1. Breitenbach, Judith E. MS, RN

Article Content

In a nutshell, informatics is the science and art of turning data into information that we can use to make decisions. The focus is on the management of that information, which is generated by the data collected through the use of computerized systems. Nursing informatics is broadly defined as "the use of information and computer technology to support all aspects of nursing practice, including direct delivery of care, administration, education, and research." For example, we use informatics when we analyze patient length of stay, demographics, and lab results. We accomplish this through the use of healthcare information technology (HIT) available within the clinical setting. Let's take a closer look.


At a glance

The electronic health record (EHR) has been defined by the U.S. Department of Health and Human Services as "an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization." Computerized provider order entry (CPOE) is a part of the EHR system, which allows the healthcare provider's order to be electronically submitted into the computerized system that interfaces with other EHR systems, such as the clinical lab, radiology, or pharmacy departments.


Studies have shown that CPOE implementation reduces medication errors. When orders are entered into the CPOE, they're automatically sent to the pharmacy for verification and dispensing. The medications are entered into the electronic medication administration record (eMAR) for review by the nurse before being given to the patient. After viewing the eMAR, the nurse must scan the drug and the patient's barcoded ID wristband to ensure that the six rights of medication administration are met.


Clinical documentation software allows the healthcare team to record patient care. These systems support workflow processes and assist in the development of the patient's care plan that can be shared across disciplines. Often, they're designed based on the procedures and protocols established within individual agencies. However, the same general concepts apply when accessing and documenting patient care. The use of standardized language, pull-down menus, decision trees, and keywords contributes to the development of a concise patient record in which numerical data can be grafted, problem lists generated, and critical information extracted.


Cover the basics

To navigate these systems, nurses need to have basic computer skills. This includes knowledge of how to use the associated hardware, as well as an understanding of the operating system (see The hard and soft of HIT). You don't need to understand how the software was developed to be successful in navigating the system. Health information systems are developed from already established processes and known data sets regarding the provision of patient care.


Delve deeper

According to the American Nurses Association (ANA), nurses interested in pursuing a career in nursing informatics facilitate the "integration of data, information, and knowledge to support patients, nurses, and other providers in their decision making in all roles and settings." The informatics nurse specialist (INS) acts in the role of project manager, consultant, educator, researcher, product developer, decision support/outcomes manager, advocate/policy developer, entrepreneur, and/or administrator. The INS "incorporates theories, principles, and concepts from appropriate sciences into informatics practice; integrates ergonomics and human computer interaction principles into informatics solution design, development, selection, implementation, and evaluation; and systematically determines the social, legal, and ethical impact of any informatics solution within nursing and healthcare," according to the ANA.


Nurses who work within the informatics field can become board certified through the American Nurses Credentialing Center. At the very least, every nurse should meet the Quality and Safety Education for Nurses (QSEN) competencies for the knowledge, skills, and attitudes expected in the use of HIT.


Professional organizations that support the role of nursing informatics in healthcare include the American Nursing Informatics Association, which focuses on the use of technology in the caring of others and supporting the advancement of nursing informatics through "communication, education, research, and professional activities," and the Healthcare Information and Management Systems Society (HIMSS), which globally engages in initiatives to improve health outcomes through the use of information technology. In 2004, HIMSS partnered with the American Medical Informatics Association to support the Alliance for Nursing Informatics, with the mission to "advance nursing informatics practice, education, policy, research, and leadership through a unified voice of nursing informatics organizations." Together these organizations foster an integrated front for improving care quality, safety, and access while increasing cost-effectiveness within healthcare systems.


HIT the ground running

After looking at the historical development and implementation of the EHR, it's obvious that computerized documentation isn't going away (see The history of HIT). Standards are in place to ensure patient safety and positively impact healthcare outcomes. Computerized systems are continuously being updated and refined to meet the expectations established via the Health Insurance Portability and Accountability Act and the Affordable Care Act. The savvy nurse understands the importance of staying current with computer skills and meeting the expectations as outlined in the QSEN informatics competencies.


did you know?

Technology can make our daily practice more efficient and our environment safer, but it may also be negatively affecting our physical and mental health. See page 44 of this issue for tips on how to assess and educate your patients about the healthy use of smart devices and other technology, as well as what you can do to ensure the safe use of technology at work.

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The hard and soft of HIT

It's important to have a basic understanding of computerized systems to comprehend how data are stored and interpreted to provide information for decision making at the bedside.


Hardware (physical components)


* Central processing unit: the computer's "brain"


-arithmetic logic unit, which executes instructions


-memory, which consists of read-only memory (permanent data that provide instructions or rules of operation) and random access memory (temporary memory storage, or RAM)


-control unit, which provides instructions for input and output devices


* Input devices


-such as keyboards, scanners, barcode readers, optical pens, and voice input systems


* Output devices


-such as headphones, printers, speakers, and monitor screens


* Either input or output


-such as webcams, CD/DVD players, touch screens, fax machines, and digital cameras


* Primary and secondary storage devices


-primary storage, such as RAM and cache, is the computer's internal memory that works while the computer is running; it's volatile, meaning that once the system is shut down, the content is erased


-secondary storage, such as hard drives, CDs, and thumb drives, may be removable; it's nonvolatile, meaning that the content remains until it's deleted or overwritten



Software (operating system)


* Operating systems: oversee the operation of the computer itself


* Applications: programs designed to accomplish a particular task





In order for exchange of information to take place, the hardware and software components must use a network. Networks can be within a local or wide area. Both the Internet and extranet (private networks) allow for the flow of data through the use of software and programming languages. Computers use binary code (a series of 1s and 0s) to receive, process, and store data.


An integral part of healthcare, information management is dependent on the use of networks. In order to accomplish this, computers must share a common language, thus ensuring interoperability. This means that when systems share data, the receiving system must be able to understand and use the data. There are three types of interoperability: technical (the ability to exchange data from one point to another), semantic (the meaning of the data remains the same from point A to point B), and process (the coordination of processes during the exchange).


Standardized data sets have been developed to ensure interoperability among systems. These terminologies define specific nomenclature relevant to clinical practice. The most widely used classification is the Systematized Nomenclature of Medicine-Clinical Terms. Other prominent classifications systems include the Clinical Care Classification, International Classification for Nursing Practice, Nursing Interventions Classification, Nursing Outcomes Classification, Perioperative Nursing Data Set, International Classification of Diseases, and NANDA International.


The history of HIT


* 1950s: The use of computers within the U.S. healthcare system begins, with institutions utilizing mainframe computer systems for administrative functions.


* 1960s-1970s: Hospitals develop computer-based information systems for physician order entry and quality reporting.


* 1980s: The field of informatics emerges as a viable method of using technology to support patient care.


* 1990s: The incorporation of large U.S. hospital systems and the growth of the Internet create a need for more enhanced computer systems.


* 1992: The ANA recognizes nursing informatics as a specialty.


* 1996: The implementation of the Health Insurance Portability and Accountability Act ensures the rights of U.S. citizens to certain privacy protections regarding individual identifiable information, which leads the way for the development of the EHR.


* 2004: The adoption of an interoperable EHR is called for by 2014. The position of the National Coordinator for Health Information Technology is established. At the same time, the U.S. Congress establishes the President's Information Technology Advisory Committee (PITAC) to support greater use of informatics in healthcare.


* 2005: The PITAC responsibilities are transferred to the President's Council of Advisors on Science and Technology.


* 2009: The Health Information Technology for Economic and Clinical Health Act is established, which leads to a three-stage implementation program for meaningful use of EHR technology. The Centers for Medicare and Medicaid Services is charged with oversight of the EHR meaningful use incentive.


* 2011-2012: Stage 1 of meaningful use is initiated, with data capturing and sharing.


* 2014: Stage 2 of meaningful use is implemented, with advancement of clinical processes.


* 2016: Stage 3 of meaningful use is underway, with actualization of improved patient outcomes.




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