|
|
BONUS
CONTENT FROM NURSING MADE INCREDIBLY EASY!
Deep
impact: Informatics and nursing
By Joyce Sensmeier, RN,BC, MS, CPHIMS, FHIMSS
It’s exciting to realize that
many hospitals and health systems are currently purchasing and
implementing information systems that can positively impact patient
care delivery. Currently, 56% of U.S. hospitals have some level
of electronic medical record application installed to support
care delivery.1 However, it’s essential that nurses guide
these projects to ensure that their work is supported, not compromised.
Healthcare has been slow to take
advantage of the benefits that computerization can bring, and
most hospitals still do much of their record keeping on paper.
The technology awakening creates an opportunity for nurse informaticists
to take the lead in bridging the gap between information technology
(IT) and patient care to move healthcare into the digital age.
Where we’re at
Nursing informatics was recently ranked by Yahoo Education as
one of the 10 Great Careers You’ve Probably Never Heard
Of.2 The American Nurses Association identified nursing informatics
as a specialty in 2001. And U.S. News & World Report recently
listed health informatics specialists as number one in ahead-of-the-curve
careers.3 While more than 8,000 nurses are practicing as nurse
informaticists, many more are needed to achieve widespread adoption
of the electronic health record (EHR).
A recent study found that the health
IT industry needs at least 40,000 additional professionals to
move toward a paperless system.4 To reach this goal, much work
is needed to educate both nurses and faculty in informatics competencies
so that technology can be embraced as a tool in everyday practice.
The TIGER (Technology Informatics Guiding Education Reform) Initiative
is making strides to promote this education. TIGER started out
as a grassroots effort to engage all stakeholders in a common
vision of ideal EHR-enabled nursing practice, and today more than
120 diverse organizations have joined the effort. Hundreds of
nurses have volunteered their expertise to work on the nine collaborative
TIGER teams, each focused on a key topic and led by industry experts.
The goal of the collaborative teams is to share their findings
and recommendations with all practicing nurses and nursing students
through targeted outreach activities with summary reports to be
published this fall.5
There are many opportunities to take
advantage of technology to improve the efficiency of nursing care.
Nurses from 36 medical-surgical units recently participated in
a time and motion study to assess how nurses spend their time.
Study results showed that changes in technology, work processes,
and unit organization and design were areas of potential improvement
in the use of nurses' time and the safe delivery of patient care.6
Proposed improvements included creating closed-loop medication
administration systems, wireless networks, handheld and ear devices
for the delivery of patient information, and systems that track
the physical location of a medical provider. These ideas bring
forward a vision of nurses and other caregivers working in an
environment seamlessly supported by technology that’s pervasive
rather than invasive. Involving nurses in this transformation
is critical to its success.
Challenges to overcome
The opportunities may be plentiful, but challenges still exist.
Only 39% of the chief information officers (CIOs) responding to
the 19th Annual Healthcare Information and Management Systems
Society Leadership Survey identified clinical application support
as an IT staffing need.7 Another 20% specified the need for clinical
informaticists, and only one-quarter of the CIOs identified process/workflow
design as an area for staffing support. Although clinical information
systems were identified as one of the most important applications
for the next 2 years, financial support for IT continues to be
a barrier according to 26% of respondents.
Can patient care be improved with
IT? Over three-quarters of respondents to a recent Vantage Point
survey on IT and clinical workflow indicated that quality of care
would benefit as a result of the presence of IT that assists clinicians
in carrying out their day-to-day job.8 Eighty percent of respondents
noted that nurses at their organization are involved in how technology
should be integrated into the nursing workflow. However, nearly
40% of the respondents indicated that the technology that’s
currently available doesn't fit into workflow.8 A survey published
in The New England Journal of Medicine found that physicians who
use the EHR say overwhelmingly that such records have helped improve
the quality and timeliness of care. But fewer than one in five
of the nation’s physicians has started using such records.9
Of the more than 2,600 physicians who participated in the survey,
82% of those using EHR said the technology improved the quality
of clinical decisions, and 86% said it helped in avoiding medication
errors.10
Where we’re headed
So how can informatics positively impact nursing practice? The
ultimate goal is to use technology to bring critical information
to the point of care to increase efficiency and make healthcare
safer and more effective.11 This goal requires implementation
of an interconnected EHR system across hospitals, healthcare systems,
and regions. The need for interoperability exists across all settings
of care, including ambulatory care, and ultimately reaching into
the home.
Nurses are working as leaders in
several national initiatives to lay the groundwork for this nationwide
health information network using standardization and technical
specifications. The Healthcare Information Technology Standards
Panel is selecting standards and developing interoperability specifications
based on priority use cases and promoting the adoption of these
standards.12 The Certification Commission for Healthcare Information
Technology is developing criteria for interoperability and certifying
EHR systems.13 More specifically, IT solutions such as bar-code
systems for medication management are being used by healthcare
providers to reduce the risk of error. Results of a study published
in the journal Pediatrics showed that medical errors harm one
out of 15 children who are hospitalized. Aggressive measures,
including technology-based solutions such as closed-loop medication
administration, are needed to combat this shocking statistic.14
The National League for Nursing (NLN)
recently published a position statement calling on faculty, deans,
and administrators to require that all nursing students graduate
with knowledge and skills in each of three critical areas: computer
literacy, information literacy, and informatics. One impetus for
this statement was a 2006 NLN survey, which revealed that only
60% of nursing programs had a computer literacy requirement and
40% had an information literacy requirement. Less than 60% of
survey respondents said that informatics was integrated into the
curriculum and experience with information systems was provided
during clinical experiences.15
Given the shortage of trained, experienced
informatics nurses and the limited number of schools that include
informatics competencies in their curriculum, how can we better
embrace technology to improve nursing practice?
- Seek nursing input. Nurses should
be involved in every IT decision that impacts their workflow.
IT champions should be recruited from nursing staff members
to act as a resource and model for colleagues during system
implementations. Organizations should engage nurse informaticists
to be leaders for the design, selection, and implementation
of information systems that impact patient care.
- Invest in training. Nurses need
consistent training to feel comfortable with the use of IT in
their everyday practice. Onsite trainers are needed who can
be an available resource to reassure nurses that patient care
won't be compromised by the intrusion of a new system. Chief
nursing officers should pursue continuing education in informatics
competencies and partner with their nurse informaticist colleagues
to lead IT-based projects. Nurse educators should embrace informatics
competencies and ensure that they're incorporated into curricula.
- Promote IT excellence. Look to
other organizations that have achieved improved outcomes through
the use of technology. Learn from nurses at organizations that
have achieved awards of excellence like the Davies Award to
better understand how they successfully moved from paper-based
systems to electronic processes.16 Keep in mind that IT should
enable quality improvement by capturing data as a byproduct
of the care process, and leverage every opportunity to do so.
- Build toward an EHR. Consider
selecting systems in a staged approach so that you can build
the foundation for a fully paperless EHR.17 Start with the basics,
including ancillary systems such as laboratory, radiology, and
pharmacy. Build a clinical data repository that can collect
data from such systems and subsequently provide it at the point
of care. Add clinical documentation and clinical decision support
to elicit information from data that can further enhance nursing
knowledge. After these foundational systems are in place, add
computer-based order entry and closed-loop medication administration
to better address quality and safety issues. By using a staged
approach you'll be well positioned for success to achieve IT-enabled
clinical transformation.
References
1. Garets D, Davis M. Electronic medical records vs. electronic
health records: Yes, there is a difference. HIMSS Analytics White
Paper. Available at: http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf.
2. Santina J. 10 great careers you've probably never heard of.
Yahoo Education. Available at: http://education.yahoo.net/degrees/articles/featured_10_great_careers_you_never_heard.html.
3. Nemko M. Ahead of the curve: Health informatics specialist.
U.S. News & World Report. December 19, 2007. Available
at: http://www.usnews.com/articles/business/best-careers/2007/12/19/ahead-of-the-curve-health-informatics-specialist.html.
4. iHealthBeat. Hazy definitions for health informatics field
compound issues in work force development. Available at: http://www.ihealthbeat.org/Special-Reports.aspx?start=31.
5. The TIGER Initiative. TIGER Initiative: An update. Available
at: https://www.tigersummit.com.
6. Hendrich A, Chow M, Skierczynski BA, Lu Z. A 36-hospital time
and motion study: How do medical-surgical nurses spend their time?
The Permanente Journal. 2008;12(3):25–34.
7. Healthcare Information and Management Systems Society. 19th
Annual 2008 HIMSS Leadership Survey. Available at: http://www.himss.org/2008Survey/DOCS/19thAnnualLeadershipSurveyFINAL.pdf.
8. Healthcare Information and Management Systems Society. HIMSS
Vantage Point. IT & clinical workflow. Available at: http://www.himss.org/content/files/vantagepoint/pdf/VantagePoint_200802.pdf.
9. Lohr S. Most doctors aren't using electronic health records.
The New York Times. June 19, 2008 Available at: http://www.nytimes.com/2008/06/19/technology/19patient.html.
10. Blumenthal D, DesRoches C, Donelan K, et al. Health information
technology in the United States, 2008: Where we stand. Available
at: http://www.rwjf.org/qualityequality/product.jsp?id=31831.
11. National Quality Forum. Wired for quality: The intersection
of health IT and healthcare quality. Available at: http://www.qualityforum.org/news/Issuebriefsandnewsletters/ibhitMar08.pdf.
12. Healthcare Information Technology Standards Panel. Quality
Interoperability Specification. Available at: http://www.hitsp.org
.
13. Certification Commission for Healthcare Information Technology.
New CCHIT Certified 08 Materials. Available at: http://www.cchit.org.
14. Monegain B. Medical errors threaten one in 15 hospitalized
children. Healthcare IT News. April 7, 2008.
15. National League for Nursing. Position statement. Preparing
the next generation of nurses to practice in a technology-rich
environment: An informatics agenda. Available at: http://www.nln.org/aboutnln/PositionStatements/informatics_052808.pdf.
16. Healthcare Information and Management Systems Society. HIMSS
Davies Awards program: What's new? Available at: http://www.himss.org/ASP/daviesAward.asp.
17. Information and Management Systems Society. HIMSS Analytics.
EMR adoption model. Available at: http://www.himssanalytics.org/hc_providers/emr_adoption.asp.
Source: Men in Nursing.
May 2009. |