Leadership informatics
WHO defines patient safety solutions as "
"any system design or intervention that has demonstrated the ability to prevent or mitigate patient harm stemming from the processes of healthcare.
Applicants for the credentialing examination are required to meet the following criteria:
A baccalaureate or higher degree in nursing or a baccalaureate in a relevant field b. A current, active license as a professional nurse in the United States or a legally recognized equivalent in another country c. The equivalent of 2 years of full-time professional practice as a nurse d. Thirty contact hours of continuing education applicable to nursing informatics within the past 3 years e. A minimum of 2,000 hours of practice in informatics nursing in the past 3 years, or a minimum of 12 semester hours of graduate credits in nursing informatics courses with at least 1,000 hours of practice in informatics nursing within the previous 3 years, or completion of a graduate program in nursing informatics that includes at least 200 hours of faculty supervised clinical practicum
AACN i
American Association of Colleges of Nursing organization that provides a voice for baccalaureate and higher-degree nursing education programs in the United States, providing curriculum elements and a framework for baccalaureate and higher-degree nursing programs
Nursing Administration
Automated staff scheduling • Online bidding for unfilled shifts • E-mail for improved communication • Cost analysis and finding trends for budget purposes • Quality assurance and outcomes analysis • Patient tracking and placement for case management
following competencies for the beginning nurse:
Basic computer literacy, including the ability to use basic desktop applications and electronic communication • The ability to use IT to support clinical and administrative processes, which presumes information literacy to support evidence-based practice • The ability to access data and perform documentation via computerized patient records • The ability to support patient safety initiatives via the use of IT • Recognition of the role of informatics in nursing
consumer applications may include:
Communication with healthcare providers via e-mail and instant messaging • Remote monitoring and other telehealth services • Support groups • Online scheduling
Nursing Research
Computerized literature searching • The adoption of standardized language related to nursing terms • The ability to find trends in aggregate data, which is data derived from large population groups • Use of the Internet for obtaining data collection tools and conducting research • Collaboration with other nurse researchers
benefits of automation are related to decision-support software and computer programs that organize information to aid in decision making include the following:
Decision-support tools as well as alerts and reminders notify the clinician of possible concerns or omissions. For example, the client states an allergy to penicillin, and this is documented in the computer system. The physician orders an antibiotic that is a variation of penicillin, and this order is entered into the computer system. An alert informs the clinician that a potential allergic reaction may result and asks for verification of the order. • With access to reference databases, nurses can easily review information on medications, diseases, and treatments as part of the automated system. • Effective data management and trend-finding include the ability to provide historical or current data reports. • Extensive financial information can be collected and analyzed for trends. Information related to cost by diagnosis and treatment can be more easily tracked using computer systems. For example, one can determine the least expensive drug that is effective for a particular diagnosis. • Data related to treatment such as inpatient length of stay and the lowest level of care provider required could be used to decrease costs.
Formal educational programs.
Early leaders in nursing informatics obtained their expertise through experience as well as classes in related areas such as computer science and information science. Grant monies from the Division of Nursing of the Health Resources and Services Administration (National Advisory Council on Nurse Education and Practice 1997) were used to establish the first two graduate programs in nursing informatics at the University of Maryland in 1988 and at the University of Utah in 1990.
Some specific benefits of electronic medical records include the following:
Improved access to information. The electronic medical record can be accessed from several different locations simultaneously, as well as by different levels of providers. • Error reduction and improved communication. Automation eliminates problems associated with illegible handwriting and provides a series of checks and balances. • Decreased redundancy of data entry. For example, allergies and vital signs need be entered only once. • Convenience. Diagnostic images are a part of the record and can be viewed from various locations. • Decreased time spent in medication administration and documentation. Automation facilitates efficient medication administration and allows direct entry from monitoring equipment, as well as point-of-care data entry. • Increased time for client care. More time is available for client care because less time is required for documentation and transcription of physician orders. • Facilitation of data collection for research. Electronically stored client records provide quick access to clinical data for a large number of clients. • Improved quality of documentation. Prompts help to ensure that key information is noted. • Improved compliance with regulatory requirements. Automated systems can require information needed for regulatory bodies, ensuring that it is included in documentation. • Improved record security. Access to the health record is limited to individuals with computer access. • Improved quality of care and patient satisfaction. Built-in tools remind nurses to provide interventions appropriate for certain patient problems. • Decreased administrative costs for location and maintenance of client records. • Creation of a lifetime clinical record facilitated by information systems.
Data gatherer.
In this role the nurse collects clinical data such as vital signs.
Data and information are collected when nurses record the following activities:
Initial client history and allergies • Initial and ongoing physical assessment • Vital signs such as blood pressure and temperature • Response to treatment • Client response and comprehension of educational activities
International Steering Committee of the Centre approved solutions for the following:
Look-alike, sound-alike medication names • Patient identification • Communication during patient handover • Correct procedure and body site • Electrolyte solution concentration control • Medication accuracy • Catheter and tubing misconnections • Needle reuse and injection device safety • Hand hygiene
Clinical health informatics.
Multidisciplinary field that focuses on the enhancement of clinical information management at the point of healthcare through improvement of information processes, implementation of clinical information systems, and the use and evaluation of CDS tools as a means to improve the effectiveness, quality, and value of the services rendered.
Knowledge builder.
Nurses display this role when they aggregate clinical data and show patterns across patients that serve to create new knowledge or can be interpreted within the context of existing nursing knowledge.
differentiated practice
Nursing informatics differs from other specialties within nursing because it focuses on data, information, and knowledge; the structure and use are the same; and efforts to guarantee that nursing information is represented in efforts to automate health information. It shares an interest in the client, the environment, health, and nurses in other areas of specialty practice.
Nursing Education
Online completion of mandatory education requirements • Online course registration and scheduling • Computerized student tracking, testing, and grade management • Course delivery and support for Web-based education • Remote access to library and Internet resources • Teleconferencing and Webcast capability • Presentation software for preparing slides and handouts • Online test administration • Communication with students
According to the AHRQ the PCMH is defined by the following attributes:
Patient-centered • Comprehensive • Coordinated care • Accessible • Subject to continuous improvement through a systems-based approach to quality and safety
Five of the six competencies defined in phase I of the project were recommended by the IOM for all healthcare professionals
Patient-centered care • Teamwork and collaboration • Evidence-based practice • Quality improvement • Safety • Informatics
experienced nurse competencies to include the following:
Proficiency in his or her area of specialization and the use of IT and computers to support that area of practice including quality improvement and other related activities (ANA 2008) • Knowledge representation methodologies for evidence-based practice • The ability to use information systems and work with informatics specialists to enact system improvements • Proficiency in using evidence-based databases • The promotion of innovative applications of technology in healthcare
The Informatics Nurse possesses the following skills
Proficiency with informatics applications to support all areas of nursing practice including quality improvement activities, research, project management, system design, development, analysis, implementation, support, maintenance, and evaluation • Fiscal management • Integration of multidisciplinary language/standards of practice • Skills in critical thinking, data management and processing, decision making, and system development, and computer skills • Identification and provision of data for decision making
Institute for Healthcare Improvement (IHI)-challenged U.S. hospitals to join in a campaign to save 100,000 lives during an 18-month period that commenced in 2005. the implementation of specific evidence-based and life-saving protocols that included:
Special Rapid Response Teams that were called at the first sign of patient decline • Evidence-based care for acute myocardial infarction • Medication reconciliation as a means to prevent adverse drug events (ADEs) • Steps to prevent central-line infections • Prophylactic use of perioperative antibiotics to prevent surgical site infections • Preventive measures against the development of ventilator-associated pneumonia
Defined research priorities.
Target areas for research were identified and published in the early 1990s. These centered primarily on the development of a standard language for use within nursing, which would allow nurses from different regions of a country or the world to establish that they were describing the same phenomenon and to conduct studies that could be replicated. In more recent years, survey results identified additional areas deemed critical for research, although the development of a standard nursing language remains crucial. The development of databases for clinical information is another priority area.
A credentialing process. .
The American Nurses Credentialing Center (ANCC 2001) used the foundation provided by the ANA in its 1994 definition of nursing informatics and scope and standards of practice
The HITECH Act provided additional funding for informatics education and training. These included:
The establishment of Regional Extension Centers to provide information and assistance to providers striving to become meaningful users of EHRs • Monies for institutions of higher education (or consortia) to support curriculum development in HIT • Efforts to create or expand intense, nondegree Community College programs designed to be completed in 6 months or less • A component of the Health IT Workforce Program designed to rapidly prepare persons to serve in designated HIT professional roles • The establishment and initial administration of a set of health IT competency examinations (ONC 2011)
Information user.
The nurse interprets and structures clinical data, such as a client's report of experienced pain, into information that can then be used to aid clinical decision making and patient monitoring over time. Quality assurance and infection control activities exemplify other ways in which nurses use information to detect patterns.
Representation by one or more organization(s).
This criterion is met because nursing informatics interests are represented by work groups within the AMIA and the IMIA, in a number of regional groups within the United States, and in national groups abroad. Table 1-4 displays some of these groups.
Knowledge user.
This role is seen when individual patient data are compared with existing nursing knowledge.
MSN graduates are expected to:
Use patient care technologies to deliver and enhance care • Use communication technologies to integrate and coordinate care • Analyze data to improve patient outcomes • Manage information for evidence-based care and patient education • Use and facilitate electronic health records (EHRs) to improve patient care
Nursing Practice
Worklists to remind staff of planned nursing interventions • Computer-generated client documentation including discharge instructions and medication information • Monitoring devices that record vital signs and other measurements directly into the client record • Computer-generated nursing care plans and critical pathways • Automatic billing for supplies or procedures with nursing documentation • Reminders and prompts that appear during documentation to ensure comprehensive charting • Quick access to computer-archived patient data from previous encounters • Online drug information
Technology Informatics Guiding Education Reform (TIGER) Initiative emerged from
a national gathering of leaders from nursing administration, practice, education, informatics, technology, and government, as well as other key stakeholders, who realized that nursing must transform itself as a profession to realize the benefits that electronic patient records can provide
informatics nurse specialist (INS).
advanced, graduate education in nursing informatics or a related field and may hold ANCC certification play an active role in research and theory development and in the design and testing of information systems and the human-computer interface; he or she also needs to help shape policy and serve as an advocate for the design and use of informatics to serve other healthcare professionals and the public responsibilities in administration, telehealth, education and professional development, compliance issues, and discovery in databases and analysis. prepared to assess work processes and subsequently design, select, implement, and evaluate data structures and suggested technology intended to improve productivity and contribute to the body of nursing knowledge.
Laboratory information systems
also connect to nursing systems. When a laboratory test is ordered and entered into the computer on the hospital unit, the information is transferred to the laboratory computer system
Medical informatics refers to the
application of informatics to all of the healthcare disciplines as well as to the practice of medicine.
Experienced Nurse
builds upon the competencies required for entry-level practitioners using basic computer skills to information regarding the patient
Data are a
collection of numbers, characters, or facts that are gathered according to some perceived need for analysis and possibly action at a later point in time
Decision-support software (DSS)
computer application that analyzes data and presents them in a fashion that facilitates decision making. incorporate lab values, standards of care, and other patient-specific informatio contains alerts that help to promote safety.
Scope and Standards of Nursing Informatics Practice (ANA 2001) noted that nursing informatics displays 5 of the 12 defining characteristics that must be present for a nursing specialty.
differentiated practice defined research priorities representation by one or more organizations formal educational programs credentialing process
International Council of Nurses Professional Organizations
federation of national nurses associations from more than 130 countries works to ensure quality nursing care for all through programs in three critical areas—practice, regulation, and social welfare extremely important for meaningful exchange of electronic data in a format that retains its meaning across settings and countries.
Entry-Level Core Competencies
focuses primarily on developing and using skills that rely upon the ability to retrieve and enter data in an electronic format that is relevant to patient care, the analysis and interpretation of information as part of planning care, the use of informatics applications designed for nursing practice, and the implementation of policies relevant to information.
Bioinformatics. T
he application of computer and IT to the management of biological information including the development of databases and algorithms to facilitate research.
purpose of TIGER
higher-quality patient care through the use of IT.
informatics nurse (IN)
individual has experience or an interest in the area but no formal informatics preparation. may work under a variety of different titles and in various settings employs strategies that transform data into information and information into knowledge and ensures that information is disseminated at appropriate times for appropriate uses in the healthcare continuum
Consumer health informatics. Study of
patient use of online information and communication to improve health outcomes and decisions.
E-Prescribing
lectronic transmission of drug prescriptions from a hospital-based inpatient ordering system (CPOE) or handheld device fewer errors, improved communication, greater efficiency, improved compliance with recommended treatment guidelines, lower costs, and less time to fill prescriptions
pharmacy information systems
make use of data collected by nursing information systems, such as current medications, allergies, client demographic information, and diagnosis.
The QSEN project (2014)
outlines recommended skills to ensure nurse competency in patient safety:
Informatics Nurse Specialist
possesses a sophisticated level of understanding and skills in information management and computer technology, demonstrating most of the competencies seen at the previous three levels. conduct informatics research and generate informatics theory.
patient-centered medical homes (PCMH) is a model of
primary care intended to improve coordination of care, provide better access to care, and improve patient satisfaction.
Computerized Physician (or Provider/Prescriber) Order Entry (CPOE)
process by which the physician or another healthcare provider, such as a nurse practitioner, physician's assistant, or physical or occupational therapist, directly enters orders for client care into a hospital information system
Joint Commission, formally known as the Joint Commission for Accreditation of Healthcare Organizations provides
provides accreditation of healthcare organizations and related services to ensure that safety and quality standards are met.
benefits of CPOE
reduction in transcription errors; a decrease in elapsed time from order to implementation; standardization and more completeness of orders; fewer medication errors; and the ability to incorporate CDS, alerts for critical lab values, and prompts when certain tests are due
Informatics is the
science and art of turning data into information.
Knowledge is the
synthesis of information derived from several sources to produce a single concept or idea. It is based on a logical process of analysis and provides order to thoughts and ideas and decreases uncertainty