Assignment: Use of Informatics in Professional Nursing
Hood (2014) stated “in professional nursing, informatics plays a critical role in how nurses access, enter, manage, and store key knowledge essential for professional practice and client care” (p. 380). Think about your workplace, the incorporation of information technology and how you use it on a daily basis plus the potential ethical issues surrounding data security and confidentiality. Answer the three questions below with your thoughts supported by the lesson OR assigned readings and a scholarly article. (minimum a full paragraph per question). APA citation and reference required; at least one internal citation/reference and one external. Assignment: Use of Informatics in Professional Nursing
For internal references and for information to support the discussion, see attached docs named:
Hood, L. J. (2014).docx and EVERYDAY INFORMATICS.pdf
- How do you use informatics and technology in your nursing practice? ( for details regarding my current nursing practice see attached doc named: my current position)
- How do you see that use changing in the future?
- What ethical issues have arisen or might arise from use of technology and informatics in professional nursing?
Reading Hood, L. J. (2014). Leddy & Pepper’s conceptual bases of professional nursing (8th ed.). Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams & Wilkins. Chapter 15: pp. 380–383 and 397–402 380 Section 2 The Changing Health Care Context Real-Life Reflections (Continued) computer systems and technology they use in practice. Susan poses the following questions during their discussion: “I know that computers are wonderful, but how can I get my older staff members to overcome their computer phobia? How can we ensure confidentiality of client information with computerized medical records? What key elements need to be included in an employee policy related to computer use and confidentiality of information? How much time is actually required of staff for computer documentation? What are the legal implications for nurses who use technology for remote client monitoring?” For optimal professional practice and client care, nurses must have well-refined computer skills. This chapter provides an overview of the informatics and technology used in today’s nursing practice and explores the implications for professional nurses as technology plays an increasingly important role in health care delivery. Key computer competencies for professional nursing and advances in technology for clinical practice are presented. Finally, the chapter challenges students to consider the advantages, dis- advantages, and ethical issues of technology use for client care. Changes in technology occur quickly. In fact, by the time this chapter is published, some of the information presented will likely already be obsolete. Faster, improved models of computer equipment seem to be introduced just as soon as the latest model has been purchased. New materials superior to silicon continue to make computer chips smaller and faster. In fact, purchasing a hard copy of any book (including this one) may one day be a rarity, especially with the proliferation of e-readers capable of storing hundreds of books. Every day, more and more nurses access, record, and store clinically relevant information via computer. InformatIcs and HealtHcare: The average person today has access to more information online than a single person could possibly comprehend in a lifetime. Information science deals with the discovery of “efficient collection, storage, and retrieval of information” (Agnes, 2005, p. 733)Assignment: Use of Informatics in Professional Nursing. Informatics, or the science of information (Agnes, 2005), has emerged as the practical application of organizing information for a specific purpose. Because of the wide array of information avail- able, devising effective methods for organizing and managing it is imperative. Essential information in one area of life may be irrelevant in another. For example, how informatics is used to generate, store, manage, and communicate information for computer gaming has little relevance to health care providers (unless a provider is working in the field of neuroscience and is studying the effects of computer gaming on memory). Take Note! In professional nursing, informatics plays a critical role in how nurses access, enter, manage, and store key knowledge essential for professional practice and client care. Informatics and Professional nursing Nurses use a variety of computers in daily clinical practice. Nurses document various aspects of client care using computers, thereby creating an electronic health record (EHR) for each client. An EHR stores client health information digitally in a secure database. When consumers receive care from an integrated health system, EHRs can be accessed nearly seamlessly. Section 1561 of the 2010 Affordable Care Act sets regulations for EHR use across the care continuum and for the security of the protected health information contained in them, and sets specific dates for regulation implementation (HealthIT.gov, 2010). In the future, all health care providers across the continuum of care will be able to access EHRs when consumers receive care services. Many people keep personal health records. Those who are computer savvy keep personal electronic health record (PEHR). PEHRs emerged when people entered their personal health information into their home computers. Today, a number of insurance companies and primary care provider practices offer software or online tools for consumers to develop and maintain. Some PEHRs are stored in secure electronic databases; others can be accessed using smart phones. Benefits of a PEHR include error reduction and seamless health care delivery. A PEHR enables a new care provider to access specific health information about a client, including diagnostic tests (including viewing digitalized radiographic films if the PEHR is linked to an integrated health care delivery system), accurate lists of currently prescribed medications, and up-to-date thirdparty payment information (Nelson, 2007). Unfortunately, there are no universal or standardized versions of EHRs or PEHRs. The American Health Information Management Association keeps records of progress toward standardization and policy development about electronic health information on its website. The “Putting Patients First” initiative from the National Health Council was the first to specify that health information to be “portable, belong to the patient, and empower the patient to make informed decisions regarding care” (Nelson, 2007, p. 27). The National Health Council also emphasized the importance of standardization of electronic platforms used for PEHRs so that when a person changes insurance coverage or health care providers there is no loss of health information. The Affordable Care Act has also set regulations defining criteria for standardization of PEHRs (HealthIT.gov, 2010). Currently, more than 60 software programs are available for PEHRs; some offer the ability of transfer of data between software programs. Hospitals, outpatient facilities, physician offices, and integrated health care systems currently purchase computer platforms and software for keeping client EHRs and some offer clients access to PEHR software programs. Some physician offices send annual reminders to clients to update PEHRs. Logue and Effken (2012) developed the Personal Health Records Adoption Model to explain why some people decide to use PEHRs. This model identifies four interactive factors that contribute to behavior required for PEHR adoption by health care consumers. 1. Personal factors encompass cognitive abilities, emotional attributes, and biologic characteristics that influence decisions for changing behaviors (intention to act and actual action). 2. Environmental factors include social and physical conditions that influence behavior. 3. Technology factors include resource avail- ability, compatibility, and cost; perceived usefulness; perceptions of external control; ability to observe and try the system; complexity; and relative advantage. 4. Chronic disease factors are separated from personal factors based on the belief that self- management of and chronic diseases them- selves create specific contexts and a variety of influencing factors, especially when people with chronic disease have specific care preferences, understand the complex nature of their disease, see multiple health care providers in various settings, engage in negotiated collaboration with health team members, and prefer to self-manage their condition. Before people adopt PEHRs, they need to have some ability to understand and use computer technology, perceive that PEHRs would be useful and advantageous, and have the time to enter and update personal health data. Nurses can assist clients directly by helping them enter data or indirectly by providing education, sup- port, and guidance as clients develop and maintain their PEHRs. Many nurses currently use computer tab- lets, smartphones, and other electronic devices with software or apps for managing daily tasks, keeping calendars, calculating medication dos- ages or complex clinical calculations (e.g., body mass index, corrected serum calcium levels), and consulting clinical references (e.g., medication information and terminology, disease references, medical calculation software programs). Some health care organizations issue unit cell phones to nurses for use in the clinical setting to facilitate staff communications. Most health care organizations provide convenient ways for nurses to access and document information in client EHRs, such as having computers in every room, providing mobile, laptop, or tablet computers, or placing computers in strategic locations throughout the work setting. computer and Informatics competencies for Professional nurses Computer use in health care delivery became prevalent in the early 21st century. In their pioneering efforts to determine professional nurse knowledge and skills in informatics, Staggers, Gassert and Curan (2001, 2002) conducted a Delphi study that serves as the basis for today’s competencies. The 2003 Institute of Medicine report, Health Professions Education: A Bridge to Quality, noted deficits in current education of all health professionals, including the following six core areas that needed vast improvement: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics (these are also the six key areas for Quality Safety Education for Nurses [QSEN] competencies). In 2004, President Bush issued a mandate that required all American health organizations providing direct client care to use EHRs by 2014. To meet this challenge, professional nurse leaders, educators, and informatics experts recognized the need to develop a vision for integrating informatics into practice, education, and research (Sherwood & Barnsteiner, 2012). In 2006, the Technology Information Guiding Education Reform (TIGER) Initiative established seven “pillars” or key areas for nursing workforce development: management and leadership, education, communication and collaboration, informatics design, information technology, policy, and culture. The final report resulted in the TIGER Nursing Informatics Competencies Model, which addresses the basic computer competencies, information literacy, and information management skills nurses need. Listed competencies from the model have become part of most baccalaureate and higher degree nursing pro- grams (TIGER Summit, 2007). In 2008, the American Association of Colleges of Nursing (AACN) revised its criteria for program accreditation to include informatics competences. The current AACN recommendations for professional nurse generalists outline the following informatics skills that nurses are expected to have. • Use information and communication technology to document and evaluate patient care, advance patient education, and enhance the accessibility of care. • Use appropriate technologies in the process of assessing and monitoring patients. • Work in an interdisciplinary team to make ethical decisions regarding the application of technologies and the acquisition of data. • Adapt the use of technologies to meet patient needs. •Teach patients about health care technologies. • Protect the safety and privacy of patients in relation to the use of health care and information technologies. • Use information technologies to enhance one’s own knowledge base. In 2009, QSEN established specific knowledge, skills, and attitudes for all professional nurses to achieve to display competency in nursing informatics (and in the aforementioned key areas). The experienced nurse must be able to use applications for diagnostic coding, evaluate computer-assisted instruction as a teaching method, and integrate selected resources into a client file. The experienced professional should also be able to define how computerized information affects the nurse’s role, assess the accuracy of health information posted on the internet, and serve as an advocate for client system users. Box 15.1, Professional Building Blocks “Check- list for Professional Nurse Competencies in the Use of Technology and Informatics” provides a tool for nurses to verify their level of competence with informatics and technology for general clinical practice. Nurses who specialize in nursing informatics have additional advanced competencies such as developing backup systems in the event of a computer systems failure, designing software programs applicable to clinical care settings, and troubleshooting software and computer system problems as they arise. EVERYDAY INFORMATICS Why Nurses Need to Understand Nursing Informatics DEE McGONIGLE, PhD, RN, CNE, FAAN, ANEF; KATHY HUNTER, PhD, RN-BC, CNE; CAROLYN SIPES, PhD, RN-BC, CNS, APN, PMP; TONI HEBDA, PhD, RN-BC, MSIS, CNE N ursing informatics is an exciting nursing specialtydit affects learning environments, meaningful use, interprofessional collaboration, patient care settings, strategic planning, patient satisfaction, and, ultimately, patient outcomes. Simply put, nursing informatics is the practice of using nursing science and technology to enhance the pathway that data take to become knowledge to improve patient care. Furthermore, nursing informatics “is the synthesis of nursing science, information science, computer science, and cognitive science for the purpose of managing and enhancing health care data, information, knowledge, and wisdom to improve patient care and the nursing profession.”1(p90)Assignment: Use of Informatics in Professional Nursing According to Hebda and Czar, it 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. The definition of nursing informatics is evolving as advances occur in nursing practice and technology.”2(p6) Nursing informatics is important to all nursing specialty areas. It is important for nurses to understand the relevance of nursing informatics to their practice. In clinical practice, for example, nursing informatics can be used to track patient outcomes, find data trends, and assess workload and interventions. It also can help develop technologies, such as apps, to help health care workers virtually monitor and stay in touch with patients, improve workflows, and help patients deal with their diseases. The use of nursing informatics in nursing education supports virtual teaching and learning, assessment, analytics associated with educational outcomes, and the paradigm shift of bringing the library to the student virtually. Nurse executives use nursing informatics to help them with cost containment, improved workflows, decision support, budgeting tools, and trending costs and savings. Nursing informatics also can facilitate and support nursing research by evaluating patient outcomes, evidence-based practice, standardized terminologies, and virtual knowledge bases. As nurses learn nursing informatics, they must learn to use all information technologies effectively, recognize the benefits and limitations of this technology, and integrate them into how they implement these technologies. In this era of large amounts of data, nursing informatics competencies are key to safe, efficient, and quality practice, and good use of nursing informatics can result in enhanced patient care outcomes. THE DATA, INFORMATION, KNOWLEDGE, AND WISDOM PATHWAY The principles and practices of nursing informatics allow nurses to understand the process they use to convert raw data into the wisdom they need to care for patients. This process is called the data, information, knowledge, and wisdom pathway. The data, information, knowledge, and wisdom http://dx.doi.org/10.1016/j.aorn.2014.06.012 324 j AORN Journal September 2014 Vol 100 No 3 Ó AORN, Inc, 2014 EVERYDAY INFORMATICS www.aornjournal.org are not synonymous, because knowledge includes pathway is used in all levels of nursing practice. As others’ thoughts and information, whereas wisdom nurses access data and process it into information is focused on one’s own mind and the synthesis of and knowledge, they build the wisdom necessary one’s own experience, insight, intuition, underto positively affect the lives of their patients. standing, and knowledge. Wisdom could be Nursing informatics provides the tools and capathought of as the foundation of the art of nursing. bilities necessary to enrich the data, information, knowledge, and wisdom pathway and, therefore, literally puts the information and knowledge nurses PERSONAL IMPORTANCE need at their fingertips. The focus of this new “Everyday Informatics” The pathway begins with data. Data are raw column is to help nurses understand and implement facts that do not have meaning without context. the concepts of nursing informatics and optimize After data have been processed to have meaning, patient care by using health care technology. Exthey become information. For information to be amples of concepts and topics that will fit within valuable, it must be accessible, accurate, timely, this column include electronic health records (EHR) complete, cost effective, flexible, reliable, relevant, personal health records, electronic access to simple, verifiable, care (eg, telehealth), and secure. terminologies and The next step is taxonomies (eg, the Nursing informatics provides the tools and for information to capabilities necessary to enrich the data, Perioperative Nursing information, knowledge, and wisdom pathway become knowledge, Data Set3 language), and, therefore, literally puts the information which is information virtual environments, and knowledge nurses need at their fingertips. that the user can relate social networking and to other information professional boundand can apply to a task aries, simulation, or use to reach an informed decision. As nurses robotics, databases and database management, acquire important knowledge and skills and hone analytics, dashboards and benchmarking, accessitheir ability to observe patients and their environbility, privacy, meaningful use, and optimization. ments (ie, acquiring more data), they learn to place Innovative ideas and questions of how perioperatheir observations in proper contexts to generate tive nurses embrace the rapid advancement of information. As their knowledge grows, nurses technology and retain the art of the practice at can assess the information they have acquired, the same time generates content for this column. communicate applicable findings, and take approThe team members who will be writing this priate actions based on these assessments. Nursing column with me are Kathy Hunter, Toni Hebda, informatics informs and supports these activities. and Carolyn Sipes. I asked them each to say why Wisdom, the final step on the pathway, is the they believe nursing informatics is important. Their application of knowledge to appropriate situations responses are included here. by using insight or intuition while being thoughtful, judicious, and practical. Nurses need to apply their Monitoring Patients knowledge to patients’ situations and rely on their Kathy Hunter: Years ago, when I was working knowledge, integrated with evidence-based practice, full time nights in the Maryland Shock-Trauma to enhance patient care. Wisdom uses knowledge Unit, we had computer display units in every paand experience to heighten common sense, pertient cubicle that were connected to patient moniceptions, and the ability to think critically and use toring equipment. Laboratory data were provided sound clinical judgment. Knowledge and wisdom directly from the trauma laboratory. Vital signs AORN Journal j 325 September 2014 Vol 100 No 3 EVERYDAY INFORMATICS work. Today, the informaticist functions in the role data were collected from the monitors. Critical of a facilitator for information technology and parameters could be automatically calculated or clinical staff members as well as performs many requested as needed. Any parameters one wanted other roles. On some projects, informaticists might could be graphed in combination on demand. There work as analysts, or work to interpret and assist also were programs for collecting nursing data (ie, with a workflow design and implementation, or assessments). This system was pretty primitive collect and analyze data that might be used in a compared with those available today, but even then manager’s monthly dashboard report. They provide I could see the value of having the collected data shoulder-to-shoulder support for clinical staff displayed across timedwatching trends was a big members during the go-live phase of the implepart of nurses’ ongoing monitoring. Entering the mentation. The role data was worth the for the informaticist effort because the is expanding even information we reInformaticists provide shoulder-to-shoulder further as organizaceived helped keeping support for clinical staff members during the go-live phase of electronic health record tions recognize the up with patients’ often value a nurse inforrapid physical changes. implementation. maticist can bring. It was this realization An example that that first got me inemphasizes the value of an EHR and role of the volved in what is now called informatics. nurse informaticist was when both the Cleveland Clinic and a competitor were implementing the Implementing EHRs same EHR system. A patient had tests and radioCarolyn Sipes: During the past 11 years, I have graphs performed at one facility, and a physician worked as a consultant with several health systems, told me how he had cancelled tests and radiographs both nationally and internationally. Even today, I see he had ordered for the patient because the tests the same issues arise with EHR implementation had already been run at the competing hospital. regardless of whether they are large or small imWorking with the nurse informaticist who faciliplementations, or whether they are national or intertated the communication between the two hospinational implementations. The one consistent theme tals, he said he trusted their results and would use throughout all of these implementations is the lack of those instead. The philosophy of using a national communication and understanding between what EHR system and adding the skills of a nurse ininformation technology department personnel think formaticist who understands the functions of both should be implemented for clinical staff members has saved many health care dollars. versus what the nurses and other clinical staff members really need to complete their day-to-day tasks. Supporting Nurses’ Work Health systems are becoming better at recognizing the Toni Hebda: Nurse informatics supports the work need and value of the nurse informaticist who can that nurses do. It allows quick access to information facilitate the process and communication between the when and where it is needed by the people who two specialties. need it to facilitate the delivery of safe, effective In the past, and even today, one of the key risks patient care, support administrative decisions, and for project failure in an EHR implementation is enhance the education of nursing students, health when it is the sole responsibility of the information care consumers, and the public through the use of technology department to design a system for well-designed and well-used technology. Nurse clinical users without their input into what is informatics provides the tools to make nursing required for them to successfully complete their 326 j AORN Journal EVERYDAY INFORMATICS contributions to health care delivery visible, support research, and allow virtual real-time decision making through the use of analytics, which is a method that allows the discovery and communication of meaningful patterns in large unorganized data sets. Nursing informatics is an exciting area of specialization that focuses on working smarter, not harder. Editor’s note: The second edition of the Perioperative Nursing Data Set (PNDS) was superseded by the third edition (PNDS 3) in 2011. The PNDS 3 terminology is only distributed through AORN and AORN SyntegrityÒ licensed vendors. For questions about PNDS 3 implementation into the EHR and electronic perioperative record solutions, please contact the AORN Syntegrity team via e-mail at firstname.lastname@example.org. AORN Syntegrity is a registered trademark of AORN, Inc, Denver, CO. References 1. McGonigle D, Mastrian K. Nursing Informatics and the Foundation of Knowledge. 3rd ed. Burlington, MA: Jones & Bartlett; 2015. 2. Hebda TL, Czar P. Handbook of Informatics for Nurses & Healthcare Professionals. 5th ed. Upper Saddle River, NJ: Prentice Hall; 2013. 3. Petersen C, ed. Perioperative Nursing Data Set. 3rd ed. Denver, CO: AORN, Inc; 2011. www.aornjournal.org Dee McGonigle, PhD, RN, CNE, FAAN, ANEF, is the chair of virtual learning environments and professor of graduate programs at Chamberlain College of Nursing, Columbus, OH. Dr McGonigle has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Kathy Hunter, PhD, RN-BC, CNE, is the dean, MSN Indirect Care Tracks, Chamberlain College of Nursing, Columbus, OH. Dr Hunter has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Carolyn Sipes, PhD, RN-BC, CNS, APN, PMP, is an associate professor, MSN Program Online, Chamberlain College of Nursing, Columbus, OH. Dr Sipes has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Toni Hebda, PhD, RN-BC, MSIS, CNE, is a professor, MSN Program Online, Chamberlain College of Nursing, Columbus, OH. Dr Hebda has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. AORN Journal j 327 Copyright of AORN Journal is the property of Elsevier Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. Hello everyone, Many problems emerge when introducing evidence and clinical strategies into daily practice and the health insurance field is not excluded. Even though there is no direct or bedside care in the insurance industry, it is a challenge for many nurses practicing in this field as we are constantly dealing with medical necessity. I am currently working at UM department of a private healthcare organization and based on my experience you have to go the extra mile sometimes to make sure you are advocating for the members. Utilization Management ensures that health plan’s members receive the right care at the right time to increase clinical outcomes and lower costs. UM’s goal is not predestined to merely limit or restrict care, but to guarantee that appropriate care is provided to the patients. Stricker,P. (2012,Febuary). This position is also challenging at times because we are not providing direct care and we are making decisions based on assessments and evaluations performed by another healthcare provider that sometimes are vague or do not cover all required aspects. Other challenges are poor medical history documentation or poor communication with the facility or doctor’s office requesting the services. For example, the nurse received a request for a PET scan and when running criteria, the request is not meeting the need to approve the service. At this point, the nurse must make sure that the criteria was run correctly based on the clinical information provided by the requesting provider and if not meeting due to lack of clinical information , every effort must be made to make sure the provider is aware and this information is submitted in a timely matter to prevent a denial . Also, there are cases where the criteria is not met but there is substantial clinical information that the clinical reviewer must include in the denial referral to the medical director of the healthcare organization for approval consideration. Evidence-based, decision support criteria from Milliman, InterQual and others are a crucial part of any UM program by providing unbiased criteria to help decide the right care. Stricker,P. (2012,Febuary)Assignment: Use of Informatics in Professional Nursing .Even though multiple clinical software have developed to assist in this process, the result is not always correct. The critical thinking and clinical background of the nurse take a colossal part at this point. Nurses, as other healthcare practitioners, adhere to the use of numerous forms of evidence that aid them guide their actions, including research. From previous years, several advances have been made involving scientific evidence in clinical practice to improve patient’s care. (Hood, L. J. 2014). Utilization management is a pretty new model or setting in comparison with other healthcare scenarios, and the department is constantly revising and implementing evidence best practices to overcome barriers at the time of making a case determination. One example is having interdisciplinary meetings to revise difficult cases and create tools to promote positive clinical results. Peer to Peer Review is another process that has been established to discuss the case between doctors and nurses when the information submitted is insufficient or in complex cases. Hello everyone, “Quality in health care means different things depending on individual perspectives”. (Hood,L. J 2014). Nurses are constantly fomenting patient safety and care quality through our daily activities and encounters with patients and other healthcare professionals. Health plan utilization review nurses have fewer chances than nurses working at the hospital or clinic to directly affect the quality of patient care because they do not have direct contact with the patient. Nevertheless, this does not indicate that utilization review nurse cannot be a positive influence; they could be a channel of information and support patient care coordination. Working at a health plan as a utilization review nurse, some of our functions are to pre-certify patients for medically necessary procedures or hospital admission. We are promoting patient safety and improving quality by making these recommendations based on reviews of medical records, talking to patients and providers, and as much additional research as needed. To get this accomplished, we must follow established protocols to determine if patients meet the criteria for insurance reimbursement. Other utilization review nurses work in hospitals, nursing homes and clinical settings where they manage patient care through daily case reviews and create discharge plans that help patients transition smoothly and safely to their homes or other facilities. Through regular reviews and audits, we ensure that patients receive the care they need without burdening the health care system with unnecessary procedures, ineffective treatments or overlong hospital stays. Utilization review nurses also help insured persons to make informed decisions about their health care by educating them on the benefits and limitations of their Medicare, Medicaid or private health care coverage. At my current role, for potential quality of care issues or critical incidents, the nurse will discuss the issue with the supervisor and submit a report via email to a designated mailbox. Examples of issues that warrant further investigation and should be reported are: patient that fell while inpatient; patient prematurely discharged from the hospital; patient that suffer a complication from surgery or a hospital stay and any other the nurse perceive that care received was not appropriate. I would suggest having more training available to keep nurses up to day with recently implemented processes and daily distribution and reinforcement of workflow to follow in different situations. I had discussed these ideas with my manager along with information supporting these needs. We have an open door policy in our department and all suggestions to promote patient safety and care quality are discussed and elevated for developing subsequent strategies for improvement that across departments.
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Assignment: Use of Informatics in Professional Nursing