CHN agencies have used computers since the late 1960s, when computers were introduced into the healthcare industry. Many of the early systems focused on regulatory compliance, billing applications, and statistical reporting related to community health, which encompasses public health and home health compliance. As healthcare services continued to evolve, community health services grew primarily due to consumer choice, cost control initiatives, and the increase in numbers of healthcare recipients with chronic illnesses.
Concurrently the numbers of hospital beds were decreasing with an increase of services in community health settings (Elfrink and Martin, 1996). The changing healthcare trends have been the impetus for increasingly sophisticated management information systems (MISs), which transformed data into information to measure outcomes, track client progress, exchange healthcare information among physicians, nurses, insurers, managed care companies, regulatory agencies, and public reporting, and analyze financial data. These systems supported clinical care delivery, electronic billing, and had the potential for multiple user access.
Further advancements led to four domains of concentration which directed unique MISs for practice: (1) public health that focused on population interventions and the outcomes related to epidemiologic and/or mortality/ morbidity trends; (2) home health that focused on skilled nursing care for individuals in the home and the outcomes related to care delivery for individuals or aggregated populations; (3) special population community practices (i.e., mental health) that focused on specific diagnostic care and/or treatment needs and the outcomes related to care delivery for individuals, diagnostic groups, and/or aggregated populations; and (4) outpatient care that focused on intermittent, episodic, or preventative care for individuals and the outcomes related to interventions for individuals and/or aggregate groups, inclusive of national health prevention standards. Concurrently, these MISs also offered clinical documentation capabilities at the point of care, provided billing functions, supported submission by computer of data for regulatory compliance, provided statistical reporting, and even developed decision support features.
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