Seven time periods: - Advances in relational databases, client-server architectures, and new programming methods - Better application development at lower costs – The complexity of technology, workflow analysis, and regulations shaped new roles in nursing – Legislative activity in the mid-1990s paved the way for electronic health records through the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (public-law 104-19) – In 1992, the ANA recognized nursing informatics as a new nursing specialty separate Scope of Nursing Informatics Practice Standards, and also established a specific credentialing examination for it – The demand for nursing informatics (NI) expertise increased – The ANA developed the Nursing Information and Data Set Evaluation Standards (NIDSEC) to evaluate and recognized nursing technology rapidly changed in the 1990s – The purpose of Information systems was to guide the development and selection of nursing systems that included standardized nursing terminologies integrated throughout the system