Workforce Development: The Future of Nursing Informatics

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1 Workforce Development: The Future of Nursing Informatics Susan Brown, MSN, FNP-BC, CPHIMS Director, Clinical Informatics, CVS Health Dan Feinberg, MBA,Director, Graduate Health Informatics Program, Northeastern University DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 OBJECTIVES Describe the current Nursing Informatics workforce. Discuss issues identified by healthcare leaders as aligned with the Nursing Informatics discipline. Identify Nursing Informatics professional development needs and opportunities.

3 Session Format 1. Presentation 2. Interactive discussion

4 Nursing Informatics (ANA, 2014) Integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom Supports nurses, consumers, patients, interprofessional healthcare team in decisionmaking Improves health of populations, communities, groups, families, and individuals

5 ANA Tenets of Nursing Informatics Unique body of knowledge, preparation & experience Synthesis of data and information into knowledge and wisdom Collaboration is an integral characteristic Incorporates key ethical concerns advocacy, privacy, and confidentiality security of data and information

6 ANA Tenets of Nursing Informatics Supports decision-making to achieve healthcare consumer safety and advocacy Considers impact of technological changes on patient safety, healthcare delivery, quality reporting, and the nursing process Leads in the design and promotion of useful, innovative information technologies

7 ANA Tenets of Nursing Informatics Supports data analytics to improve population health outcomes and global health Promotes data integrity and the access and exchange of health data for all consumers Supports agenda on interoperability Interleaves user experience and computer-human interaction concepts

8 Functional Areas of NI (ANA 2014) Administration, leadership, and management Compliance and integrity management Consultation Coordination, facilitation, and integration Development of systems, products, and resources Educational and professional development Genetics and genomics Information management/operational architecture Policy development and advocacy Quality and performance improvement Research and evaluation Safety, security, and environmental health Systems analysis and design

9 Nursing Informatics WORKFORCE

10 NI Workforce Data Sources National Workforce Survey of Registered Nurses National Council of State Boards of Nursing (NCSBN) Forum of State Nursing Workforce Centers Nursing Informatics Workforce Survey Health Information and Management Systems Society (HIMSS) Impact of the Informatics Nurse Survey HIMSS

11 National Workforce of RNs Budden JS, Zhong EH, Moulton P, Cimiotti, JP. (2013). Highlights of the national workforce of registered nurses. Journal of Nursing Regulation, 4(2): 5-14.

12 Standard Occupational Classification US Dept Of Labor Bureau of Labor Statistics, 2010 Standard Occupational Classifications (SOC) for healthcare and related industries lack codes associated with health informatics occupation:

13 Practitioner Job Titles Not Represented Bioinformatics Specialist/Analyst Clinical Informatics Specialist/Analyst Clinical Applications Specialist/Coordinator Health Data Analyst/Specialist Health Informatics Specialist Informatics Analyst/Specialist/Coordinator Terminology Specialist Nursing Informaticist/Informatician Physician Informaticist/Informatician Pharmacy Informaticist/Informatician Laboratory Informaticist/Informatician Imaging Informaticist/Informatician Public Health Informatics Specialist

14 Leadership Job Titles Not Represented Bioinformatics Advisor Chief Medical Information Officer Chief Public Health Informatics Officer Chief Nursing Information Officer Chief Health Information Officer Clinical Informatics Director Clinical Information Systems Director Director Clinical Information Services Health Informatics Researchers/Scientists Professor Health/Clinical Informatics

15 Standard Occupational Classification: Health Informatics Practitioner Proposal Collaborative: Alliance of Nursing Informatics (ANI) American Health Information Management Association (AHIMA) American Medical Informatics Association (AMIA) Cuyahoga Community College (TRI-C) Center for Disease Control and Prevention (CDC) College of Healthcare Information Management Executives (CHIME) Commission on Accreditation for Health Informatics and Information Mgmt Ed (CAHIIM) Commission on Certification for Health Informatics and Information Management (CCHIIM) Health Information and Management Systems Society (HIMSS) Minnesota Department of Health / Minnesota e-health Initiative (MDH) Oregon Health and Science University (OHSU) University of Colorado Denver Anschutz Medical Campus (CU) University of Minnesota Institute for Health Informatics (U of M) University of Pittsburgh Dept of HIM, School of Health and Rehabilitation Sciences (Pitt) University of Texas School of Biomedical Informatics at Houston (UTH) Department of Veterans Administrations, Health Informatics Department (VHA)

16 HIMSS

17 Job Responsibilities Systems Implementation System Optimization/Utilization Systems Development Clinical Analytics Quality Initiatives/Reporting Informatics Education Liaison/Communicator Regulatory Initiatives n/a n/a n/a n/a n/a n/a 15% 16% 22% 21% 22% 23% 22% 23% 29% 31% 32% 43% 45% 39% 38% 41% 53% 57% Selection options expanded for 2014 survey 2014 Results 2011 Results 2007 Results

18 HIMSS

19 Post-Graduate Nursing Education 2004 Compared to 2014 Masters in Nursing 31% 41% Other Masters 14% 18% PhD in Nursing 2% 3% Other PhD 1% 1% 2014 Results 2004 Results

20 Prior Informatics Education/Training On-the-Job Training 15% 58% Masters/PhD 21% 28% Program/Course 0% 26% Certificate 15% 19% Bachelors 1% 3% 2014 Results 2011 Results Survey question was revised in 2011 and not comparable to 2007 survey

21 Current Informatics Education/Training On-the-Job Training 23% 26% Masters/PhD 9% 11% Certificate 5% 7% Program/Course n/a 4% Bachelors 1% 1% 2014 Results 2011 Results Survey question was revised in 2011 and not comparable to 2007 survey

22 Certification Held ANCC 19% 23% 23% CPHIMS 3% 4% 6% Other Nursing Specialty 9% 17% 20% None 52% 55% 55% 2014 Results 2011 Results 2007 Results

23 Nursing Informatics Certification Pursuing ANCC 35% 37% CPHIMS 18% 17% PMP 3% 6% Other Nursing Specialty CAHIMS n/a n/a 4% 5% None 43% 42% 2014 Results 2011 Results Survey question was revised in 2011 and not comparable to 2007 survey

24 Top Barrier to Success as Nurse Informaticist Past 10 Years Lack of Administrative Support Lack of Staffing Resources Lack of Financial Resources Organizational Strategic Plan User Acceptance Software Architecture/Design Infrastructure Regulations 1% 2% 6% 6% 7% 7% 7% 9% 12% 12% 12% 14% 17% 16% 18% 16% 2014 Results 2004 Results Percent of respondents who rated option as the top/largest barrier for select responses appearing in both years

25 Sources of Information for Day-to-Day Activities Networking with Peers Websites Electronic Journals Association Newsletters List Serves Print Journals Internal Help Desk Blogs Social Networking Books ebooks n/a n/a n/a n/a n/a n/a n/a 23% 21% 31% 20% 27% 18% 16% 17% 17% 37% 50% 46% 55% 56% 44% 56% 59% 43% 58% 70% 69% 70% 73% 75% 68% 84% Selection options expanded for 2014 survey 2014 Results 2011 Results 2007 Results

26 Impact of the Informatics Nurse Survey (HIMSS 2015)

27 Applications Installed at Respondents Organizations Top 10 Electronic Medication Administration Record (emar) EMR/EHR Nursing Clinical Documentation Ancillary Billing/Financial Management CPOE 92% 91% 91% 91% 90% 90% Clinical Information Systems Bar Coded Medication Management PACS 85% 85% 85% Non-Nursing Clinical Documentation 82% Which applications are currently installed at your organization?

28 Applications Being Installed at Respondents Organizations Top 10 Health Information Exchange Mobile Applications 27% 26% Medical Device Integration 23% Voice Recognition Electronic Prescribing Remote Monitoring/Telehealth Immunization Information Systems Point of Care Clinical Decision Support Quality Improvement Personal Health Record 20% 18% 18% 17% 15% 14% 14% Which applications are currently installed at your organization?

29 Impact of Informatics Positions on Quality of Care High Impact 60% Medium Impact 32% Low Impact 6% Don't Know 2% In general, what impact do informatics nurses have on the quality of care that patients receive at your organization?

30 Areas Where Informatics Nurses Bring a High Degree of Value Implementation 85% Optimization 83% Analysis 75% Design 73% Selection 50% Identify the overall value that informatics nurses bring to the following with regard to clinical systems.

31 Areas Where Informatics Nurses Bring a High Degree of Value Workflow Patient Safety User Acceptance Design/Configuration Compliance with Policies/Regulations Accuracy of Documentation Definition of Alerts/Reminders Screenflow Completeness of Documentation Quality Outcomes Reduction of Never Events Reporting Integration/Interface with Other Systems 80% 76% 75% 71% 70% 67% 67% 66% 65% 64% 61% 57% 51% Identify the level of impact that having informatics nurses involved in the analysis, design, optimization, implementation and selection process had on each of the areas below.

32 Informatics Nurses and Emerging Technologies Medical Device Integration 70% Smart Devices Personalized Healthcare 49% 53% Remote Monitoring Data Warehousing Voice Recognition Predictive Modeling 33% 29% 27% 22% Other 5% In which of the below areas do informatics nurses play a role with regard to emerging technologies?

33 Trends Rapidly evolving technology Changing practice roles in nursing Regulatory changes and quality standards that include healthcare consumers as partners Care delivery models and innovation Increasing informatics competency requirements for all nurses

34 Nursing Informatics Competencies

35 Competency Identification American Association of Colleges of Nursing (AACN) American Nurses Association (ANA) American Organization of Nurse Executives (AONE) Health Information and Management Systems Society (HIMSS) Technology Informatics Guiding Education Reform (TIGER) National Council of State Boards of Nursing (NCSBN)

36 AACN: Informatics Competencies BSN Information Management and Application of Patient Care Technology Graduate Informatics and Healthcare Technologies Doctoral Clinical Scholarship and Analytical Methods for Evidence-Based Practice

37 ANA NI Standards: 1. Assessment 2. Diagnosis, Problems, and Issues Identification 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation 7. Ethics 8. Education 9. Evidence-Based Practice and Research 10. Quality of Practice 11. Communication 12. Leadership 13. Collaboration 14. Professional Practice Evaluation 15. Resource Utilization 16. Environmental Health

38 AONE (2012) Nursing Informatics Executive Leader Leadership Education and Credentialing Governance and Reporting Structures

39 HIMSS Nursing Informatics Position Paper Summer 2015

40 TIGER: Informatics Competencies (2009) Basic computer competencies Information literacy Information management

41

42 NCSBN Transition to Practice (TTP) preceptor model Communication and teamwork Patient-centered care Evidence-based practice Quality improvement Informatics

43 NI Workforce & Competencies Key responsibilities: Systems implementation / optimization / utilization / development Top installations: emar, EHR, CPOE, HIE, mobile apps, device integration Primary source of education / training: On-the-job Major sources of information, day-to-day: Peers Web Barriers to success: Lack of admin support, staffing & financial resources

44 Interactive Discussion

45 RESOURCES American Nurses Association (2014). Nursing Informatics: Scope and Standards of Practice, 2 nd ed. ANA: Silver Spring, MD. American Organization of Nurse Executives (AONE). (2012). Position Paper: Nursing informatics executive leader. Budden JS, Zhong EH, Moulton P, Cimiotti, JP. (2013). Highlights of the national workforce of registered nurses. Journal of Nursing Regulation, 4(2): Hill T, McGonigle D, Hunter KM, Sipes C, Hebda TL. (2014). An instrument for assessing advanced nursing informatics competencies. Journal of Nursing Education and Practice, 4(7): Health Information and Management Systems Society (HIMSS). (2015). Nursing Informatics Workforce Survey, Institute of Medicine (IOM). (2010). The future of nursing: Leading change, advancing health. National Academies Press: Washington DC. Technology Informatics Guiding Education Reform (TIGER). (ND.) The TIGER Initiative. Informatics competencies for every practicing nurse: Recommendations from the TIGER Collaborative. National Council of State Boards of Nursing (NCSBN). (ND). Transition to Practice.

46 Susan Brown, MSN, FNP-BC, CPHIMS Dan Feinberg, MBA

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