Computer Software

Software is the general term applied to the instructions that direct the computer’s hardware to perform work. It is distinguish from  hardware by its conceptual rather than physical nature. Hardware consists of physical components, whereas software consists of instructions communicated electronically to the hardware.

Software is needed for two purposes. 

First, computers do not directly understand human language, and software is needed to translate instructions from human language into machine language.

Second, packaged or stored software is needed to make the computer an economical  work tool. users could create their own software everytime they needed to use the computer.Software supplied as organized instruction sets called "programs" or more typically as a set of related programs called "package".

Brief History Of Computer Programming Software

Types of Software

System Software

System software consists of the variety of programs that control the individual computer and make the user application programs work well with the hardware. System software consists of the variety of programs to initialize, or boot up the computer when it is first turned on and control all the functions of the computer hardware and application software.

System software helps speed up the computer's processing , expands the power of the computer by creating cache memory reduces the amount of confusion when multiple programs are running together , "cleans up" the hard drive so that storage is managed efficiently, and perform other such system manageable tasks.

Basic Input Output System.

The first level of system control is handled by the basic input output system (BIOS) stored on a read only memory (ROM) chip on the motherboard. The software on the BIOS chip is the first part of the computer to function when the system is turned on. It first searches for an operating system (OS) and loads it into the random access memory (RAM). Given that the BIS consist of a set of instructions permanently burned onto a computer chip, it is combination of hardware and software. Programs on a chip are called "firmware".

Operating Systems

OS are actual software, loaded from the hard drive into RAM as soon as the computer is turned on. OS can be upgraded or entirely changed through software. The user simply deletes OS files from the hard drive and installs a new OS from a CD-ROM or floppy disks or downloads it from the Web or other sites. Oss handles the connection between the CPU and peripherals called the interface. The OS manages the interfaces to peripheral hardware, schedules tasks, allocates storage in memory and on disks, and provide an interface between the machine and the user. One of the most critical task of the OS involves the management of storage.

User Interfaces

Disk Operating System

DOS OSs were first designed for mainframe computers and replicated the procedures programmers used under manual OS. They were an extension of the move away from the dependency of human operators and tedious memory allocation programming requirements.

Graphical User Interface

In 1979, Steve Jobs made a decision to abandon DOS and move to a GUI system for a new product to be called Macintosh. In 1984, Macintosh with the first commercially available GUI was introduces. This was the "computer for everybody". Although GUI did not eliminate the need for users to spend time learning new programs, it did bring  closer to reality the ideal that computers could become "self-teaching" devices. People could begin to use the computers with minimal training , using built-in tutorials and online answers to common questions. 

Bill Gates, founder and CEO of the Microsoft Corporation, quickly recognized the need to provide a GUI product and immediately began the development of Windows, the GUI for the IBM PC platform. The popularity of GUIs is a function of their use of pictures rather than typed narrative commands. 

Utility Programs

In addition to the operating system, there are variety of other system programs available to the user called utility programs. these are designed to enhance the function of the OS  or to add facilities that the basic OS does not offer. 

Language Translation Utilities

People and computers do not speak the same language. At the machine level, computers could only understand binary. human beings do not speak binary. it is difficult to write a program in the machine's language. Translation programs are needed to convert instructions written in an English- like language into binary. these type of translation programs are called assemblers, compilers, or interpreters. Translation programs today are often 90% or more portable among different computer platforms.

The World Wide Web and Web Browsers

The WWW is a sort of network system utility program for the Internet. It provides a protocol for document transfer across the Internet. A web browser is a utility program that allows the users to access the web and the material available through the web. The Internet is a system of data and voice lines routed through dedicated servers to create a network of networks; it consist of linkages that allow users from one computer to access the documents and files available on another network. 

Application Software

Includes the various programs people use to do work, process data, play games, communicate with others or watch multimedia programs on a computer. When the user orders the OS to run an application program, the OS transfers the program from the hard drive, diskette, or CD-ROM into RAM and executes it.

Application Software are written in a particular programming language. then the program is "complied" into machine language so the computer can understand the instructions and execute the program.

Programming Languages

 A programming language is a means of communicating with the computer. while it is certain possible for programmers to learn to use binary-- some highly sensitive defense applications are still written in machine language-- the language is inefficient of human resources, and its programs are virtually impossible to update and debug. Since the invention of computers, users have longed for a machine that could accept instructions in everyday human language.Although that goal largely escapes the industry, a variety of English-like languages have been developed.

Visual Programming Language Microsoft Corporation has marketed two very popular such as programs: Visual BASIC (Beginner’s All-purpose Symbolic Instruction Code) and Visual C11.these programs have been used for a variety of applications, especially those who allow users to interact with electronic companies through the Internet.

Fourth Generation Languages Fourth Generation Languages are specialized application programs that require more involvement of the user in directing the program to do necessary work. Procedural languages include programs such as spreadsheets, statistical analysis program, and database query languages.

Fifth Generation Languages or third level languages are called natural language. In these programs, the user tells the machine what to do in the user’s own natural language or through use of a set of very English-like commands. Ideally, the voice recognition technology is integrated with the language so that voice commands are recognized and executed.

Common Software Packages for Microcomputers

Standard office package includes a word-processing program, a spreadsheet, a presentation graphics program and some form of data-based management. The most commonly used programs are e-mail and word processor. Another very common product is a desktop publisher.  Software packages are sold on CD_ROM disks and many software companies are now marketing their products through the Internet and the costumers download the software directly through the Internet from the vendor’s Internet site.

Software Package Ownership Rights

A program sold to one costumer can be installed on a very large number of machines. If the program were sold outright, users would have every right to distribute them as they wished. As a result, the software industry has followed an ownership model more similar to that of the book publishing industry than to the model used by vendors of most commercial products.

Common Software Useful to Nurses

In most hospitals, software used by nurses includes admission, discharge, nd transfer (ADT) system that help with patient tracking, medication administration record (MAR) software. Increasingly, hospitals have added charting software that computerizes at least some parts of the nursing record. In addition, quality and safety groups such as the Leapfrog group consider a computer physician order entry (CPOE) system to be so important that they check the list it as a separate item on their quality checklist. Additionally, nurses may have the support of computer based systems for laboratory and radiology orders and results reporting.

Chat Rooms

Chat rooms are like electronic conference calls. Multiple users can send and receive messages at the same time . some chat rooms are private and require a password to enter. Others are open to the public. All members of the chat room can see all the messages posted. The strengths of chat room technology include the ability of many people to “meet” without having to leave their homes. Chat rooms have dangers. Users can remain anonymous, and anybody cn participate in a public chat room. There have been cases where pedophiles have used chat rooms to become acquainted with children and to entice them face-to-face.

Electronic Bulletin Boards

They may be called discussion boards, litservs, or electronic forums but they all work in similar ways. This technology creates space where user s can post a message. In the better software, the messages can be posted according to user-defined categories.

Listservs

The least powerful version of an electronic bulletin board. This program functions more like an electronic mailing list than a true discussion board. When a user posts a message to the board, it is merely e-mailed to all members of the conference. The software may or may not store all messages in an accessible archive so users can review all the entries at one time.

Computer Programming

Computer programming refers to the process of writing a computer program, which is a series of instructions written in proper secquences to solve a specific problem. A program primarily encompasses the program instructions and is generally written by a computer programmer.

The five major steps in writing any computer program are as follows:

·         Problem definition (Functions Specification)

·         Program design

·         Writing the code and program documentation

·         Alpha testing

·         Beta testing and program documentation

Problem or Functions Specification

Defining the problem to be solved or the functions to be performed by the programs is the most critical step in programming. It requires that the problem or task be very precisely defined and the procedures to be performed by the program be perfectly understood. The problem definition must be analyze and outline in detail the scope of the problem  and all the elements needed to solve it.

Program Design Specifications

Once the problem is specified, the process for solving the problem must be designed. There are generally two types of specifications involved in the program creating. The first is the set of functional specifications that identifies all the function the program is to perform. This should include a narrative description of the functions of the system and graphical representation of the system’s process flow. This is to ensure that both the system designer and the people who have contracted for the designer’s services share the same understanding of the planned system.

Programs Preparations

The actual writing (or coding) of the program,, entails translating the design specifications into the programming language to be used. The program instructions must be coded in detail and in logical sequence so that the  program can process data correctly. The programming language selected must not only be appropriate for processing the problem but must be translated by the computer. 

Documentation

Two types of documentation:

1. First, the program itself should be designed in a highly structure, top-down manner and the lines of code should be liberally sprinkled with explanatory statements. These statements are not part of the program itself; however, they clearly identify what program modules or individual lines of code do in the program. Program documentation al includes a narrative manual of instruction to system administrative who will have to maintain the program after the initial programming is completed.
2. User’s manual. The user’s manual provides clear direction and examples of how to make the program work as intended. It should also provide suggestions for to proceed when users cannot get the program to function as they expect.

Program testing

•       Alpha testing

The programming team and system analysis carefully desk check the program in a process called “alpha testing.” This process is also called “desk-checking”. The purpose of alpha testing is to see if all the processes appear to be functioning as specified in the flow charts, functional specifications and design specs.

•      Beta testing

The second level of testing is called “beta testing.” In the beta testing, the program in installed in the actual user environment and further programming of screen formats and other user interface functions is performed. Documentation adequacy is examined. Users begin the final testing phase by entering real data and checking that the system products are accurate and complete.

Program implementation

Program implementation is the final step in programming. In this phase, the program is implemented throughout the beta site. All users are trained and the full day- to- day data load is imposed on the system. Sometimes when a large amount of data that the system must handle on a daily basis are entered, and the full range of program functions is called, new problems arise. Programmers must be readily available to solve these problems at any time of day and night. This step is where user- related problems are most like to discovered. When these problems are solved and the beta site is up and running smoothly then –and only then – is the program ready to be sold in the consumers market.

Computer systems

Every functioning computer is a system; that is, it is a complex entity, consisting of an organized set of interconnected components or factors that function together as a unit to accomplish results that one part alone could not. At a minimum, computer must have atleast four components to function. These minimum components are a power source, a CPU, a peripheral to allow input and a peripheral to permit output. Of course, computers typically have more than four components. “Computer system” may refer to a single machine that is unconnected to any other computer. However, it can also be a system consisting of multiple, interconnected computers that functions to facilitate the work of groups of providers and their support people in a system called a network.

System Theory

System theory provides the conceptual basis for understanding complex entities that consist of multiple interrelated parts working together to achieve a desired result. Such entities are called systems. A system,  is orderly and predictable in its functioning. The key concepts of system theory are parts, interaction, interdependency, input, output, processing, feedback and control.

The primary propositions of the theory are the following:

1.            A system takes in input on which to perform processes.
2.            The processes performed by a system on input result in system output.
3.             The processes in a system subject to control forces.
4.             Feedback is the key mechanism of control in a system.
5.       A system’s parts interact in such a way that the parts are interdependent with respect to the system’s processes
6.       Impingement on one part in a system will produce effects on the system’s processes and may produce distortions on the other parts of the system. A corollary to this proposition is the following.
7.            Distortion in one part of a system may be a symptom of a problem in another component (this called a secondary malfunction)
8.       Thus, correction of  a malfunctioning part will correct the system functioning only if the malfunction was a primary malfunction and not secondary malfunction
9.            Effects on the system’s processing function will affect the system’s output.
10.     A system is more than the sum of its parts. Thus, while a system can be broken down into its component parts, if this is done the system no longer exist.

System Elements

Interdependent parts

The most defining attribute of a system is that its parts interact to conduct some process. Without the interaction, the system process could not occur.  In computer systems, the process involves mathematical, logical or data transfer operations requiring interaction among the CPU, RAM and ROM chips and the motherboard’s power source.

Input

Input is any factor from the external environment that is taken into the system. Input in a computer system may serve to initiate system functioning, as when the machine is turned on and the OS is  loaded into RAM. It may consist of data that the system is to process.

Process

Process is the activity of the system. A system performs process on its inputs to produce outputs, or create some sort of result. Process in a computer system can be seen in the example of a presentation graphics system. The hardware, software and peripherals constitute the interdependent parts. The commands entered by the user, the numerical data for a graphic  and the alphanumeric characters used as title, labels and notations on the graph constitute the input. The system sends translated data and commands to the CPU (processes) on the input to create a graphic image (e.g., pie graph and bar graph)

Output

Output is any product or waste produced as a result of system process. Output is the reason the system was created or purchased. Typical computer output includes electronic data transmission from the main memory to a hard or floppy disk, paper reports or data transmissions.

Control

“Control” refers to any component or activity that serves to prevent or correct problems or errors in the system’s input, process or output. A system must function within rules and procedures that keep it functioning smoothly. Most application programs also incorporate control functions to help the user avoid erroneous results. Control in computers functions by checking, validating and verifying input and output data and by checking for and flagging certain conditions during processing.

Feedback

Feedback is output from one part of a system process that serves as input to another part of a system process. Feedback is special case of control. Feedback within a system typically used as part of a system’s self-regulation function. In a computer system, feedback components are important functions of the OS and utility programs. 

Classification of systems

Closed systems

A closed system is defined as a system with the following characteristics: differentiation, isolation, independence and self-sufficiency. A close system is clearly differentiated from all other systems and factors in its environment. In this sense, a closed system is self-contained. A close system has to be self-sufficient, because any input from the external environment is a threat to the integrity of a closed system.

Open systems

Open systems are systems that exhibit integration, fluid or fuzzy boundaries and interaction with their environments (Markas,2002)

Computer systems

The term “computer system” is used to describe the of peripherals, computer “box” and software that together perform computing functions for one or more users. The term “computer system” is vague and could refer to anything from a hand-held personal computer to an organization’s entire network of computers.

Information systems

 An information system is the collection and integration of various pieces of hardware and software and the human resources that meet the data collection, storage, processing and report generation needs of an organization. The key  pieces of an information system are the hardware, software and the database or databases in which the organization’s data are stored.

Information System Types:

Management Information Systems. An MIS provides managers information about their business operations. A MIS is defined as an organized system for managing the flow of information in an organization in timely manner. Its primary use is assisting in the decision-making processes.  Most MIS systems have programs that support strategic planning, management control and operations support. Strategic planning refer to the policy decisions made by the top-level team of administrators. The management control functions refers to the program and personnel decision made by middle level managers, supervisors and head nurses. 

Bibliographic Retrieval Systems.

A bibliographic retrieval system is a retrieval system that generally refers to bibliographic data, document information or literature. Such a system is primarily used to store and retrieve data and not to conduct any computations. The system is designed to provide bibliographic data on journal articles, books, monographs and textual reports.

Stand-Alone, Dedicated or Turnkey System.

A stand-alone system is a special purpose system. It is developed for a single application or set of functions. A patient classification system is an example of a standard alone system. Most stand-alone systems are described by their purpose, such as pharmacy or laboratory system or an imaging system in the radiology department.

Transaction Systems.

Is a system used to process predefined transactions and produce predefined reports. It is designed for repeated operations using a fixed list. From this list, displayed on a computer terminal, a user selects the names of transactions to be processed. A computer program is written so that it can be used repeatedly to process the same type of transactions and generate the same type of reports or products.An inventory system is an example of a transaction system.

Physiologic Monitoring Systems.

Physiologic monitoring systems are being used more frequently to measure and monitor continuous automatic physiologic findings such as heart rate, BP and other vital signs. Monitoring systems provide alarms to detect significant abnormal findings when personnel are needed to provide patient care and save lives.

Decision Support Systems.

 A decision support system is a computer system that supports some aspect of the human decision-making process. This type of system guides the user in a highly structured approach that helps identify the salient components of the problem. Decision support systems work with the user to support, but not replace human judgment in a decision-making situation.

Expert Systems. 

An expert system is a computer system containing information and decision-making strategies of an expert to assist non-experts in decision-making. An expert system is designed for users to simulate the cause and effect reasoning that an expert would use if confronted with the same situation in a real environment.

Artificial Intelligence Systems.

An artificial intelligence (AI) system is a system that attempts to model human reasoning processes. The field is concerned with symbolic inference and knowledge representation.  Symbolic inference is concerned with deriving new knowledge from known facts the use logical inference rules.  A true AI system can also track the accuracy of its predictions and judgments and later its own decision-making rules, based on knowledge it generates for itself. Pattern recognition and problem solving are important aspects of AI.

Natural Language Systems.

A natural language system is a system that can understand and process commands given in the user’s own natural, spoken language. It does not require the user to learn a special vocabulary, syntax and set of programming rules and instruction. Natural language requires the computer to understand a wide range of words, speech styles (accents) and syntax and sentence structure.

Hospital Information System

A HIS, sometimes called a medical information system (MIS) or patient care system (PCS), provides support for a wide variety of both administrative and clinical functions. The purpose of an HIS is to manage information needed to facilitate daily hospital operations by all health care personnel. 

HIS configurations

A HIS can use several different computer system configurations. The most common configuration uses a mainframe computer with hardwired terminals or workstations. Users are able to work directly with the mainframe through an interactive interface and real-time processing. The HIS software is either on the mainframe or on a network server.

Program Modules Available in an HIS

Programs typically offered in an HIS include admission and discharge, patient tracking, finance, payroll, billing, budgeting support, inventory and management reporting programs. Clinical support programs are increasingly being viewed as critically important modules in an HIS. Administrative applications refer to the support of the administrative functions of patient care. They generally include budgeting and payroll, cost accounting, patient billing, inventory control, bed census and medical records. 

Patient classification systems are one of the most popular modules for nursing administration. These systems support the process of assigning nursing stuff to units and patients. Other supports for upper and middle management include stuff scheduling and budget support modules.

Semiclinical Modules

Two modules in a HIS: 

• ADT module monitors and sometimes controls the flow of patients in a hospital from admission to discharge. Admissions and discharges constitute the hospital’s patient census, which is a key factor in billing and future planning for how to best deploy hospital resources.

• Order-entry-results-reporting (OE) module is almost always available in a HIS. Order entry means that the stuff can enter laboratory, pharmacy and radiology orders online. Results reporting means that the lab, pharmacy and radiology can enter the results into the computer system and have those results available to the nursing unit. 

Clinical support modules

Charting Systems

During 1990s, most vendors greatly upgraded their clinical record products and most vendors now offer some form of online charting. Usually included are the medication administration reports, admission assessments, special assessments (e.g., neurologic assessments and labor records) ' nursing care plan , vital signs records, wound care and hygienic care records.

Point-of-Service Systems

It is a special type of clinical system. It system uses a hand-held or bedside PC to ensure that data are entered at the point at which they are collected. It is designed to save time by recording critical clinical data such as patient assessment, drug administration, vital signs and so forth. It also provides immediate access to key patient information to all care providers involved with the patient. It is generally installed in a direct patient care unit, such as the intensive or critical units in a facility where an HIS is installed.

Laboratory, Pharmacy and Radiology modules

A typical laboratory system, for example, includes a laboratory test request, generates the specimen labels, tracks the specimen through the various laboratory stages, generates the results and communicates the findings to patient’s medical record. 

Pharmacy systems track medication orders and changes in orders. They often have drug interaction warning programs, dosage calculators and other support for the pharmacy function.

Radiology systems usually separate products developed by companies that specialize in diagnostic computer imaging systems. 

Network systems

A network is a set of interconnected computer that, through hardware and software technology, work cooperatively for the purpose of information and application program interchange. A network requires hardware and network communication software that allows different computers make sense of the electronic signals and data streams sent back and forth across the wires.

The central concept of network science is cooperation. All computers in a network must function in an interdependent way. Merely connecting computers with a wire does not produce a network. A network must have software that can interpret the signals it receives.

Efficiencies related to storage and data integrity

In a HIS, many departments often must use the same data items. Storing the same information in multiple computers increases the cost o storage and may increase organization’s cost of maintaining accurate records. Storing the patient’s identifying information in only the one record that can be accessed by all the departments means that storage space is conserved.

Even more important, patient may visit multiple departments and clinics over time. This might include hospital admissions, pharmacy, laboratory, several clinics, the billing department, medical records and so on.  Thus, the integrity  of data in at least some of the departmental computers is compromised. 

Software Savings

Many health care organizations have a LAN in which most of the workstation uses “desktop office” software (e.g., Microsoft office). If the organization had to individually purchase the “desktop office” software for each workstation, the purchase cost might be prohibitive. As a result, the major software vendors offer what is called a “ site network license.” When a site license is purchased, the cost per workstation is considerably less than the cost of  purchasing the same number of software packages individually.

Saving in Human Time and Efficiency

In many cases, multiple departments in an organization need the same information. When networks allow all of the departments to use the same information, only one has to collect and enter the data. Networks also facilitate the work of groups within an organization. One can initiate a document, and others can add to the document, edit it and print it. Electronic mail (e-mail) on networks greatly reduces human dependence on real-time communication devices such as telephones.

Network Functions

1.   File transfer (from one computer to another)

2.   Information availability (e.g., data and text files can be simultaneously received by more than one recipient at the same time)

3.    Resource sharing ( e.g., programs and data are available to all users simultaneously)

4.  Online transactions (e.g., grocery stores use computer networks for their charging and inventory control programs attached to the laser scanners at the checkout stand)

5.   Provision of a powerful communication medium among widely separated employees who may use different computer platforms

6.    Interactive environment

7.   Education and entertainment (sharing privately or publicly developed educational offerings, games, movies, recordings, and so forth) and 

8.    E-mail

Network Security

The data or information on a network is valuable property to its owner. Loss or damage to health care data can be costly and can create serious legal liability for a facility that loses critical patient care data or other business data and communications.

Modern security practices weave layers of physical, administrative, electronic and encrypted security around valuable data. An administrative security program focuses on passwords, access rights and personnel issues. System administrators have to work with managers to ensure that only people with a current need to access information are on authorization lists. 

Electronic security techniques are designed to keep hackers away from important data. These techniques operate at different levels, but generally they recognize and accredit the source of the data. Starting with connections from outside the LAN, many modems can receive a call and, on command, dial back the caller at a prestored number to foil a would be intruder. 

Types of Networks

Local Area Network – A LAN is a data network intended to serve a single building or a group of buildings in close proximity to each other. The connections among the machines on the network are by means of physical wiring.  This direct wiring between the machines is called hard wiring, and machines on network are said to be “hard wired” into the system. Due to the hard wiring, very fast data transmission rates are made possible by LAN technology.

Wide Area Network- A WAN is system of connected computers spanning a large geographical area, often a continent or country. This network is usually constructed with serial lines, telephone lines, satellites and FDDI ( fiber –optic distributed data interface) cables for WANs. It can also be constructed by connecting LANs.

The Internet

The internet is a network of networks. It might be visualized as widest of WANs. The internet is a collection of thousands of networks linked by a common set of technological protocols that make it possible for users of any one of the networks to communicate with or use the services located on any of the other networks. These protocols are referred to as Transmission Control Protocol over Internet Protocol or TCP/IP.