Welcome to Module two, Technology and Events Influencing Nursing Informatics Pioneers. My name is Bonnie Westra, and I'm an associate professor at Emerita and Co-Director for a Center for Nursing Informatics at the University of Minnesota, School of Nursing. In this course, we will examine the major events and milestones that influence the pioneers to develop the specialty of informatics. We also will provide examples of strategies used by the pioneers who assisted in formalizing nursing informatics as a profession. The emergence of different technologies created numerous new scenarios that required nursing practice, research, and education to change. As nursing informatics pioneers gained knowledge and experience in working with these new technologies, they described insights about how they could be used to benefit nursing and to improve patient outcomes. So, some technologies were hardware, such as the change from mainframe to personal computers. Some of the pioneers took programming courses, and they started to develop their own software programs to represent and document evidence-based practice guidelines to support nursing practice. These are the areas in which the pioneers demonstrated their leadership as they applied these types of technology to the practice and education of nurses. So, what technologies are emerging in your nursing practice? How are these technologies affecting nursing care? What is your vision for use of technology to benefit nursing and to improve patient outcomes? You can see that the milestones occur within ten-year blocks. So, in the 60s, computers are beginning to emerge and to be used in hospitals. Initially, it was for administrative functions or the computers were used for clinical functions like order entry and lab results. Nurses were expected to assist in the implementation and training. As they did this, they began to use computers and understand how this might benefit nursing. So, in the 1970s, a number of nursing conferences on use of computers were started. Early pioneers began to share their knowledge of information systems, and how these can benefit their colleagues by holding other conferences and building a network of what was called Computer Nurses back then. The focus wasn't only on hospitals, but the focus of computers also occurred in public health and home care as well. Nursing informatics exploded in the 1980s. Technology challenged creative professionals in the use of computers in nursing, which became revolutionary. With the emergence of new computer technology and architecture, the need for software to support nursing evolved. The use of computers then presented the need for practice standards and determine its data standards, the vocabularies, and the classification schemes that could be used for the computer-based patient record systems. The pioneers led the way through conferences, publications, and beginning work with professional organizations such as scamper, which I referred to in the previous module. That is, symposium on computer applications in medical care. They also worked with the American Nurses Association. In the 1990s, the pioneers led efforts within the ANA, the American Nurses Association to define the scope of nursing informatics practice standards. Considerable effort was led by the pioneers then to develop nursing terminologies. As a result, early pioneers led the way to have the ANA initiate the steering committee on databases to support nursing practice. This committee was responsible for recognition criteria of when nursing terminologies and datasets were appropriate to forward for inclusion in public policy. In the 2000s, the federal government passed legislation to require inter operable electronic health records. The pioneers in nursing informatics lobbied really hard for the inclusion of nursing data. However, that did not occur. It wasn't until after 2010 that the ANA and subsequently, the office of the national coordinator included nursing data in inter-operable electronic health record recommendations. This sequence of milestones and events required strong leadership on the part of the pioneers to see the opportunity computers and technologies could provide. They did that to make nursing visible, and to make visible the contribution of nursing to improving the health of populations. In the chapter assigned for this module called Historical Perspective of Computers in Nursing, there is an outline of many events and the leaders involved who developed the nursing informatics specialty. This table from the chapter provides an overview of the important dates and events. What dates and events would you add to the table? In the next slides, I will share specific examples about the early days of nurses responses to technology from the histories of Judy Murphy, Carol Romano, and Judy Ozbolt. So, one of the pioneers Judy Murphy worked as a nurse educator in a large hospital system. One of her jobs was to train the staff on how to implement mainframe computer applications on the nursing units. Judy was responsible to make sure that this occurred. Well, it dawned on her that there was an opportunity for the computer department to actually hire runners, and that that could really make a difference. So, she went to the head of the computer department to see about working with them and they said they weren't interested. Well, she then went to her director of nursing with the same vision of how working with the computer department and nursing could really make a difference. At that time, the director wasn't interested either. So, over the next two years, she kept plugging along and eventually that is in fact what happened. Her visionary and leadership strategy was to plant seeds and over time to demonstrate how these seeds grow and can make a difference. So, Rear Admiral Carol Romano was one of the earliest pioneers in the 70's who actually implemented an electronic health record at the National Institutes of Health in their Clinical Center. She became involved in implementing the EHR, not because of her expertise in computers but because of her experience as a staff nurse and the fact that she had seniority. So, she worked for a leader, Vernice Ferguson who clearly saw that if they were going to implement electronic health record, then nursing would be involved and it would meet the needs of nursing as well. Well, you can't always choose your boss, but it wasn't unusual for the pioneers to comment on how important their organizational leader was to their success and to align their vision with that of the leadership. Over her career, Carol used her experience and insights that nursing should drive technology not technology drive nursing. She then identified the skills and knowledge that she needed which later became foundational as she implemented one of the first courses in nursing informatics. The philosophy that guided her work over 33 years was to focus on, "What are the patient information needs", and how information system should be developed to support information flow to and from each of the different players. She notes that conflict does occur but if you look at that, if you get everybody in the same room, over time that conflict can be resolved. All right. The majority of pioneers in nursing informatics did not have software programming experience. Rather, they work collaboratively with the information technology department and medicine to shape the content that was included in the electronic health record. For instance, Romano noted that while they were implementing physician order entry, she made sure that it got implemented in ways that nurses saw the implications for their own practice and how do we evaluate the outcomes of nursing and medicine who both contributed to patient care. As Romano stated, "When you're first in a field, you have no footsteps to follow". So, she identified nursing leaders and others who had vision about the potential for Nursing Informatics and the opportunities that technology and informatics could hold for developing nursing. A key lesson for you as an emerging leader is to find others whether they are in your field or not, who have vision and can help mentor you as you develop your informatics leadership. Romano talks about convening conferences at NIH, National Institute of Health, for the early pioneers to share their experiences. Additionally, she worked with others to publish papers and from the conferences to share with those who were not able to attend. As a result of her own experiences and others, she began to define the skills and the competencies for Nursing Informatics. At the University of Maryland, she led the development of the first graduate program in Nursing Informatics. Her exampled leadership shows collaboration and creating the future education to bring others along with her ideas. Dr. Judy Ozbolt described how technology influenced her. She said, "One day a professor in my research class, a man named Sam Schultz who later went on to found HL7, talked about how computer programs were being written so that they would take patient data and formulate medical diagnosis. So, I thought" said Judy, "wow, that's really interesting". So, from this she envisioned a similar experience of taking patient data and formulating nursing diagnosis. At that time in 1972, she was one of the founding members to help form the North American Nursing Diagnosis Association, that was the first standardized nursing terminology and now is international. So, over time, many terminologies in nursing were developed and a rivalry began between them about whose was the best. So, through her involvement in many organizations, nursing and interprofessional, she invited terminology leaders to figure out how they might work together. A key leadership lesson she exemplified is the importance of building a broad network to be able to help her and to establish her reputation when she called on people. Her network not only included nursing, but pioneers in Interprofessional Health Informatics Standard experts as well, so that they could learn from each other. In addition to sharing through multiple conferences, the pioneers began a newsletter. That newsletter eventually evolved to become Computers Informatics in Nursing. In addition, there were many books that began to come out to help teach informatics in the curriculum that started in 1980. So, this supported education both at the undergraduate level and then at the graduate levels. The nursing leaders believed that sharing their knowledge was essential in bringing leaders together and developing them in the future. As you can see, pioneer nursing informatics leaders responded to technology by envisioning possibilities and building networks. They developed collaborative and creative cultures of leadership that continue today. So, now it's your turn. Read the chapter on historical perspectives of computers in nursing. Additionally, the amia website for Nursing Informatics History Project includes a theme about the significant events that shaped the field of nursing informatics in the video library too. A transcription of the video is included linked into this module since it wasn't available on the website. The interview with Dr. Carol Romano is a good exemplar of nursing leadership strategies and you should view the video or read the transcript. Also included is a website about computer development for background information. So, now in this module, what you will do is complete your interview of someone who is a Nursing Informatics Leader or someone in a similar role. There is a discussion for you to participate in regarding technology changes in your workplace and how you responded to them, what leadership behaviors and cultures were helpful to support positive changes. Finally, complete the brief quiz at the end of the module.