Examples of recent advances from fourth to fifth generation computing as applied within the health domain are discussed in Chap. 3 in eHealth and in Chap. 9 where the authors discuss mobile computing, telehealth and independent living.
Tracing and reviewing some of the more significant events over time which have had a direct impact on the computing industry and, as a consequence, on the development of nursing informatics is summarised in the following section. The topic is extensive and challenging to summarise in its entirety. We have therefore opted to include some online resources to support various sections where appropriate and selected what we believe to be the significant milestones for the reader to view, which is available for download (Presentation 4.1).
A clear historical vantage point is presented from which to view informatics, and the impact that it has on the nursing profession. Readers are encouraged to view the following links which graphically demonstrate some of the major paradigm shifts that have occurred in the computing industry. The first resource is the Times Photos [4] which has some excellent images that illustrate the computers in a short presentation from 1946 to the present time. The second resource is the The Computer History Museum [5] which explores the timeline of computing history from 1939 to 1994, in a comprehensive manner, and is available to browse both by year and by category. These online resources also summarise generations one to three of the computing paradigm on computing devices. What follows in the proceeding sections are some of the key milestones which have been summarised.
Historical Milestones of Computing
The Computer Society divides the history of computer development into three periods which they estimate were approximately 20 years in duration. There were: the formative years dating from 1946 to the mid-60s; the growth period from the mid-60s to the late 80s prior to the internet becoming a main communication distribution network, and the most recent 20 years with the coming of the age of the Internet [2].
Historical Milestones in Nursing
There are many perspectives about how nursing groups related to informatics have been initiated, grown over time and progressed through various stages of evolution to a state of maturity and performance.
One early but influential pioneer within the profession of nursing was Florence Nightingale. She considered information a key resource for the management of health and argued the case for standardized clinical records. She sought to source information so that more detailed analysis on patient outcomes could be achieved in the longer term. Her frustration at the time (1863) is conveyed below [6, p. 175].
There is a growing conviction that in all hospitals, even those which are best conducted, there is a great and unnecessary waste of life….In attempting to arrive at the truth, I have applied everywhere for information, but in scarcely an instance have I been able to find hospital records fit for any purpose or comparison. If they could be obtained, they would enable us to decide many other questions besides the ones that eluded to ….If wisely used, these improved statistics would tell us more of the relative value of particular operations and modes of treatment than we have any means of obtaining at present. They would enable us, besides, to ascertain the influence of the hospital…… upon the general course of operations and diseases passing through its wards; and the truth thus ascertained would enable us to save life and suffering, and to improve the treatment and management of the sick….
Florence Nightingale 1863 Notes on Hospitals cited in Longman and Green 1863, p. 175–6 [6]
While the vision for information and communication technology was yet to be realised, it is evident from her quote that a key requirement for safe, effective practice was reliable data. She articulated a need for data which could be analysed statistically in order to improve the health care processes at the time. The data that she did collect she also mapped to graphical representations of care. Sadly this need persists even today as the evidence base demonstrates the ongoing debate within modern nursing research on how nursing can best record their specific contribution to the healthcare process and patient outcome. This was addressed in Chap. 2.
Application of the Tuckman model of group development to the historical evolution of nursing informatics offers us an example to view the transformation of process and concept, and refinement of both self-image and impact beyond the immediate group of nursing informatics as an advocate to the entire profession of nursing. This notion was initially introduced and discussed in Chap. 2. Table 4.1 maps Tuchman’s Group Formation Framework [7] to Scholes et al. historical timeline [8].
Stage of development linkage to NI | Description |
|---|---|
Forming | This is the initial stage of team or group development, characterized by members trying to find common ground and interests in pursuit of a shared goal. Meetings tend to be specifically goal directed and members act on an independent basis. Team members start to get acquainted and develop relationships that will support later stages of the group evolution |
Nursing submissions to informatics conferences were limited, small numbers of contributions to the Medinfo Conferences in 1974 (5 papers) and in 1977 (2 papers). MIE conference 1978 (3 papers) | |
Storming | Increased clarity emerges during this second phase about the topics to be addressed by the group. Different ideas will be promoted by group members and this is where the storming occurs as options are debated and decisions are made. Group members need increasing clarity on the group roles, accountabilities, and leadership and may develop bylaws of Terms of Reference |
Example 1980s MIE | |
Papers demonstrating interests in nursing related activity particularly in regard to nursing contribution to information systems and databases. MIE nursing papers submitted in 1984 (13 papers), Medinfo Conference 1983 (387 papers). Nursing informatics as a speciality identified by Marion Ball 1983 | |
Norming | This phase is where the group comes to a consensus on their overall goal and works toward a plan of action. Options for group activities are identified and members can work effectively independently, interdependently or in groups. Bylaws or Terms of Reference would be actively used effectively to guide group functions and relationships. Some members may have to abandon their own ideas in favor of the group’s priority in order to enable the team function in a coherent and cohesive manner |
Example IMIA-NI Special interest group formalised 1990s | |
Development of Nursing Language Classification and Retrieval e.g. Minimum Datasets Development e.g. Health Information: Nursing Components (Canadian Nursing Minimum Dataset) | |
Nursing Interventions Classification 1992 | |
MIE nursing papers 1996 (125 papers) Medinfo 1995 (318 papers) | |
Performing | Not every team will reach this level of development. This stage is characterized by a well-defined and motivated group being able to function as a coordinated system to accomplish approved objectives. Consensus is not always unanimous and disagreement can be effectively used to support the growth of the group. If major changes occur within the group, it is possible for the group to return to earlier stages such as storming and norming |
National groups developed to lobby and integrate into existing national organisations such as ISO TC 215 and CEN TC 251. Nursing informaticians contributing to the development of health informatics standards internationally. Nursing categorical structure for representing nursing diagnosis and nursing actions in terminological system developed internationally ISO 18104 | |
Adjourning | In this stage, the goal has been accomplished and the group no longer needs to exist or the group is shut down by an eternal mechanism. The group can complete and archive files, adjourn and disband. Occasionally, the group will identify a new goal that infuses new life into the group and hey will continue on |
As nursing informatics is still an evolving specialist area, this phase within Tuckman’s model is not applicable |
The papers submitted to conferences over this time were analysed and presented by trend to reflect the scientific and site attractions at the conference from the seventies through to the nineties. For the 1981 conference, the Medical Informatics European Conference (MIE) received an increasing volume of papers on language classification and retrieval, with over 34 % of the papers relating to this topic. Likewise, other large trends at MIE in 1991 related to Decision Making and Artificial Intelligence (AI). However the IMIA-NI congresses which began in 1982 also had some interesting trends and Fig. 4.2 is offered as a summary of the most popular categories with a timeline.
The Emergence Technology in Healthcare
For decades, healthcare has lagged behind a broad range of sectors, including government and industry, in the evaluation and adoption of technology. A variety of factors contributed to this delay in adoption. One reason was that first- and second-generation computers were not well suited for the complexity of data processing needs of hospitals.
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