgment in a a decision making situation. Example: Nurse Staffing

Example: Expert System Computer system containing the information and decision making strategies of an expert to assist non experts in decision making. Designed for users to simulate the cause and effect reasoning that an expert would use if confronted with the same situation in a real live environment.

Artificial Intelligence Systems System that attempts to model human reasoning processes. Concerned with symbolic inference and knowledge representation. Track the accuracy of its predictions and judgments and alter its own decision making rules based on new knowledge it generates for itself.

 * Symbolic Inference concerned with deriving new knowledge from known facts and the use of logical inference rules. Ex: If A > B and B > C, then A must be greater than C.
* Knowledge Representation the field concerned with devising ways to represent and use abstract knowledge and then store those representation and use rules in a computer system.

Natural Language System A system that can understand and process commands given in the users own natural, spoken language. Does not require the user to learn special vocabulary, syntax, and set of programming rules and instructions.

HOSPITAL INFORMATION SYSTEM

Provides support for a wide variety of both administrative and clinical functions.

Purpose
Manage information needed to facilitate daily hospital operations by all health care personnel. Administrators: manage financial budgets and establish charges for services. Physician: diagnose, treat, evaluate patient condition. Nurses: assess, plan, provide patient care

HIS Configuration
Mainframe computer with hardwired terminals or workstations Local Area Network

Program Modules Available for HIS

Admission and discharge Patient tracking Finance, Payroll, Billing, Budgeting support Inventory Management reporting program Administrative programs: Cost accounting, patient billing, inventory control, bed census, medical records, patient classification system

Semi-clinic Modules
Admission/Discharge/Transfer (ADT) Monitors and controls the flow of patient in a hospital from admission to discharge.

Order-Entry-Result-Reporting Module (OE) Staff can enter laboratory, pharmacy, radiology orders online. Results can also be posted.

Clinical Support System

Charting System Includes medication administration, Reports, admission assessment, shift assessment, special assessment, some elements of NCP (nursing diagnosis, interventions), and vital signs.

Point-of-Service System / Point-of-Care System Special type of clinical system Uses a hand held or bedside PC to ensure data are entered at the point at which they are collected Designed to save time by recording critical clinical data, provides access key to patient information for health care providers Laboratory, Pharmacy, Radiology Modules

Open Source Software (OSS) and Free Software (FS)

Definition of Terms

Free Software Matter of the users freedom to run, copy, distribute, study, change, and improve software. Free in terms of freedom to change not the price. Kinds of Freedom Freedom to run program for any purpose Freedom to study how the program works and adapt it to your needs. Freedom to redistribute copies so as you can help your neighbor Freedom to improve the program and release improvements to public so that the whole community benefits.

Open Source Software Provide free access to programmers instructions to computer in programming language in which they are written. Freeware Software that is offered free of charge but without the freedom to modify the source code and redistribute changes.

Shareware Offered on a try before you buy basis.

 Electronic equivalent of generic drugs Accessible to user, anyone can see the how the software works and can make changes to the functionality. Free, less expensive than acquiring propriety alternatives Leads to development of local software capacity.

Proposed Benefits of OSS/FS

Issues in OSS/FS
Licensing Copyright and Intellectual property Total Cost of Ownership (TCO) - Sum of all expenses directly related to the ownership and use of product over a given period of time. Support -Do not have the same level of documentation, training, and support. Business Models Security and Stability

Data Processing

Definition of Terms
Data Raw uninterrupted facts that are without meaning.

Approaches to Data Organization Sorting Classifying Summarizing Calculating

Information Produced when data is processed and interpreted. Information System Used to process data and produce information. Examples: Computer System, Human Information System, Manual Information System

Database An organized collection of related data. Example: Phonebook Building Blocks Field - Record Files Database Factors Affecting Finding of Information How the data are named (indexed) and organized The size and complexity of the database The type of data within the database The methodology or tools used to research database.

Types of Data
Computer-Based Data Types

Grouped either by numbers, letters, or combination of both.

Conceptual Data Types

Reflect how users view data, can be based on event that data are attempting to capture and based on the source of data.

Computer programs used to input, store, modify, process, and access data in a database. Example: Computerized library system, Automated Teller Machine

Database System Design (Process of configuring the database software) Database software (DBM Software) is used to enter project data into the computer. Three interacting parts must be present: data, DBMS configures software program, query language used to access data.

 Decrease

data redundancy ** Data redundancy occurs when data are stored in the database more than once. Increase data consistency Improve access to data

TYPES OF FILES

PROCESSING FILES > EXECUTABLE FILES

Consist of a computer program or set of instructions that, when execute, causes the computer to open or start a specific computer program of function. Files that tell a computer what actions the computer should perform when running a program. Example: set-up.exe (tell the computer to begin installing the related computer program on the computer.

PROCESSING FILES > COMMAND FILES

Are set of instructions that perform a set of functions as opposed to running a whole program. Example: autoexec.bat (batch files that tells the computer to open or start a virus checking program when the computer is booted)

DATA FILES
Contain data that have been captured and stored on a computer using a software program. Example: .doc, .txt, .ppt ** Master Index File contains unique identifier and related indexes for all entities in the database. Example is identification file for all patient records

D ATABASE

MODELS

American National Standard Institute (ANSI) Standard Planning and Requirements Committee (SPARC) Model

Proven effective since 1970s

Identifies three views or models of data elements and their relationships

Three views:

Users View - Wish of all requirements that the user will have for the database. List of functional specifications describing queries, reports, and procedures that can be produced by the database Logical View Physical View

Conceptual Models

Includes a diagram and a narrative description of the data, elements, their attributes, and the relationship between the data Defines the structure of the whole database in terms of the attributes of the entities (data elements), relationships, constraints, and operations.
Include all data elements, the definition and attributes of each datum, and all relationships between data.

One-to-one One-to-many relationship

S TRUCTURAL OR PHYSICAL
MODEL
Includes each of the data elements and the relationship between the data elements, as they will be physically stored on the computer.

Approaches:

Hierarchical Database

All access data starts at the top of the hierarchy or at the root Effective at representing one-to-many relationships

Network Model

Developed from hierarchical models. Child node is not limited to one parent

Represent many-to-many relationship

R ELATIONAL D ATABASE
MODEL
Consist of a series of files set up as tables. Each column represents an attribute, and each row/tuple is a record. Joins any two or more files and generates a new file from the records that meet the matching criteria.

Object-Oriented Database Model

Developed because the relational model has a limited ability to deal with binary large objects or BLOBs.

Entity as well as attributes of the entity are stored with the object.

** BLOBs complex data types such as images, sounds, spreadsheets, or text messages.

DATABASE LIFE CYCLE

Initiation
Occurs when a need or problem is identified and the development of DBMS is seen as a potential solution.
Looks at the needs, current approaches, what are the potential options for dealing with the need.

Planning and Analysis

Begins with an assessment of the users view and the development of the conceptual model.
Includes internal and external uses of information.

Detailed System Design

Begins with the selection of the physical model, hierarchical, relational or object oriented.
Revisions may be expected.

Includes training the users, testing the system, developing a procedure manual for the use of the system, piloting DBMS, and finally going live.

Evaluation and Maintenance

Common Database Operations

Data Input Operations

Used to enter new data, update data in the system, or change/modify data in the DBMS. A well designed screen is important, it will discourage data entry errors.

Data Processing Processes

DBMS-directed actions that the computer performs on the data once entered into the system. Used to convert raw data into meaningful information. ** Online Transaction Processing real time processing of transactions to support day-today operations.

Data Output Operations

Includes online and written reports. Approach to designing these reports have an impact on the information the reader actually gains from the report.

DATA WAREHOUSE

DEFINITION
Largest collection of data imported from several different systems within one database. Data sources could either be internal or external. Definition by Bill Immon (father of data warehouse): subject oriented integrated, time variant, non volatile collection of data used to support the management decision making process.

PURPOSES
Spares users from the need to learn different application. Makes it possible to separate analytical from operational processing.

FUNCTIONS
Extract data from various computer systems and import data into the warehouse. Function as a database able to store and process all the data in the database. Deliver data into the warehouse back to the user in the form of information.

ACTIVITIES SUPPORTED BY DATA WAREHOUSE

Decision support for caregivers at the point of care Outcome measurements and quality improvement Clinical research and professional education Reporting to external agencies Market trend analysis and strategic planning Health service management and process reengineering Targeted outreach to patients, professionals, and other community groups

DATA 2 KNOWLEDGE (D2K)

Process of extracting information and knowledge from large-scale databases Uses powerful automated approaches for the extraction of hidden predictive information from large databases.

Process of D2K Carefully assessing questions that users need to answer Prepare the data (selected, cleaned, transformed into consistent format) Data mining processes can be done. ** Predicting discovering variables that predict or classify a future event. ** Discovery discovering patterns, association, or clusters within large dataset. ** Deviation discover norm via pattern recognition and then discover deviations from these norm Interpret, evaluate and use data mining result within institution.

Internet: A Nursing Resource

ISOC (Internet Society)

Overall organizing force of Internet An international, non-profit group, professional membership organization with no government allegiances Comprised of 150 organization, 16000 individual members that represent 180 nations Maintain standards, develop public policy, provide education, increase membership

Technology Behind the Internet

TCP (Transfer Control Protocol) Allows computers to connect to a network and exchange data. Carries out task of breaking messages into small packets. Ensures that packets/programs are all received and are in correct order.

IP (Internet Protocol) Lower level protocol responsible for making decision about these packets and routing them.

Domain Name System (DNS)

Permits us to give globally unique names to networks and computers

Examples: Top Level Domains (TLD) .aero (air transport industry) .biz (for businesses) .com (commercial) .coop (cooperatives) .edu (educational institutions) .gov (government agencies) .info (all users) .net (network resources) .org (non-profit organizations) .pro (professionals)

Use of the Internet

File Transfer Protocol (FTP) Upload files and download files from distant computers. ** Uploading process of moving a file from the users computer to another computer ** Downloading transfer of file from another computer to users computer.

Telnet Allows a connecting computer to behave like a terminal for distant computers regardless of the type of computer that is either the target or the originator of the Telnet session. Example: Internet Service Providers (ISP) Usenet News and Online Forums

Email Anatomy of email address Using email Use of emoticons and abbreviations Organizing received files File attachments Cautions and suggestions

Mailing List First created by Eric Thomas in 1986 Set up to provide an arena for discussion on specific topic Have to mailing addresses (address of the software that manages the list and the subscribers)

Worldwide Web (www) History Appeared in the last half of the 1990s First proposed by Tim Berners-Lee in 1989 First prototype appeared in 1990 with a subsequent release in 1991 1992 first browser was released to the public as freeware

How www Functions Browser software programs that allow any computer to be a web client Hypertext Transfer Protocol (HTTP) enables transmitting and interpretation of files not just text. Invented by Ted Nelson in 1960s. Uniform Resource Locator (URL) - contains the name of the computer where the document you are seeking is located along with other specifics to locate it. Example: http://www.yahoo.com/yahoogroups

Value Opens the world to you Easy access of information Online journals Professional information (organizations) Continuing educations Tutorials

The Internet as Source of Information Evaluating Information Credibility source, how current, usefulness, relevance Content hierarchy of evidence, presence of original sources Disclosure purpose of the site, sponsor Links quality of links Design accessibility, easy navigation, searchable Interactivity allow feedback, exchange

Patient/Consumer use of the Internet

Many hospitals and insurance agencies including the federal government has web sites setup for patients
Hours and services Maps or obtain location Locate and see physicians credentials

Other organizations allow submission of information on online forms, checking of health care benefits and even ordering prescription medicines online

Desktops vs notebooks/laptops vs tablet vs smart phones vs PDA

Desktop
Heavy to hand carry
Larger display Processing power (GHz)

Memory Capacity (GB)

Not designed to run on battery power

Smart phones
Functions as telephone, email, internet

access and PDA organization function Fits in a shirt pocket Weigh ounces Has 2 inch or slightly larger display Limited memory Limited storage capacity Has 3 hrs talk and 10 hours standby battery life

Notebooks/laptops Light enough to hand carry Has slightly smaller display Slightly less processing power and storage capacity Possible to add external devices Run on battery power Tablet Ability to provide input using stylus Lighter Slightly smaller display Slightly less processing power and storage capacity

PDA
Weighing 8 ounce or less
Small enough to fit a shirt pocket Comes w/ a miniature keyboard and a

stylus for data entry Possible to add external keyboard

Mobile devices continuum of portability

Portable
A device w/c can be rolled from room to

room

Mobile
Devices w/c are small and lightweight

enough to be hand carried

Handheld
Device w/c can be held in the palm of one

hand and used w/ the other hand

Uses of PDA
Normal functions: to do, notepad, calculator, address book, date book WLAN, web browsers Document viewers Office utilities Reference material (journal, articles) Application: NANDA, ECG, Pharmacology, Dictionary, BMI Calculator

Use of computer based clinical decision Support system for health professionals

Definition of Terms
Decision Support System Automated tools designed to support decision making activities and improve the decision making process and decision making outcomes.

Nursing Decision Support System (NDSS)

Tools that help nurses: Improve their effectiveness Identify appropriate interventions Determine areas in need of policy or protocol development Support patient safety initiatives and quality improvement activities.

Clinical Decision Support System (CDSS)

Designed to support health care providers in making decisions about the delivery and management of patient care. Typically designed to integrate a medical knowledge base, patient data and an inference engine to generate case specific advice.

Goals of CDSS
Patient Safety Improved outcomes for specific patient populations Compliance with clinical guidelines, standards of practice, regulatory requirement. Optimization of both efficiency and effectiveness with which clinical decisions are made and care is delivered.

3 main purpose of (DSS)

Assist in problem solving w/ semi structured problems Support, not replace, the judgment of a manager or clinician Improve the effectiveness of decision making process

History: Early systems

INTERNIST I Developed at Pittsburgh University in 1974 Support the diagnostic process in general internal medicine by linking disease with symptoms

MYCIN I Rule based expert system to diagnose and recommend treatment for certain blood infections Functional in 1976

COMMES (Creighton Online Multiple Modular Expert System) and CANDI (Computer-Aided Nursing Diagnosis and Intervention Assist nurses with care and planning and nursing diagnosis.

Types of DSS
Administrative and Organizational System
Supports organizational, executive/managerial, financial and clinical decisions

Integrated System
Supports outcomes performance management by integrating the operational data (the business side) w/ clinical data (the clinical side)

Key CDSS Functions by Perreault (1999)

Administrative- support for clinical coding and documentation Management of clinical complexity and detailskeeping patients on research and chemotherapy protocols, tracking orders, referrals, follow up and preventive care Cost control- monitoring medication orders and avoiding duplicate or unnecessary tests Decision support- supporting clinical diagnostic and treatment plan processes promotion of best practice, use of condition-specific guidelines, and population based management

Classification of CDSS
From ontologic perspective (Tan and Sheps, 1998) Data-based system (population based) Model-based system (case based) Knowledge-based system(rule based) Graphic-based system

Examples of CDSS application

Reminders and alerts Therapy critiquing and planning Diagnostic assistance Laboratory system w/ interpretation Prescribing decision support Clinical workstations w/ online literature Image recognition and interpretation Signal interpretation w/c activates interpretative alarms Natural language/speech recognition Evidence based quality improvement Multitask tools for assessment, diagnosis and management

Barriers in using CDSS

Lack of noticeable benefits Insufficient cost benefits Inadequate staff training Lack of system support Lack of exposure to technology

Essential elements needed for informatics structure (McCormick,1998)

Standardized vocabularies
To describe patient diagnoses, intervention and outcomes

Computer based methods

Examine linkages among patient problems, interventions, outcomes and variations

Integrated clinical information system

Data required for improvement are collected and returned to the provider

Five Elements for Real Time CDSS by Sittig (1999)

1. Integrated real-time patient database combines data from multiple sources. 2. Data driven mechanism event triggers to go in effect and activates alerts and reminders automatically. 3. Knowledge engineer translate knowledge representation scheme. 4. Time driven mechanism permit automatic execution of program at specific time.

5. Long clinical term repository data collected over time from variety of resources.

Responsibility of user: ethical and legal issues

No legal ramification of not following CDSS advice But the legal responsibility for treatment and advice given to a patient rest w/ the clinicians regardless of whether a CDSS is used.

Implications of Future Uses of CDSS in Nursing

Allow patient to access to the knowledge base of the system. Computer as health medium Development of CDSS program for other clinical users including nurses

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