Information technology

The term information technology (IT) includes not only the use of computers but also communications networks and computer literacy—knowledge of how to use computer technology. As in other fields, the basic tasks of gathering, allocating, controlling, and retrieving information are the same. The push to use IT in all aspects of health care, from the electronic health record (EHR) to integrated hospital information technology (HIT) systems, makes it crucial for health care professionals to be familiar with basic computer concepts. In this chapter, we will focus on computer literacy, computers, and networks. Currently, computer literacy involves several aspects. A computer literate person knows how to make use of a computer in his or her field to make tasks easier and to complete them more efficiently, has a knowledge of terminology, and understands in a broad, general fashion what a computer is and what its capabilities are. Computer literacy involves knowledge of the Internet and the World Wide Web and the ability to take advantage of their resources and to critically judge the information. A computer is an electronic device that accepts data (raw facts) as input, processes, or alters them in some way and produces useful information as output. A computer manipulates data by following step-by-step instructions called a program. The program, the data, and the information are temporarily stored in memory while processing is going on, and then permanently stored on secondary storage media for future use. Computers are accurate, fast, and reliable.

“Technology will provide no miracles that feel like miracles for long,” observes editor and historian Frederick Allen. Adds science-fiction writer Bruce Sterling, “We should never again feel all mind boggled at anything that human beings create. No matter how amazing some machine may seem, the odds are very high that we’ll outlive it.” The personal computer is over two decades old. The Internet has been familiar to the public for over 10 years. It has been more than five years since the now common place “www” for World Wide Web began appearing in company ads. And, like cars, elevators, air-conditioning, and television—all of which have wrought tremendous changes on society and the landscape—they are rapidly achieving what technology is supposed to do: become ordinary. They are becoming part of the wallpaper of our lives, almost invisible.

When computer and communications technologies are combined, the result is information technology ”info tech” defined as technology that merges computing with high-speed communications links carrying data, sound, and video. Note there are two parts to this definition computers and communications. A computer is a programmable, multi use machine that accepts data raw facts and figures and processes, or manipulates, it into information we can use, such as summaries, totals, or reports. Communications technology, also called telecommunications technology, consists of electromagnetic devices and systems for communicating over long distances. Online means using a computer or other information device, connected through a voice or data network, to access information and services from another computer or information device.

Hardware and Software

To understand the myriad uses of IT in health care, you need to familiarize yourself with computer terminology, hardware, and software applications. Every computer performs similar functions. Specific hardware is associated with each function. Input devices take data that humans understand and digitize those data, that is, translate them into binary forms of ones and zeroes, ons and offs that the computer processes; a processing unit manipulates data; output devices produce information that people understand; memory and secondary storage devices hold information, data, and programs.

Although all computers perform similar functions, they are not the same. There are several categories based on size, speed, and processing power: supercomputers are the largest and most powerful. Supercomputers are used for scientific purposes, such as weather forecasting and drug design. Supercomputers take complex mathematical data and create simulations of epidemics, pandemics, and other disasters. Mainframes are less powerful and are used in business for input/output intensive purposes, such as generating paychecks or processing medical insurance claims. Minicomputers are scaled-down mainframes; they are multiuser computers that are used by small businesses. Microcomputers (personal computers) are powerful enough for an individual’s needs in word processing, spreadsheets, and database management. Small handheld computers called personal digital assistants (PDAs) originally could hold only a notepad, a calendar, and an address book. Today, sophisticated PDAs are used throughout the health care system. Physicians can write prescriptions on PDAs, consult online databases, and capture patient information and download it to a hospital computer. PDAs also hold reference manuals and are used in public health to gather information and help track diseases and epidemics. The embedded computer is a single-purpose computer on a chip of silicon, which is embedded in anything from appliances to humans. An embedded computer may help run your car, microwave, pacemaker, or watch. A chip embedded in a human being can dispense medication, among other things.

Hardware

The physical components of a computer are called hardware. Pieces of hardware may be categorized according to the functions each performs: input, process, output, and storage. As you recall, inside the computer, all data are represented by the binary digits (bits) 1 (one) and 0 (zero). To translate data into 1s and 0s is to digitize.

Input Devices 

Input devices function to take data that people understand and translate those data into a form that the computer can process. Input devices may be divided into two categories: keyboards and direct-entry devices. Direct-entry devices include pointing devices, scanning devices, smart and optical cards, speech and vision input, touch screens, sensors, and human-biology input devices. The pointing device with which you are most familiar is the mouse, which you can use to position the insertion point on the screen, or make a choice from a menu. Other pointing devices are variations of the mouse. Light pens, digitizing tablets, and pen-based systems allow you to use a pen or stylus to enter data. The marks you make or letters you write are digitized. Most scanning devices digitize data by shining a light on an image and measuring the reflection. Bar-code scanners read the universal product codes; optical mark recognition devices can recognize a mark on paper; optical character recognition devices can recognize letters. Special scanning equipment called magnetic ink character recognition (MICR) is used by banks to read the numbers at the bottoms of checks. You are familiar with fax machines, which scan images, digitize them, and send them over telecommunication lines. Some scanning devices, called image scanners, scan and digitize whole pages of text and graphics. One scanning device of particular interest to those with impaired eyesight is the Kurzweil scanner—hardware and software—which scans printed text and reads it aloud to the user. Radio frequency identification (RFID) tags (input devices) are now used to identify anything from the family dog to the sponge the surgeon left in your body, by sending out radio waves. One medical insurance company is conducting a two-year trial with chronically ill patients who will have an RFID the size of a grain of rice implanted. The RFID will contain their medical histories. It transmits 30 feet without the person’s knowledge. In 2006, one U.S. company implanted chips in two of its employees “as a way of controlling access to a room where it holds security video footage for government agencies and police.” Several different kinds of cards are used as input devices: your automated teller machine (ATM) card or charge card contains a small amount of data in the magnetic stripe. A smart card can hold more data and contains a microprocessor. Smart cards have been used as debit cards. Several states now use smart cards as driver’s licenses. The card includes a biometric identifier and may include other personal information as well. Privacy advocates fear that there is so much information on the cards that they can become a target for identity thieves. An optical card holds about two thousand pages. The optical card may be used to hold your entire medical history, including test results and X-rays. If you are hospitalized in an emergency, the card—small enough to carry in your wallet—would make this information immediately available. Vision input systems are currently being developed and refined. A computer uses a camera to digitize images and stores them. The computer “sees” by having the camera take a picture of an object. The digitized image of this object is then compared to images in storage. This technology can be used in adaptive devices, such as in glasses that help Alzheimer’s patients. The glasses include a database of names and faces; a camera sees a face, and if it “recognizes” the face, it gives the wearer the name of the subject. Speech input systems allow you to talk to your computer, and the computer processes the words as data and commands. A speech-recognition system contains a dictionary of digital patterns of words. You say a word and the speech-recognition system digitizes the word and compares the word to the words in its dictionary. If it recognizes the word, the command is executed. There are speech dictation packages tailored to specific professions. A system geared toward medicine would include an extensive vocabulary of digitized medical terms and would allow the creation of patient records and medical reports. This system can be used as an input device by physicians who, in turn, can dictate notes, even while, for example, operating. Speech recognition is also especially beneficial as an enabling technology, allowing those who do not have the use of their hands to use computers. In English, many phrases and words sound the same, for example, hyphenate and -8 (hyphen eight). Speech-recognition software allows mistakes such as these to be corrected by talking. The newest speech-recognition software does not need training and gets “smarter” as you use it. It looks at context to get homophones (to, too, two) correct. Of particular interest to health professionals are input devices called sensors. A sensor is a device that collects data directly from the environment and sends those data to a computer. Sensors are used to collect patient information for clinical monitoring systems, including physiological, arrhythmia, pulmonary, and obstetrical/ neonatal systems. In critical care units, monitoring systems make nurses aware of any change in a patient’s condition immediately. They detect the smallest change in temperature, blood pressure, respiration, or any other physiological measurement. The newest kinds of input devices are called human-biology input devices. They allow you to use your body as an input device. They include biometrics, which are being used in security systems to protect data from unauthorized access. Biometrics identify people by their body parts. Biometrics include fingerprints, hand prints, face recognition, and iris scans. Once thought to be almost 100 percent accurate, biometric identification systems are now recognized as far from perfect. Line-of-sight input allows the user to look at a keyboard displayed on a screen and indicate the character selected by looking at it. Implanted chips have allowed locked-in stroke patients (a syndrome caused by stroke where a person cannot respond, although he or she knows what is going on) to communicate with a computer by focusing brain waves (brain wave input); this is experimental; research is continuing. 

Processing Hardware and Memory

Once data are digitized, they are processed. Processing hardware is the brain of the computer. Located on the main circuit board (or motherboard), the processor or system unit contains the central processing unit (CPU) and memory. The CPU has two parts: the arithmetic-logic unit, which performs arithmetic operations and logical operations of comparing; and the control unit, which directs the operation of the computer in accordance with the program’s instructions. The CPU works closely with memory. The instructions of the program being executed must be in memory for processing to take place. Memory is also located on chips on the main circuit board. The part of memory where current work is temporarily stored during processing is called random-access memory (RAM). It is temporary and volatile. The other part of memory is called read-only memory (ROM) or firmware; it contains basic start-up instructions, which are burned into a chip at the factory; you cannot change the contents of ROM. Many computers have open architecture that allows you to add devices. The system board contains expansion slots, into which you can plug expansion boards for additional hardware. The board has sockets on the outside, called ports. You can plug a cable from your new device into the port. The significance of open architecture is the fact that it enables you to add any hardware and software interfaces to your existing computer system. This means you can not only expand the memory of your computer but also add devices that make your computer more amenable to uses in medicine. Expansion boards also allow the use of virtual reality simulators, which help in teaching certain procedures.

Output Devices

Once data are processed, output devices translate the language of bits into a form humans can understand. Output devices are divided into two basic categories: those that produce hard copy, including printers and plotters; and those that produce soft (digital) copy, including monitors (the most commonly used output device). Soft copy is also produced by speakers that produce speech, sound, or music. 

Secondary Storage Devices 

The memory we have discussed so far is temporary or volatile. To save your work permanently, you need secondary storage devices. Magnetic disk and magnetic tape and optical disks are used as secondary storage media. Magnetic media (disk, diskette, tape, and high-capacity Zip disks) store data and programs as magnetic spots or electromagnetic charges. High-capacity optical disks (compact disks [CDs] or digital video disks [DVDs]) store data as pits and lands burned into a plastic disk. Solid-state memory devices include flash memory cards used in notebooks, memory sticks, and very compact key chain devices; these devices have no moving parts, are very small, and have a high capacity. USB flash drives have a huge capacity for information.

SOFTWARE

Software refers to the programs—the step-by-step instructions that tell the hardware what to do. Without software, hardware is useless. Software falls into two general categories: system software and application software.

System Software

 System software consists of programs that let the computer manage its resources. The most important piece of system software is the operating system. The operating system is a group of programs that manage and organize resources of the computer. It controls the hardware, manages basic input and output operations, keeps track of your files saved on disk and in memory, and directs communication between the CPU and other pieces of hardware. It coordinates how other programs work with the hardware and with each other. Operating systems also provide the user interface—that is, the way the user communicates with the computer. For example, Windows provides a graphical user interface, pictures or icons that you click on with a mouse. When the computer is turned on, the operating system is booted or loaded into the computer’s RAM. No other program can work until the operating system is booted. 

Application Software 

Application software allows you to apply computer technology to a task you need done. There are application packages for many needs. Word-processing software allows you to enter text for a paper, report, letter, or memo. Once the text is entered, you can format it, that is, make it look the way you want it to look. You can change the size, style, and face of the type. In addition, margins and justification can be set to any specifications. Style checkers can help you with spelling and grammar. Word-processing software also includes thesauri, headers and footers, index generators, and outlining features. Electronic spreadsheets allow you to process numerical data. Organized into rows and columns intersecting to form cells, spreadsheets make doing arithmetic almost fun. You enter the values you want processed and the formula that tells the software how to process them and the answer appears. If you made a mistake entering a value, just change it and the answer is automatically recalculated. Spreadsheet software also allows you to create graphs easily—just by indicating what cells you want graphed. Electronic health records (EHRs) can use spreadsheets to graph a series of a patient’s blood values over time.

Database management software permits you to manage large quantities of data in an organized fashion. Information in a database is organized in tables. The database management software makes it easy to enter data, edit data, sort or organize data, search for data that meets a particular criterion, and retrieve data. Once the structure of the table is defined and the data entered, that data can be used for a variety of purposes without being retyped. Eye-pleasing, businesslike reports can easily be generated by simply defining their structure. There are also specialized software packages used in specific fields such as medicine. For example, there are specialized accounting programs used in medical offices. Microsoft is considering developing a new software package for the health care industry. Communications software includes Web browsers, such as Internet Explorer. These programs allow you to connect your computer to other computers in a network.