What is LINUX?

   LINUX is an operating system developed by Linus Torvalds of Finland inspired and inspired by loosely based based on UNIX derivative called MINIX by Andrew Tanembum. LINUX is distributed free in the Web and as distribution CD's. The license GPL (General Public License) has been given to LINUX to encourage programmers to develop Linux utilities, software and enhancement.s. Because the above mentioned features LINUX is considered a FOSS (Free Open Source System).  

     Linux is, in simplest terms, an operating system. It is the software on a computer that enables applications and the computer operator to access the devices on the computer to perform desired functions. The operating system (OS) relays instructions from an application to, for instance, the computer's processor. The processor performs the instructed task, then sends the results back to the application via the operating system.

  As an open operating system, Linux is developed collaboratively, meaning no one company is solely responsible for its development or ongoing support. Companies participating in the Linux economy share research and development costs with their partners and competitors. This spreading of development burden amongst individuals and companies has resulted in a large and efficient ecosystem and unheralded software innovation.


    Linux is designed for microcomputers, with technical features such as multitasking, virtual memory, TCP/IP drivers, and multi-user capabilities. These features of LINUX a popular operating system for e-mail and web servers and local area networks. The UP Manila National Telehealth Center is making use of Ubuntu as operating system for their PCs. 

 

Theories of Nursing Informatics

A.Change Theories

  Change means making something different from the way it was originally. Change may be planned or unplanned. Unplanned changes bring about unpredictable outcomes, while planned change is a sequence of events implemented to achieve established goals. In nursing a change agent is a person who brings about changes that impact nursing services. The change agent may be a nurse leader, staff nurse or someone who works with nurses. Change theories are used to bring about planned change in nursing. Nurses and nurse leaders must have knowledge of change theories and select the right change theory as all the available change theories in nursing do not fit all nursing change situations.

1. Roger's Diffusion of Innovation Theory (unplanned change)

         Everette Rogers modified Lewin's change theory and created a five-stage theory of his own. The five stages are awareness, interest, evaluation, implementation and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Adopters are divided into 5 categories:

• Innovators (2.5%). They readily adopt the innovation; often seen as troublesome and are not able to sell others on the innovation.
• Early adopters (13.5%). They are respectable opinion leaders who acts as promoters for the innovation. 
• Early majority (34%). They are averse to risk of the innovation but are willing to make safe investments.
• Late majority (34%). Adopts innovation because of peer pressure, not because they see a use for innovation.
• Laggards (16%). They are suspicious about innovation and change and are very stubborn. They may grasp those weaknesses that others have failed to recognize.

2. Lewin's Change Theory (planned change)

     Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage, and refreezing stage. Lewin's theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force. He describes the processes that occur in a planned change into three stages: Unfreezing, moving and refreezing.

• Unfreezing. Making use of processes that reinforces an individual's involvement in the change, having their own opinions respected and with continuous communication during the process while reducing forces that restrains the same individual from committing himself to the process such as psychological defenses or group norms.
• Moving. Planned change is implemented where anxieties are high that has to dealt with. The new system should be tested prior to implementation and users be provided with adequate training.
• Refreezing. The planned change becomes a norm. The users should be made to feel confident with the change and feel in control of the new process. A help system or support group should be made available to provide answers to their needs.

B. Information Theories

1. Blum's Theory

Blum stated in1986 that computer functions can be categorized into three groups: One where data is processed, another group where information is processed and another one where knowledge is processed.

2.Data-Information-Knowledge-Wisdom Continuum

Graves and Corcoran based the theory on nursing informatics on data, information and knowledge as initiated by Blum. They regarded that information has various levels of complexity depending on how much interaction is dome to attain it.

• Data are elements that are uninterpreted and plainly recorded and viewed as is.
• Information comprises interpreted data based on on's capacities, attitude and behavior.
• Knowledge is an organized collection of information.
• Wisdom (added by Joos and Nelson) considers the use of values in decision making.

C. Cognitive Theories

        Cognitive theory provides principles that may be used to develop systems that concentrate on the tasks at hand, rather than requiring cognitive tasks to deal with the computer interface. It helps a health informaticist in understanding the process during decision making for better designing of programs tools.

How automated information system grew in Philippines.

      

    Knowledge generation and knowledge utilization in any community: local, national or global are initiated, promoted and sustained by the information resources of the community.  Information Centers provide bibliographic, indexing, clearing and referral services in addition to research, instructional and document support services.  Information in specific formats/media provides news gathering, interpretation and editorial services in print, broadcast, film or special media.  Information from specific providers bring to the attention of information seekers the  knowledge, thoughts or ideas of key informants, subject authorities and specialists on specific topics from indigenous belief and value systems, traditions and practices to current lifestyles and trends; and information super highway projects reflect efforts to be linked with the global information system and which could promote active participation in the development programs of the global village.

   In the Philippines, all line agencies (departments, bureaus, agencies), academic institutions (universities, colleges, institutes), business establishments, (engaged in the mass media or in the production of consumer goods or provision of services) function as information centers for these service institutions maintain information storage and retrieval units such as libraries, information offices, public affairs offices, and public relations officers.

    Automated healthcare information system (HIS) grew almost parallel with the advancements in computer technology in the country.

• In early 1970s, the first personal and network-ready computer started to appear in the healthcare community exclusively used in business and accounting. The earliest computers are mainly used to automate billing in few healthcare institutions. The computers are connected via network setup allowing multi-user environment. They used as storage drive the computers run with 8 KB internal memory (RAM) with cassette tapes. It comes with the built in software like spreadsheet and work processor and BASIC programming language.
• In the mid 1970s hospital networks expanded to include the information processes in admission, discharge and transfer or ADT section. Computers are run with 16 KB RAM and 320 KB floppy disk drive storage and in this period line printers are popularly used.
• In late 1970s network further expanded to include pharmacy section. In this period, an integrated system, which is a network of several computers using single program, was formed connecting the three big departments: accounting, ADT and pharmacy. Some programs are written with COBOL, ORACLE and BASIC language and these departments are seamlessly share their data to each other. The system required a server which is more powerful computer that provides copies of programs and data to clients, integrate functions of the terminals and backup files. During this period, XT computers with processing speeds of 10-20 MHz were commonly used.
• In early 1980s, the laboratory and imaging departments, with their special computers, attempted to connect to the main integrated system but no avail due to incompatibility reasons. Since communication is not possible, request made in the ward and other and other clinical areas were put on paper such forms or slips and brought to the laboratory or imaging departments for processing. When the result is ready, it is brought back manually. Because of detached status the two department remained stand-alone systems.
• In the middle of 1980s, integrated system expanded to the clinical area. It is believed that nursing informatics started during this period. Network ready PCs running with 80286 processor, 16 to 64 MB RAM with 20 to 40 MB hard disks are becoming common. Nursing clinical information systems were implemented and automated the process of order entry. Nurses entered orders on medication and lab exams that are promptly transmitted to the pharmacy and lab departments respectively. They also entered request for linens and supplies, request of the patient or relative were able to retrieve and print billing summary which is saving time and effort. The were also able to view the what and whereabouts of the patient.
• In the middle of 80s to late 90s hospitals bought conversion software and hardware from the same vendors who delivered the laboratory and imaging machines to link their stand-alone systems to the main system creating interfaced systems. Though connectivity to the main information system was possible, they operated somewhat with limited functionality due to persistent compatibility problems.
• In early to mid 2000s laboratory information system (LIS) and radiology information system (RIS) started to encroach into the main hospital information system that are developed with more flexible programming languages such as Oracle, SQL (structured query language) or FOSS (free open source software). LIS integrates all information systems coming from biochemistry, hematology and etc. Radiology information system or RIS integrates all information system coming from X-ray, MRI, CY, Ultrasound and other ancillary departments that produce image outputs. Interoperability between various systems was made possible with the use of the standard protocol for formatting, transmitting and receiving data known as HL7 (Health Level Seven). With the new systems expansion in the HIS, order entry and results reporting became virtually complete at the convenience of the nurses and other health care worker as end users. During this period, computers run with capacities ranging from Pentium to dual core processors, 128 MB to 2 GB RAM, and 10 to 500 GB hard disk drive with printers ranging from dot matrix to inkjet to laser printer. Inter-department communication systems (SMS, chat, conferencing, and emailing) were made possible with use of efficient wired and wireless network systems.
• In late 2000s, the Philippine Heart Center will soon implement the Internet-based hospital information system (HIS). This will allow their healthcare team to access automated HIS anywhere anytime through internet. New hospitals plan to use new fully integrated information systems while some hospitals chose to retain their old integrated systems.

          There are institutions, however, that are entirely engaged in information/knowledge generation, analysis, IEC materials production and knowledge validation like the Philippine Information Agency (PIA). The PIA through its various subprograms namely: research, institutional development, production and dissemination provide development-oriented communication services.

           Treatment with bad outcome needs to be investigated further or avoided. This most probably prompted Florence Nightingale to push through the reliable and efficient documentation of every clinical case.

Evolution of Computer in Nursing

Evolution of Computer in Nursing

     How do computers help us in many ways? How did computers came in Nursing? When and where did it start?

     History tells us that computer systems underwent many modifications and revisions as it is introduced into the market with users'  demands rapidly escalating. Highlights of the evolution is discussed below.

• As early as 1960s in US, computers were introduced in the nursing profession where they are used to record data in the office, also found integrated in diagnostic and laboratory equipment. Later part of this decade that computers are connected to form networks that were used online data communication, processing billing and accounting data. 
• Later in most parts of the world, including the Philippines, nurses recognized the computer's potential in providing documentation, quality of care and the repetitive aspects of managing patient care. In the financial and administrative functions of the patient care computers were perceived as cost-saving technologies. During this decade, many computer-based management information system were developed.
• As early as 1970s in the Philippines, the use of computers in healthcare organizations dates back. Early commercial computers by RadioShack with built in spreadsheet programs were used by the Philippine Heart Center for Asia (PHCA) to manage its patient billing. In few years, its admission discharge transfer (ADT) section and then pharmacy section followed suit. By the heavily support of the government, PHCA acquired much state-of-the-art hospital equipment. With the adoption of these equipment, the hospital's care providers were incidentally immersed with different computer systems that went along with the equipment.
• In 1980s, Worldwide, the Internet revolutionized dissemination of information and communication across the globe.
• In early 1990s, nursing informatics became a specialty and many nursing professionals entered the new field mostly by accident. Healthcare information systems were transformed, data standards and vocabularies were updated, and classification schemes were formulated that could be coded for computer-based record systems.
• During this period, many mainframe-based healthcare information systems (HIS) emerged with nursing information systems as one of its subsystems. Discharge planning systems were developed and used as referrals to community health care facilities in the continuum of care.
• In 1990s computer technology became an integral part of health care. Nursing professional organizations identified initiatives that addressed IT and informatics. Policies and legislation were adopted promoting computer technology in healthcare including nursing.
• In 1992, Nursing Informatics (NI) was approved by the American Nurses Association (ANA) as a nursing specialty. The demand for NI expertise increased greatly in the workplace. The need for computer-based nursing practice standards, data standards, nursing minimum data sets and national databases emerged together with the need of unified nursing language. Nurse administrators demanded that HISs include care protocol and nurse educators continued to require use of innovative technologies for all levels and types of nursing and patient education. 
• In the latter part of 1990s, miniaturization and dramatic improvement in processing power brought computers to the bedside and all of the point-of-car e settings. Workstations and local area networks (LAN) were developed for hospital nursing units.This led to a new nursing function called telemetry allowing distant monitoring of patients. LANs were linked to wide are network (WAN) that is in turn linked to the Internet. E-mailing, text messaging, chatting, file downloading and uploading and other Internet tools helped revolutionized nursing information systems.
• In early years of 2000, the development of more rugged tablet PCs and personal digital assistant (PDAs), programs with advanced reliability and security feature, and wireless technology made it possible to automate and optimize many nursing practices on bedside or point-of-care (POC). Very reliable and accurate information and knowledge support rested on the highly standardized and secured electronic health record. Serious consideration was given to open source software that could be reprogrammed to match with different healthcare environments and be used for seamless communication. Internet has provided a real time multimedia communication that led to development of distant nursing care or telenursing.

        At present, electronic health record was used to streamline health care transactions and reduce regional or national spending on health. It is also used as powerful tool for education, research and discovery of new knowledge.