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Nursing 353
Professor McDonald
Sharonda Pigue & Cheton Lemare

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We will discuss what is Nursing Informatics and how nursing has contributed to Healthcare Informatics.

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Three ways that mobile EHR contributes to improved patient care are: improving accuracy in medical documentation, improving coordination of care for proper diagnosis, improving patient involvement and communication

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Three ways that mobile EHR contributes to improved patient care are: improving accuracy in medical documentation, improving coordination of care for proper diagnosis, improving patient involvement and communication

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Bedside monitoring improves nursing observation and patient safety it is an example of the positive impact informatics has in healthcare.

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Bedside monitoring improves nursing observation and patient safety it is an example of the positive impact informatics has in healthcare.

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Nursing contributions improves patient care using technology.

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University of Maryland School of Nursing

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Nursing Informatics: Connecting Patient Care and Technology

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Nursing Informatics is a leadership role.

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Nursing Informatics is a leadership role.

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Informatics in Nursing Leadership: Leading in the Age of Technology | Canadian Journal of Nursing Informatics

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Informatics in Nursing Leadership: Leading in the Age of Technology

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information management technology enhances an increase in efficiency and productivities and in healthcare organization processes

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information management technology enhances an increase in efficiency and productivities and in healthcare organization processes

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Nursing informatics was defined as a science and practice that “integrates nursing, its information and knowledge, and their management with information and communication technologies to promote the health of people, families and communities world-wide” (Canadian Nursing Informatics Association-Canadian Nurses Association, 2017, p.1).

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Nursing informatics plays a critical role in implementing telehealth technologies designed to benefit patient-family and patient-clinician connected platforms in the inpatient setting. 

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Nursing informatics plays a critical role in implementing telehealth technologies designed to benefit patient-family and patient-clinician connected platforms in the inpatient setting. 

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COVID-19 has underscored the crucial role of nursing informatics as healthcare organizations have faced delivering care during these unprecedented times.

For decades, nursing informatics specialists have integrated nursing science with information and analytical sciences to identify, define, manage and communicate data, informatics, knowledge and wisdom. Nurse informaticists are now advancing their focus beyond EHR implementation and successfully innovating change as analysts, educators, software engineers, policy developers and operational owners to help advance healthcare.

During the pandemic, nursing informatics specialists have played a key role in establishing new clinical workflows, increasing operational efficiencies and improving care quality for their patients.

The HIMSS Nursing Informatics Workforce Survey indicates that over two-thirds (68%) of the survey respondents work for a hospital or multi-facility health system in an informatics role. Healthcare systems that have infused this nursing specialty into their healthcare workforce are well-positioned to navigate the challenges in expanding and applying new technologies to care for patients during the COVID-19 pandemic.

Clinical Workflows

Although telehealth was already in use in some healthcare systems, the COVID-19 pandemic accelerated the need for ambulatory and inpatient virtual care visit consults. In collaboration with program leaders, clinicians and information services, nurse informaticists-who understand the current practice in ambulatory and hospital clinical settings-have, in many cases, enabled health systems to accelerate telehealth solutions to keep patients and clinicians safe.

Nursing informatics specialists translate the virtual care technical and operational requirements, evaluate the core tools, develop project plans, and implement and support the system. Examples of new technologies and workflows implemented during COVID-19 have included solutions to schedule and virtually provide patient care. Further, some healthcare systems have deployed smart devices for person-to-person connective platforms in telehealth.

Operational Efficiencies

Nurse informaticists collaborate to define requirements, design, build, and implement workflow and technology solutions. Having informaticists as part of the team is beneficial for health system leaders and clinicians to promote the adoptions of new processes, as nurses are often natural change agents and can enable change management in a culture.

With their background and experience in patient care, nurse informaticists recognize the challenge and necessity of collecting meaningful data to properly deliver care. The specialty of nursing informatics has played a critical role in increasing operational efficiencies, especially in designing and building COVID-19-specific functionality in the EHR and other technology applications. For example, nurse informaticists are using their skills to streamline specific infectious disease history documentation for quicker triage. This has led to revamping documentation in EHRs and pre-screening patients before ambulatory on-site visits and entry to the hospital to proactively identify potentially infected patients and direct them to the appropriate care, as well as limit these patients from visiting our facilities for face-to-face appointments to protect patients, physicians, nurses and staff.

During the rapidly evolving COVID-19 pandemic, healthcare systems' efforts to stop the virus' spread and protect patients and employees are top priorities. Nurse informaticists assist in the deployment of telehealth and teleworking strategies for hospitals to maintain operations and keep people out of hospital facilities as much as possible. For instance, with executive leadership and informaticists on board to understand and define clinical workflows, errors and adverse events have been avoided-resulting in significant cost savings during the rapid negotiation and execution of telehealth solution contracts.

Quality of Care

During the COVID-19 pandemic, nurses are critical in delivering care and keeping patients and caregivers safe. With quickly developed technologies, nurse informaticists ensure that the essential tools are tested and assessed to mitigate telehealth's unintended consequences. Specifically, nurse informaticists uphold organizational privacy and security programs of applied telehealth technologies, adhere to HIPAA mandates, and ensure appropriate use of personal health information to meet evolving regulations.

Nursing informatics plays a critical role in implementing telehealth technologies designed to benefit patient-family and patient-clinician connected platforms in the inpatient setting. These technologies provide better patient experience with COVID-19 patients when family members are not allowed in patient care settings. Examples of telehealth technologies include implementing devices with video capability to provide human interaction, and conversational agent intelligence solutions such as voice-controlled virtual care assistants to further connectedness with patient care staff and family.

The specialty of nursing informatics has demonstrated its value for developing best practices and new processes in the fight against COVID-19. In this era of healthcare transformation, partnering with nurse informaticists benefits health systems in establishing new clinical workflows, increasing operational efficiencies and improving care quality.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates. Updated April 20, 2021

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Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency and Improving Quality

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Over the past several months, nursing informatics specialists have played a key role in establishing new clinical workflows, increasing operational efficiencies and improving care quality for their patients.

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Nursing Informatics in Healthcare improving patient safety around the world.

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Nursing Informatics in Healthcare improving patient safety around the world.

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Informatics improves patient safety, care, and costs.

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Informatics improves patient safety, care, and costs.

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The mission of ANIA is to advance nursing informatics through education, research, and practice in all roles and settings.

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The mission of ANIA is to advance nursing informatics through education, research, and practice in all roles and settings.

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ANIA Mission: To advance nursing informatics through education, research, and practice in all roles and settings.

ANIA Vision: To be the organization of choice to advance nursing informatics.

ANIA is an organization originally founded in 1982 as the Capital Area Roundtable on Informatics in Nursing (CARING). CARING was developed and organized by nurses in 1982 as a non-profit undertaking to provide a forum for the advancement of automated healthcare information systems.

In 1992 the American Nursing Informatics Association was formed in Southern California to provide networking, education and information resources that enrich and strengthen the roles of nurses in the field of informatics.

The idea of a merger between the two organizations (ANIA and CARING) began in 2005 with discussions between both Boards of Directors. In 2007 the organizations held their first joint annual conference and officially merged in 2010. After much thought and discussion, the Board of Directors proposed to change the official organization name to the "American Nursing Informatics Association" (ANIA) with a logo tagline of "where caring and technology meet." This name change retains the history of both organizations with an easily recognizable and intuitive national name for future growth. For more information on the background of ANIA, visit our History section.

Membership has broadened to include an estimated 3,000 nurses and other healthcare professionals in informatics practice and includes roles in: system design and implementation, education, research (analysis and evaluation), standards and policy development, quality improvement, as well as those in management and administration.

Today, membership is open to nurses and other professionals interested in informatics nursing. Corporations and individual corporate representatives are also welcomed as members.

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ANIA Mission: To advance nursing informatics through education, research, and practice in all roles and settings. ANIA Vision: To be the organization of choice to advance nursing informatics. ANIA is an organization originally founded in 1982 as the Capital Area Roundtable on Informatics in Nursing (CARING).

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Career Trajectories in Nursing Informatics

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Career Trajectories in Nursing Informatics

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Career Trajectories for Informatics Nurses

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Abstract

Historically, educational preparation did not address informatics competencies; thus managers, administrators, or executives may not be prepared to use or lead change in the use of health information technologies. A number of resources for informatics competencies exist, however, a comprehensive list addressing the unique knowledge and skills required in the role of a manager or administrator was not found. The purpose of this study was to develop informatics competencies for nursing leaders. A synthesis of the literature and a Delphi approach using three rounds of surveys with an expert panel resulted in identification of informatics competencies for nursing leaders that address computer skills, informatics knowledge, and informatics skills.

Introduction

With the goal that all Americans have an electronic health record (EHR) by 2014, health care leaders must be prepared to select, adopt, and implement EHRs as well as other health information technologies (HITs). Historically, nursing education did not include informatics competencies; thus, current managers, administrators, or nurse executives may not be adequately prepared to use or lead change in the use of HITs. Healthcare organizations are beginning to emphasize the need for informatics competencies appropriate for leadership roles. In fact the American Organization of Nurse Executives (AONE) included informatics in it's recent update of competencies for nursing executives, t, but most competencies were stated broadly and needed further specifications to translate them for implementation.1

More recently, the TIGER Initiative (Technology Informatics Guiding Education) identified that all nurses in every role must be prepared to make HIT the stethoscope of the 21 st century. TIER is a collaborative of 120 diverse organizations working together to educate nurses "to use informatics tools, principles, theories, and practices to make health care safer, more effective, efficient, patient-centered, timely, and equitable by interweaving enabling technologies transparently into nursing practice and education."2 Management's role is pivotal in organizational transformation using EHRs and other HITs. In fact, one of the seven pillars of the Tiger Initiative focuses on management and leadership; however, competencies in this area are yet to be defined. A number of resources for informatics competencies exist, however, a comprehensive list addressing the unique knowledge and skills required in the role of a manager or administrator was not found. 3⁻7 Therefore, the purpose of this study was to develop informatics competencies for nursing leaders.

Method

Informatics competencies for nursing leaders were developed through review of the literature and validated through a Delphi approach. The investigators used the AONE Nursing Executive Competencies 1 to identify the roles and functions of the nursing executive or nursing leaders aspiring to be executives. Informatics competencies from the literature were identified.3⁻7 Competencies from each of these sources were categorized as computer skills, informatics knowledge and informatics skills, using the framework developed by Staggers, Gassert, and Curran.7 The combined competencies were then evaluated for redundancy and reworded for consistency. The initial list of competencies was again compared with AONE's Nursing Executive Competencies. Some items were deleted, others reworded, and additional competencies added to reflect the role and functions of nursing leaders. Further subcategories were identified for categorizing competencies.

The first survey resulting from this process included a total of 119 items with 38 competencies addressing computer skills, 37 addressing informatics knowledge, and 44 addressing informatics skills. Within each of these three major categories were subdivisions for easier comprehension of content areas. Computer skills included: basic software applications, administration applications, electronic communications, data access and decision support, patient documentation and monitoring, education, systems, and research. Informatics knowledge included: data, impact, ethical and legal issues, systems, education, research, and usability and ergonomics. Informatics skills were categorized as: management, system requirements and selection, design and development, fiscal management, implementation, analysis and evaluation, and system maintenance.

A Delphi approach was used for obtaining consensus on the competencies. A purposive sample of 13 nursing leaders, informaticians, and researchers was selected from the American Medical Informatics Association Nursing Informatics Working Group, the Minnesota Organization of Nursing Leaders, and the University of Minnesota School Of Nursing. The Expert Panel consisted of registered nurses with a master's degree or higher and a minimum of five years of experience in nursing informatics, leadership in a practice setting, or research. Three rounds of surveys were completed for validating the competencies, with each successive round including refinement from results of the previous survey. Experts were given a copy of the AONE Nursing Executive Competencies and a list of the Informatics Competencies for Nursing Leaders developed by the investigators. The Panel was asked to rate the relevance of each item for nursing leaders on a 4-point Likert-type scale: 1) not relevant, 2) somewhat relevant, 3) quite relevant, and 4) very relevant. Experts also were asked to reword any items that were not clear. Open ended questions were included for additional recommendations.

Analysis

A content validity index (CVI) was calculated,8 which is the proportion of ratings for a competency that were very or quite relevant. A threshold of 80% agreement was established for determining consensus on competencies. All responses were entered into Excel and a percent agreement calculated for each competency. All competencies with 80% agreement were retained, but wording changes or reorganization of competencies recommended by respondents were made. The investigators examined competencies with ratings less than 80% for relevance based on the AONE Nursing Executive Competencies and reworded items for additional testing if they addressed an area in the AONE competencies. All other competencies with less than 80% agreements were deleted.

Results

In the first of three rounds of surveys, the return rate was 92%. Based on the responses to the survey, rewording of 34 competencies was recommended, 28 competencies were deleted, two competencies added, and four competencies were moved to another category. Participants identified the following reasons for deleted competencies: the competency was relevant for the role of the nursing informatician, end user, or researcher rather than the role of the nurse leader; or, it was not an informatics competency. Examples of competencies for nurse informaticians rather than the nurse leader included: "extracts data from clinical data sets;" or, "prepares process flow charts to describe current and proposed information flows for all aspects of clinical systems." An example of a competency rated less than 80% that was reworded included: uses project management software to plan and track progress of projects. This competency was reworded as "uses project management software." Based on the results of round one, there were a total of 93 competencies: 24 competencies addressed computer skills, 36 addressed informatics knowledge, and 33 informatics skills.

The response rate for the second survey was 83%. All competencies were rated at or above 80% agreement except five. In the category of computer skills, 2 competencies addressed using project management software and using up-to-date information science and technology as a strategic tool to promote self-health. The first competency was changed and the second deleted. "Uses project management software" competency was modified for the final survey with an emphasis on the role of the leader to include "develops the project scope, objectives, and resources for each proposed application, system, or enhancement" and "assure principles and concepts of project management are used for the implementation of information systems." Under the category of informatics knowledge, two competencies were rated at 70%: "describes how various hardware or network issues affect decisions about information systems," and "summarizes limitations of computer programs due to design and computer or network capacity at a general level." It was recommended to simplify these competencies by removing the verb and using simple concepts that address only one idea per competency where possible. The competency "collaborates on oversight to assure that testing plans are developed, implemented and evaluated at every phase of system implementations" was rated at 78% and the investigators decided to retain this competency for round three of the survey. Additional changes included recommended wording, regrouping of competencies, and removing additional redundancies identified by participants. Based on the results of round two, there were a total of 91 competencies: 24 competencies addressed computer skills, 38 addressed informatics knowledge, and 29 informatics skills.

The response rate for round three of the survey was 83%. All competencies were rated as 80% or higher in this round except two, which were deleted. One was identified as a research competency and the second was a duplicate of another competency. The research competency that was removed was "using software for qualitative data analysis or text mining." Participants identified that one competency, "[knowledge of] ergonomics of work station, bed side and portable technology apparatus in practice" included multiple concepts and this competency was split into separate competencies. Rewording recommendations were made and recommendations for reorganizing competencies. Based on the results of round three, there were a total of 92 competencies: 24 competencies addressed computer skills, 40 addressed informatics knowledge, and 28 informatics skills. The results of the final survey included the following categories and subcategories as shown below in Tables 1 - 3 .

Table 1

Basic Software Applications

Word processing software

Spreadsheet software (e.g.. Excel)

Presentation software (e.g. PowerPoint)

Internet browsers

Advances Software Applications

Forecasting

Budgeting

Human resources

Quality assurance

Staffing/Determining patient acuity

Statistical analysis

Synthesizing the whole patient picture from a multidisciplinary perspective

Planning and making decisions

Electronic Communications

Composing e-mails

Sending confidential documents

Participating in group communication

Access Data/ Information

Navigating systems (e.g., file servers)

Searching information retrieval systems

Distance-learning

Patient Related Applications

Documenting patient assessments

Creating care plans

Documenting nursing interventions

Documenting outcomes of care

Monitoring trends in patient outcomes

Supporting patient education

Table 3

Requirements And System Selection

Develop project scope, objectives, and resources

Integrate patient care processes and nursing administrative functions in system requirements

Involve front-line staff in the development of system requirements

Involve front-line staff in the development of system selection

Specify system requirements based on the needs of the organization

Collaborate with interprofessional team in system selection process

Evaluate information systems in practice settings

Advocate for the development (or purchase) and use of integrated, cost-effective health information systems within the organization

Advocate new applications meet standards for interoperability

Financial

Priorities are within budget constraints and organizational priorities

Alternatives for funding information systems

Costs and benefits analysis applied for in practice, education, administration, and/or research

Financial and staffing implications of ongoing updates to information systems

Actual vs budgeted costs for implementing nursing-related information systems

Collaborate with interprofessional team around financial issues

Implementation/ Management

Implementation of systems consistent with the vision, mission, strategic and tactical plans

Use project management for implementation of IS

Manage the impact of change due to IS implementation

Front-line staff are involved in appropriate aspects of design, implementation, and testing related to their practice

Improve the use of informatics within nursing practice

Collaborate with interprofessional team to manage information systems

Ethical/ Legal Concepts

Access to system information

Use of data (obtaining, storing, and disseminating text, data, images, or sounds)

Access to personal health information (PHI - HIPAA language)

Analysis/ Evaluation

Consistency with organizational policies, external licensing, accreditation, and regulatory agency requirements

Ensure testing plans are evaluated at every phase of system implementation

Ensure that front-line staff (users) are involved in the evaluation of information systems

Collaborate with interprofessional team to evaluate information systems

Discussion

Informatics competencies for nursing leaders were developed through a review of the literature and a Delphi process that included three rounds of surveys using an expert panel of experienced nursing leaders, informaticians, and researchers. The first round resulted in significant changes, while the second and third rounds were more editorial. There was considerable feedback from participants about informatics competencies for the nursing leader versus competencies for the nurse informatician or other nursing roles. Participants commented that informatics competencies for nursing leaders should emphasize knowledge and skills for planning, coordinating, supporting, directing, and evaluating informatics initiatives rather than "doing." For instance, nursing leaders do not need to actually perform specific informatics skills such as use project management software. The one exception was the need for leaders to be competent in computer skills.

The purpose of developing informatics competencies was to identify those areas related to nursing leadership, which included front line managers to the nursing executive. Similar to the levels of public health users,6 informatics competencies for nursing leaders varies based on their level of management.

For instance, the front line manager's role requires documenting patient care in EHRs while the role of the nursing executive is focused on procuring financial support for the EHR.

Participants who were nursing informaticians also identified that there may be differences in competencies for nursing leaders based on the reporting relationship of the informatician. Some nurse informaticians report to the chief informatics officer (CIO) while others report to the chief nursing officer. A CIO may require greater technology knowledge and skills while a nurse executive may require a greater emphasis on use of informatics in nursing.

Another key message from participants was an emphasis on interdisciplinary coordination. Nursing leaders must have computer and informatics knowledge and skills to work with other disciplines, but clearly can not operate in a silo. This influenced the development of the competencies to emphasize the interdisciplinary nature of informatics.

Conclusion

This study contributes to the identification of competencies that are unique to the role of the nursing leader. Informatics competencies that address computer skills are similar to previously identified competencies.3⁻7 However, informatics knowledge and skills are unique in this study. In future research, competencies need to be leveled by nursing leadership roles and responsibilities. Additionally validation also is needed to determine the applicability across health care settings.

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Table 2

Management Concepts

Management of system implementations

Avoidance of potential negative impacts

Allocating financial resources

Inclusion of nursing information within systems

Communicating a vision about the benefits

Anticipating changes in economic and business processes

Analysis of interprofessional workflow processes

Revising processes from workflow analysis

Decisions impacting clinical IS implementation, use, and maintenance

Change management

Data Issues

Health care data standards

Importance of integrating nursing data elements in systems

Importance of integrating standardized nursing languages in systems

Data quality issues

Data reporting issues

Information Systems Concepts

Value of clinicians' involvement in at all appropriate phases

Strengths and limitations of applications related to software programming language or design

Strengths and limitations of applications related to hardware/ networks

Technological trends, issues and new developments as they apply to nursing

"Work arounds" and the consequences of these

Human - computer interface interactions

Ergonomics of work station, bed side

Ergonomics of adjunct technologies

Ergonomics of portable technology

Application of IS technologies to clinical practice

Application of IS technologies to administration

Application of IS technologies to clinical research situations

Staff Education

Levels of informatics knowledge by roles

Methods for education

Clinical Research

Evaluating internet resources

Methods for evaluation of IS implementation and use

Reuse of patient/ administrative data for research

Application of informatics research for practice

Ethical/ Legal Concepts

Patients' rights r/t computerized information management

Principles of data integrity

Ethical principles for collection, maintenance, use, and dissemination of data and information

Application of HIPAA to information systems

Compliance with IRB for research with data from information systems

Policies and procedures consistent with regulatory and accrediting requirements for IS

Intellectual property, copyright, and fair use of copyrighted material

References

4. Curran CR. Informatics competencies for nurse practitioners. AACN Clinical Issues: Advanced Practice in Acute and Critical Care. 2003;14:320-30. [[ PubMed] Google Scholar]

7. Staggers N, Gassert CA, Curran C. A Delphi study to determine informatics competencies for nurses at four levels of practice. Nursing Research. 2002;51:383-390. [[ PubMed] Google Scholar]

8. Waltz CF, Strickland OL, Lenz ER. Philadelphia: F.A. Davis Company; 1984. Measurement in Nursing Research. [ Google Scholar]

Articles from AMIA Annual Symposium Proceedings are provided here courtesy of American Medical Informatics Association

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Informatics Competencies for Nursing and Healthcare Leaders

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Historically, educational preparation did not address informatics competencies; thus managers, administrators, or executives may not be prepared to use or lead change in the use of health information technologies. A number of resources for informatics ...

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Names at least 3 contributions Nursing Informatics  has made to the healthcare industry.
Names at least three career trajectories in Nursing Informatics

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Informatics Competencies for Nursing and Healthcare Leaders (nih.gov)

About Us | American Nursing Informatics Association (ania.org)

PowerPoint Presentation (njha.com)

https://youtu.be/6jeJvCuBbHY

Informatics in Nursing Leadership: Leading in the Age of Technology | Canadian Journal of Nursing Informatics (cjni.net)

Nursing Informatics Key Role in Defining Clinical Workflow, Increasing Efficiency and Improving Quality | HIMSS

What is Healthcare Informatics? - YouTube

(Canadian Nursing Informatics Association-Canadian Nurses Association, 2017, p.1).