Nursing Informatics Overview Mari Tietze, PhD, RN-BC, Texas Women's University School of Nursing

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1 Nursing Informatics Overview Mari Tietze, PhD, RN-BC, Texas Women's University School of Nursing ONCHIT update (REC initiatives, State HIE Medicaid) Susan McBride, PhD, RN, Texas Tech Health Science Center The Role of the CNIO Marybeth Mitchell, MSN, RN-BC, Texas Health Resources 1

2 Discuss the role of nursing informatics in deployment of safe and effective health information technology. Identify ways that nurses contribute to the meaningful use of electronic health records. Create an organization-specific nursing informatics expansion strategy based on the proposed state-wide approach. 2

3 April 24, 2010, TNA House of Delegates (HOD) adopted a resolution that TNA will promote the TIGER vision of nursing s use of informatics technology Technology Informatics Guiding Education Reform Initiative of nurse stakeholders [providers, employers, payers, vendors] formed 2006 TIGER Summit convened, developed action steps for realizing the nation s 10-year goal of electronic health records for citizens (Bush, 2004) 3

4 RESOLVED, that the Texas Nurses Association will Promote the TIGER vision of nursing s use of informatics technology Actively participate in the planning, development and implementation of IT for the state of Texas Work with other organizations to benchmark reports toward progress* * TNA. (2010). Resolution on Technology Informatics. Texas Nursing; 84 (2), 7. 4

5 Charge: Determine implications of health care informatics for nursing practice and education in Texas Charge Include nationally-based Technology Informatics Guiding Education Reform (TIGER) initiative 5

6 Composed of TNA and TONE Member from practice and academia Task Force Members Robert Middleton, Co-Chair Mari Tietze, Co-Chair Nancy Crider Mary Gotcher Susan McBride Mary Beth Mitchell Elizabeth Sjoberg TNA Clair Jordan Joyce Cunningham Cindy Zolnierek 6

7 IOM Report, Crossing the Chasm, 1999 The Future of Nursing: Leading Change, Advancing Health, 2010 ONC HITECH Act for EHR Implementatio n Incentives, 2009 ANA Standards of Nursing Practice Nursing Informatics, 2009 Leap Frog organization calling for a national databank of technologyrelated errors/near misses TIGER 3-Year Action Steps, 2007 TNA HOD Healthcare Reform increasing the distribution of care delivery Resolution on Technology Informatics,

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11 Nursing informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and the expansion of nursing knowledge (Graves & Corcoran, ANA). *American Nurses Credentialing Center certification available Saba and McCormick (2006). Essentials of Nursing Informatics, 4 th Ed., p. 184 and 4. 11

12 Medical informatics represents the way that computer science, information science and health care merge together to work toward optimization of the medical system. Health informatics is the study of how technology, particularly artificial intelligence, computer science, and informational science relates to the medical field. This field of study is typically applied to clinical care, nursing, public health, and biomedical research. EHR certified specialist (AHIMA, ONC HIT specified curriculum) 12

13 Nursing informatics uses technology to enhance patient care and nursing practice. Nursing informatics is a narrower, specialized field inside of the wider medical informatics. Nursing informatics represents the way that nurses utilize technology in their daily duties. Technologies, including tablet computers and mobile devices, can help nurses keep up with what they need. Integrated systems allow nurses to make notes that everyone can access, meaning that each change of shift runs smoothly, and time isn t taken up with trying to convey information. All nurses have the information immediately. Nursing informatics can also help with dosing instructions, staff assignments, and lab results. The idea is that technology and information should be easily accessible to nurses so that they can do a better job of caring for their patients. 13

14 Role in EHR Point of Care Technology Nursing Role Data Management & Analytics Nursing Role Improved Healthcare Nursing Role Patient Safety & Quality Copyright: Tietze/McBride 14

15 Clinical Point Of Care Repository Outcomes Measurement EMR Build from right to left Standards Taxonomies Use Cases 15

16 EHR systems, touted to improve efficiency and quality of health care delivery, may also be a source of patient errors (Langreth, 2009). In at least one case, faulty data transfer of one EHR system was suggested to be a contributing factor to the deaths of pediatric patients transferred into the hospital and the associated EHR system in question (Hans et al., 2005). In the study, a national sample of sixty-two hospitals voluntarily used a simulation tool designed to assess how well safety decision support worked when applied to medication orders in computerized order entry. The simulation detected 53 percent of the medication orders that would have resulted in fatalities and percent of the test orders that would have caused serious adverse drug events. Under-detection of errors in a computerized order entry system may negatively impact patient safety because the false sense of security, common in use of computerized systems. Source: HIT-could-negatively-affect-patients.html 16

17 EHR implementation is generally based on the assumption that they will improve care delivery. Many experts, however, believe that too many systems are being installed too fast into environments too complex to be easily computerized. In the frenzy to be eligible for federal EHR meaningful use incentive payments, and avoid reimbursement penalties starting in 2015, institutions may be setting themselves up for disastrous computer-induced medical errors (Gardner, 2010). 17

18 EHR-induced medical errors can occur for reason such as: 1. interfaces that do not transfer complete data from one system to another, or from medical devices to the EHR 2. lack of coordination among different systems (e.g. emergency department systems that hold different sets of orders from the same patient 3. not enough data on a single screen (e.g., space for only five medications at a time when the common patient may be on 15) 4. inconsistent nomenclature between system (e.g.,, calling drugs or diagnoses by different names in different systems) Wrong patient errors is the most common and most worrisome. One organization solved this by putting the patient s picture in the record and allowing the computers in the patient rooms to only show the records associated with the patients registered to that room (Gardner, 2010). 18

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21 Creation of educational content and dissemination Campaign to Raise Awareness HIT CNE for practicing nurses Nursing HIT curriculum development Constituent involvement [incl. TIGER] Benchmarking Reports Towards Progress Formation of Advisory Structure 21

22 Take the first step in faith. You don't have to see the whole staircase, just take the first step. Martin Luther King, Jr. Mari Tietze, PhD, RN-BC, FHIMSS 22