NURS 6431: Week 1: The Evolution of Health Informatics Part 1 Essay Assignment Paper

This week, you are introduced to key pioneers in the field of health informatics, and you explore how their work influences the field today.

Learning Objectives

Students will:

• Assess the impact of early work in informatics on the current field of informatics
• Create a flowchart depicting organizational information technology infrastructure*

*The Assignment related to this Learning Objective is introduced this week and submitted in Week 11.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Kaplan, B., Brennan, P., Dowling, A., Friedman, C., & Peel, V. (2001). Towards an informatics research agenda: Key people and organizational issues. Journal of the American Medical Informatics Association, 8(3), 235–241.

This article highlights key areas in the field of health informatics in which additional research needs to be conducted. The authors cite organizational and social trends, and they suggest questions that need to be addressed in these areas.

Document: Practicum Manual (PDF)

Document: Practicum Journal Template (Word document)

Pioneers in Informatics

Harriet Werley

Werley, H. H., Devine, E. C., & Zorn, C. R. (1988). Nursing needs its own minimum data set. The American Journal of Nursing, 88(12), 1651–1653.

Copyright 1988 by Lippincott Williams and Wilkins, Inc. Reprinted by permission of Lippincott Williams and Wilkins, Inc. via the Copyright Clearance Center.

In this article, Werley, Devine, and Zorn describe their development of the nursing minimum data set (NMDS). They also discuss how the NMDS was used and why it was important.

Werley, H. H., Devine, E. C., Zorn, C. R., Ryan, P., & Westra, B. L. (1991). The nursing minimum data set: Abstraction tool for standardized, comparable, essential data. American Journal of Public Health, 81(4), 421–426.

In this article from 1991, the authors explain their usage of the nursing minimum data set to standardize collections of nursing data. The authors explore the importance of standardizing nursing data, as well as these data’s availability, reliability, and benefits at that time.

Hobbs, J. (2011). Political dreams, practical boundaries: The case of the Nursing Minimum Data Set, 1983–1990. Nursing History Review: Official Journal of the American Association for The History of Nursing, 19, 127–155.

This article explores the development of the Nursing Minimum Data set (NMDS). The article details the contentious process that Harriet Werley utilized to identify information used in the NMDS.

Werley, H. (1972). Research in nursing as input to educational programs. Journal of Nursing Education, 11(4), 29-38.

In this article, Harriet Werley describes the relationship between nursing research and nursing education programs. Werley cites numerous studies that emphasize the need for additional nursing research and its integration into practice and curricula.

Robert Ledley and Lee B. Lusted

Ledley, R. S., & Lusted, L. B. (1959). Reasoning foundations of medical diagnosis. Science, New Series, 130(3366), 9–21.

Copyright 1959 by American Association for the Advancement of Science. Reprinted by permission of American Association for the Advancement of Science via the Copyright Clearance Center.

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This seminal article explores the research, observation, and risk involved in diagnosing a patient in 1959. The authors discuss the reasoning foundations behind how physicians made a medical diagnosis in their era.

Ledley, R. S. (1964). High-speed automatic analysis of biomedical pictures. Science, New Series, 146(3641), 216–223.

Copyright 1964 by American Association for the Advancement of Science. Reprinted by permission of American Association for the Advancement of Science via the Copyright Clearance Center.

The authors of this article describe contemporary technologies in the nursing field of 1964. In particular, they focus on the high-speed automatic analysis of biomedical pictures.

Ledley, R. (2004). Editorial for computerized medical imaging and graphics. Computerized Medical Imaging and Graphics, 28(1–2), 1.

This article explains how advances in medical imaging technology have drastically changed patient care. The author also defines and explains different types of medical imaging and graphics.

Ledley, R. S., & Lusted, L. B. (1960). The use of electronic computers in medical data processing: Aids in diagnosis, current information retrieval, and medical record keeping. IRE Transaction on Medical Electronics, ME-7(1), 31–47.

In this article, the authors discuss the use of computers in medical data processing in 1960. The article explains how computers changed the abilities of physicians to make educated diagnoses and keep medical records.

Ledley, R. S. (1987). Medical informatics: A personal view of sowing the seeds. Proceedings of ACM Conference on History of Medical Informatics, 1987, 31–41.

 

This 1987 article describes a personal view of medical informatics. The author relays personal experiences with early medical informatics systems.

MUMPS (Massachusetts General Hospital Utility Multi-Programming System) in Octo Barnett’s Laboratory of Computer Science, Neil Pappalardo, Curtis Marble, and Robert Greenes

Ashenhurst, R. L., McIlroy, M. D., Gawlick, H. J., Daley, L. R., Fournier, A., Cohen, D., & … Rule, J. B. (1990). ACM Forum. Communications of the ACM, 33(5), 479–482.

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This article includes numerous letters to the editor of Association of Computing Machinery’s (ACM) journal. The letters discuss numerous issues that were prevalent in computing and informatics at the time of publication.

Barnett, G. O. (1987). History of the development of medical information systems at the Laboratory of Computer Science at Massachusetts General Hospital. Proceedings of ACM Conference on History of Medical Informatics, 1987, 43–49.

In this article, the author explores the history of the development of medical information systems at the laboratory of computer science at the Massachusetts General Hospital. The author describes the importance of different medical information systems and how they were utilized at this particular hospital.

Lincoln, T. L. (1987). An historical perspective on clinical laboratory information systems. Proceedings of ACM Conference on History of Medical Informatics, 1987, 117–121.

The author of this article discusses some of the medical information systems in use in 1987.This article provides a historical perspective on clinical laboratory information systems and how they have evolved over time.

Masic, I. (2014). Five periods of development in medical informatics. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947939/

This article provides a summary of the history of medical informatics. The author describes key medical informatics pioneers and systems.

Waxman, B. D. (1987). Planting the seeds. Proceedings of ACM Conference on History of Medical Informatics, 1987, 27–29.

This article describes the history of informatics prior to 1987. The author discusses the information gathered at the proceedings of the ACM conference and who “planted the seeds” of medical information systems.

Morris Collen

Collen, M. F. (1966). Periodic health examinations using an automated multitest laboratory. JAMA: Journal of the American Medical Association, 195(10), 830–833.

Copyright 1966 by American Medical Association.  Reprinted by permission of American Medical Association via the Copyright Clearance Center.

This article explains how automated multitest laboratories changed the way basic health examinations are performed. The article gives a brief history of health examinations, the importance of automated multitest laboratories, and the equipment used.

Collen, M. F., Rubin, L., Neyman, J., Dantzig, G. B., Baer, R. M., & Siegelaub, A. B. (1964). Automated multiphasic screening and diagnosis. American Journal of Public Health and the Nations Health, 54(5), 741–750.

Copyright 1964 by American Public Health Association. Reprinted by permission of American Public Health Association via the Copyright Clearance Center.

The authors of this article provide a brief description of the current state of quantitative testing in their era. In particular, they explore the use of multiphasic screening and diagnosis at that time, and its contribution to the medical field.

Oakes, T., Syme, S., Feldman, R., Friedman, G., Siegelaub, A., & Collen, M. (1973). Social factors in newly discovered elevated blood pressure. Journal of Health And Social Behavior, 14(3), 198–204.

This article explores a study that sought to determine the social factors associated with newly discovered high blood pressure. The study demonstrates how automated multiphasic health testing can effectively gather information.

Homer R. Warner

Clayton, P. D. (1995). Presentation of the Morris F. Collen Award to Homer R. Warner, MD, PhD: “Why not? Let’s do it!” Journal of the American Medical Informatics Association, 2(2), 137–142.

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This article outlines the story of Homer Warner and his contribution to the field of medical information systems. The author describes how Dr. Warner used mathematical techniques to make technological advancements in the field of cardiology.

Warner, H. R. (1995). Viewpoint: Medical informatics: A real discipline? Journal of the American Medical Informatics Association, 2(4), 207–214.

In this article, Dr. Warner, a pioneer of medical informatics, states his views on medical informatics and how they are a necessary discipline in the medical field. Warner also discusses the history, importance, and usage of medical informatics.

Warner, H. R. (1959). The use of an analog computer for analysis of control mechanisms in the circulation. Proceedings of the IRE, 47(11), 1913–1916.

In this 1959 article, Dr. Warner discusses the use of an analog computer for analyzing the control mechanisms in the circulation system. Dr. Warner uses examples as well as history to show how an analog computer has contributed to the field of cardiology in his practice.

Warner, H. R. (2001). Good isn’t enough. Health Management Technology, 22(6), 30–31.

In this article, Homer Warner examines natural language processing (NLP) technology. Warner identifies numerous areas where NLP may be applied, and he also provides predictions for its development.

Warner, H. R. (1966). The role of computers in medical research. JAMA: Journal of the American Medical Association, 196(11), 944–949.

Copyright 1966 by American Medical Association. Reprinted by permission of American Medical Association via the Copyright Clearance Center.

This 1966 article explores the potential uses of computers in medical research. The author describes how computers had changed the field of medical research at the time of the article’s publication.

Edward Shortliffe

Hickam, D. H., Shortliffe, E. H., Bischoff, M. B., Scott, A. C., & Jacobs, C. D. (1985). The treatment advice of a computer-based cancer chemotherapy protocol advisor. Annals of Internal Medicine, Part 1, 103(6), 928–936.

The authors of this article describe their use for ONCOCIN as a computer-based cancer chemotherapy protocol advisor. The article specifies how ONCOCIN combined formal guidelines with judgments of oncologists to determine the best route of therapy for certain cases.

Shortliffe, E. H., Tang, P. C., & Deimer, D. E. (1991). Patient records and computers. Annals of Internal Medicine,115(12), 979–981..

This article explores improvements in clinical information-management systems using the computer technology of the early 1990s. The authors stress their concerns surrounding the use of technology to solve the problems of paper records.

Shortliffe, E. H. (1998). Health care and the next generation Internet. Annals of Internal Medicine,129(2), 138–140.

In this article, the author anticipates the future of health care from a 1998 perspective. The article focuses on the potential impacts of the next version of the Internet in health care.

Shortliffe, E. H. (2005). Strategic action in health information technology: Why the obvious has taken so long. Health Affairs, 24(5), 1222–1233.

This article describes the gradual advance toward implementations of health information technology. The author examines the challenges and the opportunities that the field of health information technology faced prior to the article’s publication.

Tu, S. W., Kahn, M. G., Musen, M. A., Ferguson, J., Shortliffe, E., & Fagan, L. M. (1989). Episodic skeletal-plan refinement based on temporal data. Communications of the ACM, 32(12), 1439–1455.

This article describes a medical expert system (ONCOCIN) used in the late 1980s to create skeletal-planning techniques. The authors explain how this system proved to be innovative and beneficial to the health care field at that time.

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Dr. Warner Slack

Hicks, G. P., Gieschen, M. M., Slack, W. V., & Larson, F. C. (1966). Routine use of a small digital computer in the clinical laboratory. JAMA: Journal of the American Medical Association, 196(11), 973–978.

Copyright 1966 by American Medical Association. Reprinted by permission of American Medical Association via the Copyright Clearance Center.

The authors of this article describe the use of a small digital computer in an early clinical computer laboratory. The authors examine the benefits and drawbacks of using those digital computers in a clinical laboratory.

Slack, W. V., & Van Cura, L. J. (1968). Patient reaction to computer-based medical interviewing. Computers and Biomedical Research, 1(5), 527–531.

Copyright 1968 by Elsevier Science and Technology. Reprinted by permission of Elsevier Science and Technology via the Copyright Clearance Center.

In this article, the authors discuss patients’ reactions to computer-based medical interviewing. They also theorize how patients may have thought and felt about computer-based medical technology.

Fisher, L. A., Johnson, T., Porter, D., Bleich, H. L., & Slack, W. V. (1977). Collection of a clean voided urine specimen: A comparison among spoken, written, and computer-based Instructions.American Journal of Public Health, 67(7), 640.

The authors of this article describe a study that sought to determine the effectiveness of different methods of instructing patients on how to collect a urine specimen. The article has a significant focus on the effects of computer-based instructions.

Safran, C. (2002). Presentation of Morris F. Collen Award to Professors Howard Bleich and Warner Slack. Journal of the American Medical Informatics Association, 9(4), 406–408.

This article describes the conferral of the Morris F. Collen award to Howard Bleich and Warner Slack. The article also provides an overview of the doctors’ accomplishments in the medical field.

Safran, C., & Rind, D. M. (1995). Guidelines for management of HIV infection with computer-based patient’s record. Lancet, 346(8971), 341.

This article describes a trial of an electronic medical record (EMR) system that provides electronic messages to help reinforce adherence to clinical practice guidelines. The article presents findings on the effects of the EMR’s alert messages.

Ed Hammond

Hammond, W. E. (2008). eHealth interoperability. Studies in Health Technology and Informatics,134, 245–253.

This article explores the concept of interoperability between health information technology systems. The author outlines different types of interoperability and describes their importance.

Hammond, W. E., Stead, W. W., Feagin, S. J., Brantley, B. A., & Straube, M. J. (1977). Data base management system for ambulatory care. In Proceedings of the Annual Symposium on Computer Application in Medical Care, (p. 173). American Medical Informatics Association. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464520/pdf/procascamc00015-0181.pdf

This article describes a database management system (DBMS) used for ambulatory care. The authors explain the benefits and uses of DBMSs for this type of care.

Hammond, W. E., II, Stead, W. W., Straube, M. J., & Hammond, W. E., III. (1983). Adapting to the day to day growth of TMR. In Proceedings of the Annual Symposium on Computer Application in Medical Care (p. 101). American Medical Informatics Association.

Copyright 1983 by IEEE.  Reprinted by permission of IEEE via the Copyright Clearance Center.

This article describes computer applications in medical care and computer systems in hospitals. The authors also explore the connection between medical records and quality assurance.

Stead, W. W., & Hammond, W. E. (1987). Demand-oriented medical records: Toward a physician work station. In Proceedings of the Annual Symposium on Computer Application in Medical Care (p. 275). American Medical Informatics Association.

Copyright 1987 by Institute of Electrical and Electronics Engineers.  Reprinted by permission of Institute of Electrical and Electronics Engineers via the Copyright Clearance Center.

This article provides a brief overview of the use of computer-based medical records at the time of publication. The authors also focus on using demand-oriented medical records at a physician workstation.

Stead, W. W., & Hammond, W. E. (1980). How to realize labor savings with a computerized medical record. In Proceedings of the Annual Symposium on Computer Application in Medical Care, 2 (p. 1200). American Medical Informatics Association.

In this article, the authors discuss concerns about computerized medical record systems increasing the cost of labor. The authors also examine how medical record systems may actually reduce labor costs.

Clem McDonald

McDonald, C. J., & Tierney, W. M. (1986). The Medical Gopher—A microcomputer system to help find, organize and decide about patient data. Western Journal of Medicine, 145(6), 823–829.

Copyright 1986 by BMJ Publishing Group Ltd. Reprinted by permission of BMJ Publishing Group Ltd. via the Copyright Clearance Center.

The authors of this article describe the purpose and uses of the Medical Gopher. The Media Gopher is a computer system that helps find, organize, and provide decision support based on stored patient data.

McDonald, C. J., Hui, S. L., Smith, D. M., Tierney, W. M., Cohen, S. J., Weinberger, M., & McCabe, G. P. (1984). Reminders to physicians from an introspective computer medical record. Annals Of Internal Medicine, 100(1), 130.

This article details the effects of a computerized medical record that provides reminder messages to physicians. The authors provide recommendations for similar systems in the future.

McDonald, C. J., & Hammond, W. E. (1989). Standard formats for electronic transfer of clinical data. Annals of Internal Medicine, 110(5), 333–335.

The authors of this article stress the need for standardizing the way clinical systems transmit data, and they describe some early attempts to create clinical data transmission standards.

McDonald, C. J., Murray, R., Jeris, D., Bhargava, B., Seeger, J., & Blevins, L. (1977). A computer-based record and clinical monitoring system for ambulatory care. American Journal of Public Health, 67(3), 240–245.

This article provides an overview of the Regenstrief Medical Record system, which was first implemented in 1973. The authors explain how the record system presents a pioneering approach to storing medical records electronically.

Wilson, G. A., McDonald, C. J., & McCabe, G. P., Jr. (1982). The effect of immediate access to a computerized medical record on physician test ordering: A controlled clinical trial in the emergency room. American Journal of Public Health, 72(7), 698–702.

In this article, the authors describe the results of a controlled clinical trial that tested how the availability of patient computerized medical record summaries affected the rates at which physicians ordered additional testing. No significant decrease or increase in the number of tests ordered was found to have occurred.

Optional Websites

HIMSS. (2013). Retrieved February 21, 2013, from http://www.himss.org

ANIA. (n.d.). Retrieved February 21, 2013, from https://www.ania.org

Discussion: Foundational Pioneers in Informatics

The smartphone has become an increasingly valuable tool in the field of medicine. Because of the phone’s small size and powerful computing capabilities, doctors, nurses, and researchers use these smartphones in a wide range of areas. For example, smartphones can be used as an electrocardiogram, to perform ultrasound procedures, to track patient progress, and as a decision support tool for generating diagnoses (Ozdalga, Ozdalga & Ahuja, 2012). Like most innovative technologies, the smartphone and its applications are a result of many years of incremental research and development.

In this Discussion, you focus on those who set the stage for the field of informatics today. By Day 1, your Instructor will assign you one of the pioneers in the field of informatics to research.

To prepare:

• Read the articles listed in the Learning Resources for your assigned informatics pioneer.
• Conduct research in the Walden Library or on the Internet to find additional works by or information about the individual.
• Determine his or her area of interest and affiliations in the medical world.
• Reflect on the contributions he or she made to the field of informatics. What most interests you? What most surprises you?
• Consider how these contributions impact the field of informatics today.
• Assess why it is important to be familiar with the foundational documents of nursing informatics.

By Day 4

Post an overview of the individual to whom you were assigned, including his or her principal areas of interest and medical affiliations. Highlight the contributions this individual made to the field of informatics, and explain how these contributions impact the field of informatics today. Comment on the importance of being familiar with the foundational documents of nursing informatics.

By Day 6

Respond to at least two of your colleagues on two different days who researched a different pioneer than you did. Describe what you found most compelling about the information on the individuals researched, and explain how you can use this information to better understand the current state of health informatics.