Informatics for Advance Practice Nurses: Is There Meaning Beyond Clicking?

Transcription

1 Informatics for Advance Practice Nurses: Is There Meaning Beyond Clicking? 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 Conflict of Interest Disclosure Janet Mar, FNP-BC, ACNP-BC, MSN, BSN,RN Has no real or apparent conflicts of interest to report HIMSS 2

3 Learning Objectives 1.Describe findings of a study of advance practice nurses and meaningful use 2.Describe EHR features used in effective practice management to improve patient outcomes 3.Describe the development of a module on meaningful use for advance practice nurses 3

4 The Journey 4

5 Improve transition of care Increase focus on preventive care Reduce medication errors Avoid duplication of services Reduce hospital readmission EHR Decrease cost of chronic disease management (Institute of Medicine, 2011) 5

6 Patient demographics (AAMC, 2008) 6

7 Who will take care of them? 7

8 MD shortage Shortage of primary care providers Fewer new doctors want to do primary care Not accepting Medicare and/or Medicaid Current practitioners retiring (Merritt Hawkins, 2012) 8

9 What is the solution? 9

10 Independent Nurse Practitioner Map (AANP, 2011) 10

11 NPs hidden 11

12 EHR incentive program NPs can get incentive from Medicaid Not eligible for incentive from Medicare 12

13 Technology Training & Meaningful Use (Ferris, 2010) 13

14 Nursing Informatics Education Survey of nursing education (Thompson & Skiba, 2008) Lack of interest (McNeil, 2003) Aging faculty & competency (Ngyen, 2011) Attitudes toward technology (Huryk, 2010) 14

15 15

16 Study Info Conrad Dixon Dumas Gaumer Thompson Zytkowski Year Design Article Feasibility Survey Survey Survey Article study Level of N/A Level VII Level VI Level VI Level VI N/A Evidence Sample Size N/A 12 doctoral students 104 NPs 519 NPs 1557 faculty & 540 nursing school N/A Intervention EMR use Define informatics & competency Outcome Discussion of EHR use by NP and use of standardized nursing language. Includes discussion of how NPs can promote use of EHR Synthesis table Doctoral students were asked to define informatics and determine competencies undergraduate nursing students should have. Use of computer technology by NPs 83% use at work, 88% advanced degree. However, Data entry in EMR is done by 52% in HMO, 40% in public clinics, 25% in private practice Use of info tech by NPs 89% of NPs working in ambulatory care use computers. 42% do not feel competent with technology administrators Survey of integration of nursing informatics into curriculum Nursing informatics has not been completely integrated into all levels of nursing education Nursing informatics Discussion of nursing informatics and use in all domains of nursing, including advanced nurse practitioners 16

17 EHR Literature Age of provider Computer experience EHR training EHR experience Primary care vs specialty practice Patient/provider interaction Workflow disruption 17

18 18

19 Participant Demographics NPs who use EHR in ambulatory care settings 19

20 Date of most recent degree NPs that graduated more than 11 years ago felt less confident about using EHR (Gaumer, 2007) Almost half received their degree since % received their degree in 90s 20

21 EHR Training 17 participants reported having formal training 14 reported being self taught 21

22 Years of EHR experience About half had 4 or less years experience Four had 10 years EHR experience 22

23 Primary care vs specialty practice 54% primary care 45% specialty practice 23

24 Informatics course 24

25 Post test responses Accomplish tasks more quickly Work more effectively Be more productive Makes job easier 25

26 Post test responses Interferes with workflow Interferes with patient-provider interaction 26

27 EHR use 27

28 Participant Goals Integrate EHR with affiliated institutions Set up patient portals Add EBP guidelines Utilize problem lists 28

29 Recommendations NPs-educate self in technology expertise Educators-integrate informatics into nursing curriculum MDs-involve NPs in EHR training & use IT-work with all providers & be patient 29

30 Takeaway Change the culture of advanced practice nursing education to incorporate informatics into curricula Mentor practicing NPs to provide informatics and EHR training 30

31 Thank you 31

32 Contact information Janet Mar, FNP-BC, ACNP-BC, MSN, BSN,RN Doctor of Nursing Practice candidate Arizona State University 32

33 References AACN DNP Essentials retrieved from Association of American Mecial Colleges (2008). The Complexities of Physician Supply and Demand: Projections Through Retrieved from Conrad, D. & Schneider, J.S. (2011). Enhancing the visibility of NP practice in electronic health records. Journal for Nurse Practitioners, 7, Curran, C. R. (2003) Informatics competencies for nurse practitioners. AACN Clinical Issues,14, DePhillips, H.A. (2007) Initiatives and barriers to adopting health information technology: a US perspective. Disease Management and Health Outcomes. 15, 1-6. Dixon, B.E., Newlon, C.M. (2010) How do future nursing educators perceive informatics? Advancing the nursing informatics agenda through dialogue. Journal of Professional Nursing. 26, Dumas, J.A., Dietz, E.O., & Connolly, P.M. (2001). Nurse practitioner use of computer technologies in practice. Computers in Nursing, 19, Ferris, N. (2010).Electronic health record standards. Retrieved from Gaumer, G.L., Koeniger-Donohue, R., Friel, C., Sudbay, M.B. (2007) Use of information technology by advanced practice nurses. CIN: Computers, Informatics, Nursing 25, Institute of Medicine. The future of nursing: leading change, advancing health. Washington, DC: The National Academies Press,

34 References, continued Mc Neil, B.J., Elfrink, V.L., Pierce, S.T., Beyea,S.C., Bickford, C.J. & Averill, C. (2005) Nursing informatics knowledge and competencies: a national survey of nursing education programs in the United States. International Journal of Medical Informatics,74, NONPF DNP competencies retrieved from: Simon, S.R., Soran, C.S., Kaushal, R., Jenter, C.H., Volk, L.A., Burdick, E., Cleary, P.D., Orav, E.J., Poon,E.G, & Bates, D.W. (2009) Physicians use of key functions in electronic health records from 2005 to 2007: a statewide survey. Journal of the American Medical Informatics Association, 16, The TIGER Initiative. Evidence and Information Transforming Nursing: 3-year action steps toward a 10-year vision Thompson, B.W. & Skiba, D.J., (2008). Informatics in the nursing curriculum: a national survey of nursing informatics requirements in nursing curricula. Nursing Education Perspectives. 29, Zytkowski, M.E. (2003) Nursing informatics: The key to unlocking contemporary nursing practice. AACN Clinical Issues, 14,