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The Role of Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate Education (nih.gov)

Healthcare is changing so rapidly now days. I still remember paper charting even at the hospitals. Now we rarely see a paper chart.  I really appreciate our nurse informaticist who makes our job easier and meaningful. I agree with a statement from the article that "Nurse informaticists bridge the gap between data and nursing practice by combining clinical experience and data expertise"

The Role of Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate Education (nih.gov)

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As data becomes more widely used to drive healthcare improvement, so does the term "informatics," referring to processing, storing, and retrieving data to optimize healthcare delivery and improve patient outcomes. But who are the people behind the scenes-the informaticists-who make these data processes happen? There are many types of informaticists in healthcare (e.g., nursing, lab, medical), but the nurse informaticist plays a pivotal role in identifying, defining, and sharing data, information, and knowledge in the science of nursing.

With massive amounts of data at health systems' fingertips-and exacerbated by the urgency for even more data in response to COVID-19-a nurse informaticist's role is vital for health systems to maximize data-driven nursing practice in pandemic management and the everyday clinical setting. Nurse informaticists' familiarity with nursing's frontline role in a clinical setting combined with an understanding of clinical processes and workflows enables them to maximize data and technology in daily nursing practice. More than a translator who works in silos with the IT department, a nurse informaticist bridges the gap between data and clinical nursing practice. Nurse informaticists understand the flow of data at a deep level and make modifications to support new methods that lead to safe care delivery.

The American Nurses Association defines nursing informatics as the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge and wisdom in nursing practice. Nurse informaticists support nurses, consumers, patients, the interprofessional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, processes, and technology.

The Evolution of a Nurse Informaticist

The role of a nurse informaticist has evolved since its initial function as a "clinical analyst." As healthcare focuses more on data science-centric processes to improve patient care, such as machine learning and artificial intelligence, technology adoption and communication between clinical teams and IT resources (e.g., the EHR or an ancillary system) are paramount. Because nurse informaticists practice at the intersection of technology and clinical practice, nursing informatics is now a well-established specialty that has grown beyond designing the EHR.

Technology is not just part of healthcare; it is healthcare. Examples include point-of-care solutions (e.g., electronic physiologic monitors, electrocardiogram, glucometers, and more), patient portals, external health information exchanges, and public health reporting. As such, the nurse informaticists' role is an integral part of healthcare delivery, encompassing system selection and implementation and training of technologies to provide safe, high-quality, patient-centric care across the continuum, no matter the delivery method.

Though perhaps not as well-known as other nursing fields, the American Nurses Credentialing Center (ANCC) recognizes nursing informatics as a specialty with board certification. Additionally, nursing informatics provides a career path in leadership, as demonstrated by the increase in Chief Nursing Informatics Officer (CNIO) positions across health systems. The CNIO serves as a bridge between nursing and information technology and partners with the Chief Medical Information Officer, who serves as a bridge between the medical community and information technology-together, the CNIO and CMIO focus on information, data, and communication.

With the shift to value-based care, nursing informaticists focus on a variety of technical areas to better support patients, nursing staff, and other healthcare providers:

Departmental systems improvement.

EHR implementation.

Documentation optimization.

Accurate data capture and process changes that support regulatory measures and other strategic initiatives.

Care coordination.

Population health initiatives.

Nurse Informaticists Play Pivotal Role in the Fight Against COVID-19

The nursing informatics role is expanding beyond process, implementation, and data capture in the face of COVID-19. The pandemic has resulted in new IT challenges for hospital workforce including data capture, system updates, implementation and integration of new technologies, and process changes. For example, hospital leadership faces staffing and supply chain shortages, capacity challenges, field hospital management, temporary relaxation of documentation and regulatory reporting requirements, and a focus on patient throughput; simultaneously, they must maintain compassionate, quality care. With minimal resources and waning energy, health systems engage nurse informaticists to operate safely amid shifting technology, protocols, and regulations.

Another way a nurse informaticist's role is especially valuable during a crisis is by helping to quickly adjust workflows and scale care delivery. With the dramatic increase in telehealth visits since the onset of COVID-19, nurse informaticists have worked with physicians and other disciplines to modify existing workflows and systems to properly capture consent and then document telehealth visits. With the time-sensitive shift from in-person to telehealth visits, health systems have had to leverage a nurse informaticist's expertise to rapidly design and test technology and workflows while simultaneously training end users before deployment.

Three Essential Responsibilities of a Nurse Informaticist

With COVID-19 driving more data sharing, health systems have access to have even more data. However, many organizations still struggle to leverage that data to drive long-term improvements. Nurse informaticists have three essential responsibilities that help the nursing workforce document and submit accurate data and leverage it to develop evidence-based procedures for optimal care delivery.

Responsibility #1: Understand and Communicate the "Why" Behind New Processes

Knowing the why behind any process and communicating it to the nursing workforce and key stakeholders is critical for accuracy and adoption. When a nurse informaticist explains the importance of documenting specific observations and measures (e.g., height, weight, and allergies), nurses understand the long-term ramifications of incorrect or missing data on a person's health and feel more accountable for capturing the correct data. Increased understanding also builds the nurses' confidence in the system's data, making them more likely to rely on that data to make decisions.

For example, an EHR could require documenting a patient's height and weight and allergies during the admission assessment before a team member can enter new orders into the system. An estimated height and weight or missing documentation of allergies has downstream impacts for determining correct medications and dosages as well as avoiding a potential adverse event. A crucial part of a nurse informaticist's job is to educate the workforce about the reasons behind these EHR requirements and their far-reaching effects. This insight helps the care team understand how specific data play an important role throughout the care process and decision making.

Responsibility #2: Implement New Technology and Processes

Any type of new electronic implementation (e.g., an EHR or patient portal) means a change in the clinical process. The clinical team will evaluate and adapt current processes in the context of the new technology and then implement it. With greater data access, health systems can identify additional care gaps and improvement opportunities, making a nurse informaticist's role in new process education and implementation even more critical.

New processes bring improvement opportunities, but they also bring pain points and learning curves that can discourage team members. Without proper training and implementation, new technologies can flounder, fail to gain adoption, or even lead to unsafe workarounds, resulting in compromised patient safety and team member frustration. An effective nurse informaticist guides a new process implementation from beginning to end, setting team members up for success.

For example, an ICU nurse needs to use a new module in the EHR to capture the physiological (e.g., hemodynamic) monitoring of a patient. The new module requires capturing the data directly from the monitoring device and verifying it versus manually entering it in an electronic format or historically documenting it in a paper-based flow sheet. Logging the hemodynamic monitoring electronically focuses on real-time data capture. With a manual entry process, the nurse may delay data entry until a break or at the end of his/her shift, meaning that notes (or data) wouldn't be available until later. The problem is that waiting to capture the data (the hemodynamic monitoring information) informs how other care team members will execute their care delivery and planning. If the latest data isn't available, providers make care decisions based on incomplete information.

This change in the process means the nurse has to electronically submit information throughout a shift instead of during a break. A nurse informaticist, understanding the complex nature of nursing and the challenges of disrupting a routine, would provide education about the new process before implementation, ensure testing completion and provide hands-on training within the EHR, and a thorough explanation of the new approach's benefits compared to the old method.

Responsibility #3: Validating Data with the Three Vs

The nursing informaticist role is expanding to encompass greater responsibility with data and analytics. To promote a data-driven decision making in clinical practice through effective data utilization and adoption.

1. Volume: Health systems have access to (what seems like) unlimited data. A nurse informaticist realizes the actual volume of data (e.g., clinical notes, admission assessments, vital signs medications, and lab results) and various data sources the organization can leverage to support data-driven decision making. The informaticist role is emerging to include data stewardship and data validation in support of an organization enterprise-wide data strategy.

2. Velocity: Data sharing is critical for health systems to deliver comprehensive care based on complete patient information. This means the velocity, or the speed at which data travels, is also critical. Delayed access to data can lead to postponed decision making or decisions based on incomplete data. Part of understanding data velocity is also communicating what data will be available and when to enable decisions (e.g., near real-time versus retrospective analysis). For example, real-time clinical data supporting analysis of possible and/or actual Hospital Acquired Conditions (HAC) enables the care team to take timely actions that impact patient safety versus using that same data retrospectively to identify trends over time. For population health, both clinical data and claims data are included in care coordination and closing care gaps; however, the velocity of claims data is currently less frequent than clinical systems and EHR data.

3. Variety: Validating data requires the informaticist to understand the different data sources and how they do-or do not-come together. Today's electronic environment is comprised of discrete data, unstructured data, images, and connected device data (to name a few) that need to be validated. Nurse informaticists understand the variety of data sources and how to evaluate the data to tell a cohesive story about the patient and the population. For example, a nurse informaticist might discover that missing data sets could be a result of data not integrated into the EHR. The ability to dig deeper into data variety and then adjust processes to harmonize the data is critical to delivering care based on complete data sets.

A Nurse Informaticist: Critical to Healthcare Success Now and in the Future

With a multifaceted focus to transform data into information, nurse informaticists communicate that information to team members so they can help patients reach peak health and help health systems reach optimal performance. At a crossroads where nursing, computer, and information science meet, a nurse informaticist evaluates aggregated data to drive change, improve efficiency, cut costs, and improve the quality of patient care.

As the healthcare industry relies more on data to understand patient populations, deliver value-based care, and combat COVID-19, a health system must adopt increasingly data-friendly processes and workflows across the organization. Data can improve accuracy and guide clinical best practice, but changes also bring new challenges for team members. A nurse informaticist provides information about new workflows, guides new technology and process implementation, and assesses data quality, giving care teams the best chance of optimal care delivery. With extensive clinical background, growing analytics acumen, process and workflow intelligence, and technology savvy, a nurse informaticist is critical for health systems to leverage data to better meet every team member and patient need.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

1. Three Must-Haves for a Successful Healthcare Data Strategy

2. Data Visualization Dashboards: Three Ways to Maximize Data

3. Self-Service Data Tools Unlock Healthcare's Most Valuable Asset

4. Achieve Data-Informed Healthcare in Eight Steps

5. Healthcare Data Literacy: A Must-Have for Becoming a Data-Driven Organization

PowerPoint Slides
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A Nurse Informaticist: 3 Essential Responsibilities

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As data becomes more widely used to drive healthcare improvement, so does the term "informatics," referring to processing, storing, and retrieving data to optimize healthcare delivery and improve patient outcomes. But who are the people behind the scenes-the informaticists-who make these data processes happen?

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QSEN Competencies:
Patient safety and quality are the most important topics in the healthcare field. QSEN initiatives help nurses to bring technology, evidence-based practices, informatics together to improve patient safety and quality

The Six Competencies:

Patient-Centered Care
"Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient's preferences, values, and needs."

Teamwork & Collaboration
"Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care."

Evidence-Based Practice
"Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care."

Quality Improvement
"Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems."

Safety
"Minimizes risk of harm to patients and providers through both system effectiveness and individual performance."

Informatics
"Use information and technology to communicate, manage knowledge, mitigate error, and support decision making."

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OVERVIEW

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

Using the Institute of Medicine competencies, QSEN faculty and a National Advisory Board have defined quality and safety competencies for nursing and proposed targets for the knowledge, skills, and attitudes to be developed in nursing pre-licensure programs for each competency. These definitions are shared in the six tables below as a resource to serve as guides to curricular development for formal academic programs, transition to practice and continuing education programs .

For information on applying the competencies at a graduate level, see the Graduate KSAs page.

Note: This content is reprinted with permission from the " Quality and Safety Education for Nurses" article originally printed in Nursing Outlook Special Issue: Quality and Safety Education. For guidelines on use of this material, please read our terms and conditions.

DEFINITIONS AND PRE-LICENSURE KSAS

Click here to download the PDF version

REFERENCES

¹ Institute of Medicine. Health professions education: A bridge to quality. Washington DC: National Academies Press; 2003.

² Cronenwett, L., Sherwood, G., Barnsteiner J., Disch, J., Johnson, J., Mitchell, P., Sullivan, D., Warren, J. (2007). Quality and safety education for nurses. Nursing Outlook, 55(3)122-131.

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The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

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More EHR systems do not mean better or easy care; the quality and ease to use of the system should be considered and ideally if medical records systems were able to communicate between each other. We spend so much time calling labs, hospitals when the information could be transferred within seconds.

Why Is Interoperability Important In Healthcare IT? (folio3.com)

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The importance of interoperability cannot be overstated: it is one of the key drivers of success for healthcare providers today. Moreover, interoperability in healthcare is a critical part of the movement towards value-based care that can effectively drive down costs, improve patient care, and enhance healthcare outcomes.
But what is interoperability exactly, and why is it so important?
The Healthcare Information and Management Systems Society (HIMSS) defines health information interoperability as "the ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally."

At its core, interoperability is the capacity for healthcare providers to access and share clinical information and the most up-to-date and complete patient medical records, regardless of the healthcare system where they work or the technology they use. The foundation of interoperability is made up of Health Information Exchange (HIE) networks designed to facilitate the transfer of clinical data, in addition to electronic health record (EHR) systems that store clinical information digitally. With HIEs and EHRs, patients' medical information can be accessed securely across healthcare systems.

To answer the question, " why is interoperability important in healthcare? " it is helpful to consider why the digital transformation began, where we currently stand in the interoperability movement, and what the future may hold.

Looking Back at the History of EHRs in the United States

In the 1960s, doctors and healthcare providers used handwritten paper medical records and a paper filing system to keep patient medical history; but by the mid-1960s, academic centers began to develop their own clinical information systems for storing electronic medical information. In this same period, Lockheed Martin created an innovative software for medical records that was the first to allow many users to enter the system at once.

Over the next decade, companies and medical institutions worked together to develop technology for storing and accessing electronic medical information. By the 1970s, the U.S. Department of Veterans Affairs implemented a computerized patient record system that helped to reduce medical errors and improve quality of care.

Throughout the 1980s and 1990s, a movement to end the use of paper medical records and establish an EHR system in the United States took hold. Using paper filing systems meant that patient records couldn't travel with them, be readily accessed by healthcare providers in an emergency situation, or be used when the patient transferred to different healthcare systems and providers. An electronic clinical record system that could be accessed from anywhere and by any provider or payer was believed to solve these issues and improve care coordination and patient outcomes-while reducing excess costs from redundant testing and mistakes caused by incomplete patient data.

In 2004, President George W. Bush established the Office of the National Coordinator for Health IT (ONC) to lead the implementation of an interoperable health information technology infrastructure. Then in 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act aimed to increase the use of EHR among healthcare providers by offering them financial incentives for meeting "meaningful use" criteria related to their use of EHR and technology. With financial incentives in place and Medicare/Medicaid reimbursement reductions for failure to meet the meaningful use criteria, the adoption of EHRs and HIEs ushered in an era of more secure medical record exchange and enhanced privacy for patients.

The Importance of Interoperability in Healthcare Today

Presently nothing travels as fast as information, and seamless transfer of documents and care plans via health information exchange can lead to better health outcomes. These health records can be lifesaving to ensure continuity of care, especially in situations where a patient is entering an emergency room or transferring to a new healthcare system. Since the beginning of the shift away from paper medical records, EHR vendors have multiplied, and now healthcare providers have seemingly endless options when it comes to selecting their healthcare information technology (HIT) options.

However, more EHR options does not necessarily mean that U.S. healthcare providers have achieved the level of interoperability hoped for at the advent of this transformation to digital clinical information systems. The ability of these various EHR systems to communicate and work seamlessly across devices, networks, and providers remains a challenge for the various technology and EHR vendors, government organizations, and healthcare systems to address in order to achieve optimal interoperability. EHR vendors have played an important role in facilitating interoperability, but the federal government, the ONC, and standards development organizations (SDOs) like HIMSS and Health Level Seven (HL7), have also played pivotal roles in developing standards for HIE and data sharing in healthcare.

While EHR vendors have improved the technology of their platforms to enhance the ability to communicate with other software and applications, the SDOs have been focused on developing standards regarding clinical language and terminology, patient identifiers, formats for information exchange, and privacy and security. Currently, having many EHR vendors and various HIEs that work using different identifiers, language, and formats makes exchanging critical patient health information across healthcare systems more difficult, which is why SDOs have made standardization a priority to create a more streamlined process.

For example, tech companies and EHR providers have built proprietary application programming interfaces (APIs) to allow for seamless and secure data transfer between EHRs. The HL7 took this idea of using an API and developed an API standard for interoperability, known as HL7 Fast Healthcare Interoperability Resources, or FHIR, to further break down the silos between EHR systems. All these elements are crucial to enhancing health information interoperability to improve patient care.

The Future: Heading Towards Deep Interoperability

There's no doubt that significant progress has been made when it comes to interoperability. According to a recent report from KLAS on trends in electronic medical record (EMR) interoperability, healthcare providers have noticed improvements when it comes to EHR vendors supporting data sharing with healthcare information exchange (HIE) partners, moving from 50% satisfaction when working with partners using different EHR vendors in 2016 to a 64% satisfaction rate in 2020. In addition, the KLAS report found that provider organizations are closer to achieving deep interoperability, which is based on four levels of interoperability:

1. Access to data - Often or nearly always having access to necessary data through interoperable means

2. Locating records - Can easily locate patient records or present patient records automatically to clinicians

3. Clinical interface - Have patient data integrated into the EHR system's native data fields or in its own tab in the EHR

4. Benefit to Patient - That the patient data accessed in the EHR benefits the patient care outcome

Regarding access to data, providers in the KLAS report ranked their ability to access critical patient data as 67% successful in 2020, up from just 28% success in 2017. When asked about their ability to locate the patient records they needed when helping a patient, providers said they had a success rate of just 13% in 2017, but that number jumped to 44% success in 2020. Providers ranked the ease of use for the clinical interface of their system at just 8% in 2017, but by 2020, providers ranked the interface usability at 38% satisfaction. With these improvements to their access and use of patient data in their technology, providers' say the EHR benefit to the patient more than doubled from 6% in 2017, up to 15% in 2020.

As the KLAS report demonstrates, great strides have been made even in just the past few years towards achieving deep interoperability, which would ideally be at 100% for all healthcare providers in the future. However, there is room for improvement, and obstacles to reaching optimal performance in all four stages of deep interoperability remain. Providers surveyed in the KLAS report say that EHR and HIT vendors need to focus on improving patient-record exchange, while the ONC continues to support the enhancement of information exchange through its efforts to implement FHIR-standards-based APIs as part of the 21st Century Cures Act.

Helping healthcare providers achieve deep interoperability will require breaking down silos of healthcare IT development and EHR systems. This can be accomplished by improving technology, standardizing APIs for information exchange, facilitating technology use, and continuing to measure the impact of HIT on patient outcomes and care coordination.

There are many stakeholders involved in shaping interoperability today, from payers to providers to the EHR vendors and other HIT companies. Coordinating these stakeholders to create consensus-driven improvements to technology and HIE remains an area of key focus. While obstacles remain to achieving that seamless exchange of information that is necessary to truly move to a value-based healthcare system, EHR vendors will play a critical role in helping providers to achieve deep interoperability and enhancing HIE.

As a pioneer in the interoperability space, Audacious Inquiry provides solutions to health information exchange obstacles through healthcare data integration services and products like our communication solution for efficient patient transfer, Encounter Notification Service® (ENS®) and PROMPT® - Proactive Management of Patient Transitions for admissions, discharge, and transfer (ADT) support.

For help developing a health IT strategy, connect with one of our health IT policy experts to establish a plan for your organization to enhance interoperability and seamless data transfer.

About the Author Diana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs.

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Why Is Interoperability Important in Healthcare?

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The importance of interoperability cannot be overstated: it is one of the key drivers of success for healthcare providers today. Moreover, interoperability in healthcare is a critical part of the movement towards value-based care that can effectively drive down costs, improve patient care, and enhance healthcare outcomes.

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Data-knowledge-wisdom correlation reminds a Maslow hierarchy where it starts at simple number/definition and progresses to the higher level. Knowledge applied in the contexts becomes wisdom and this is essential to the NP/MD practice.

Data, Information, Knowledge, and Wisdom (uoregon.edu)

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What is the difference between Data, Information, Knowledge and Wisdom? - Serious Insights

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A post that explores the question: What is the difference between Data, Information, Knowledge and Wisdom? written by Serious Insights Principal Analyst Daniel W. Rasmus.

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What is meaningful use? | athenahealth
The overall goal of the Meaningful Use program is to promote the widespread adoption of electronic health records systems, ultimately creating an infrastructure that improves the quality, safety and efficiency of patient care in the United States.

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EHR/EMR: Overview of the Meaningful Use & Certification Criteria

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What is the History of Electronic Health Records? - Bing video

An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports
The EHR automates access to information and has the potential to streamline the clinician's workflow.  The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

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Interoperability of Electronic Health Records- Benefits and Opportunities

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HIE allows doctors, nurses, pharmacists and other providers to share patient information in a secure, timely and efficient manner. This enables them to collaborate and consider their patients’ full medical history, medications, and other data to make informed decisions, improve diagnosis, avoid duplicative testing, and reduce medical errors and re-admissions. The electronic exchange of actionable information improves the quality, safety and efficiency of health care.

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health information exchange - Bing video

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Understanding the State's Health Information Exchange (HIE)

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The Next Evolution of Telehealth and What It Will Take to Get There (hitconsultant.net)

Healthcare organizations will need to implement telehealth for use cases beyond the reactive video-only model they’ve grown used to during COVID. Now, there is an innate need for telehealth to encompass a broader range of conditions and contexts across the whole care continuum.

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20+ Telehealth tips from a certified TeleMental Health therapist - advice for private ...

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What is Gamification? Examples and Best Practices in eLearning (valamis.com)

Gamification is the process of using game mechanics, elements, and principles and applying them to non-game contexts to engage users better.

Gamification can be used in many different contexts. Businesses often apply gamification to employee training, recruitment, evaluation, and organizational productivity

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gamification in healthcare industry - Bing video

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Bringing gamification into healthcare with Jim Feng of Phyxable

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Optimizing EMR Workflow to Reduce Medical Errors & Physician Frustration - Bing video

Medication Errors Rank Among Most

Limiting the use of copy-paste functionality, using simple EHR interfaces, improving EHR training, and promoting health IT standardization can help to reduce the likelihood of EHR-related patient safety threats.Common EHR-Related Issues (ehrintelligence.com)

02 Alarm Fatigue - Bing video

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healthcare med errors and EHR - Bing video

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Amazon Comprehend Medical is a HIPAA-eligible natural language processing (NLP) service that uses machine learning that has been pre-trained to understand and extract health data from medical text, such as prescriptions, procedures, or diagnoses.

Extract Health Data - Amazon Comprehend Medical – Amazon Web Services

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privacy and security in healthcare - Bing video

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Security, privacy, and compliance solutions for healthcare

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Data Storytelling: How to Tell a Story With Data - Venngage

How Facts and Data Tell the Story of the Covid Pandemic - Bing video

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The Cat in the Hat Knows a lot about Data Visualization

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The Infographic Guide to Medicine | AccessMedicine | McGraw Hill that features trusted medical content from the best minds in medicine. (mhmedical.com)

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use of inforgraphics in medicine - Bing video

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FALSE: Infographic on correct way to wear surgical masks

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Legal and Ethical Issues in Health Informatics | USF Health Online

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Four years ago, inside the most prestigious hospital in Tennessee, nurse RaDonda Vaught withdrew a vial from an electronic medication cabinet, administered the drug to a patient and somehow overlooked signs of a terrible and deadly mistake.

The patient was supposed to get Versed, a sedative intended to calm her before being scanned in a large, MRI-like machine. But Vaught accidentally grabbed vecuronium, a powerful paralyzer, which stopped the patient's breathing and left her brain-dead before the error was discovered.

Vaught, 38, admitted her mistake at a Tennessee Board of Nursing hearing last year, saying she became "complacent" in her job and "distracted" by a trainee while operating the computerized medication cabinet. She did not shirk responsibility for the error, but she said the blame was not hers alone.

"I know the reason this patient is no longer here is because of me," Vaught said, starting to cry. "There won't ever be a day that goes by that I don't think about what I did."

If Vaught's story had followed the path of most medical errors, it would have been over hours later, when the Tennessee Board of Nursing revoked her license and almost certainly ended her nursing career.

But Vaught's case is different: This week, she goes on trial in Nashville on criminal charges of reckless homicide and felony abuse of an impaired adult for the killing of Charlene Murphey, the 75-year-old patient who died at Vanderbilt University Medical Center in late December 2017. If convicted of reckless homicide, Vaught faces up to 12 years in prison.

Prosecutors do not allege in their court filings that Vaught intended to hurt Murphey or was impaired by any substance when she made the mistake, so her prosecution is a rare example of a health care worker facing years in prison for a medical error. Fatal errors are generally handled by licensing boards and civil courts. And experts say prosecutions like Vaught's loom large for a profession terrified of the criminalization of such mistakes - especially because her case hinges on an automated system for dispensing drugs that many nurses use every day.

The Nashville District Attorney's Office declined to discuss Vaught's trial. Vaught's lawyer, Peter Strianse, did not respond to requests for comment. Vanderbilt University Medical Center has repeatedly declined to comment on Vaught's trial or its procedures.

Vaught's trial will be watched by nurses nationwide, many of whom worry a conviction may set a precedent - as the coronavirus pandemic leaves countless nurses exhausted, demoralized and likely more prone to error.

Janie Harvey Garner, a St. Louis registered nurse and founder of Show Me Your Stethoscope, a nurses group with more than 600,000 members on Facebook, said the group has closely watched Vaught's case for years out of concern for her fate - and their own.

Garner said most nurses know all too well the pressures that contribute to such an error: long hours, crowded hospitals, imperfect protocols and the inevitable creep of complacency in a job with daily life-or-death stakes.

Garner said she once switched powerful medications just as Vaught did and caught her mistake only in a last-minute triple-check.

"In response to a story like this one, there are two kinds of nurses," Garner said. "You have the nurses who assume they would never make a mistake like that, and usually it's because they don't realize they could. And the second kind are the ones who know this could happen, any day, no matter how careful they are. This could be me. I could be RaDonda."

As the trial begins, Nashville prosecutors will argue that Vaught's error was anything but a common mistake any nurse could make. Prosecutors will say she ignored a cascade of warnings that led to the deadly error.

The case hinges on the nurse's use of an electronic medication cabinet, a computerized device that dispenses a range of drugs. According to documents filed in the case, Vaught initially tried to withdraw Versed from a cabinet by typing "VE" into its search function without realizing she should have been looking for its generic name, midazolam. When the cabinet did not produce Versed, Vaught triggered an override that unlocked a much larger swath of medications, then searched for "VE" again. This time, the cabinet offered vecuronium.

Vaught then overlooked or bypassed at least five warnings or pop-ups saying she was withdrawing a paralyzing medication, documents state. She also did not recognize that Versed is a liquid but vecuronium is a powder that must be mixed into liquid, documents state.

Finally, just before injecting the vecuronium, Vaught stuck a syringe into the vial, which would have required her to "look directly" at a bottle cap that read "Warning: Paralyzing Agent," the DA's documents state.

The DA's office points to this override as central to Vaught's reckless homicide charge. Vaught acknowledges she performed an override on the cabinet. But she and others say overrides are a normal operating procedure used daily at hospitals.

While testifying before the nursing board last year, foreshadowing her defense in the upcoming trial, Vaught said that at the time of Murphey's death, Vanderbilt was instructing nurses to use overrides to overcome cabinet delays and constant technical problems caused by an ongoing overhaul of the hospital's electronic health records system.

Murphey's care alone required at least 20 cabinet overrides in just three days, Vaught said.

"Overriding was something we did as part of our practice every day," Vaught said. "You couldn't get a bag of fluids for a patient without using an override function."

Overrides are common outside of Vanderbilt, too, according to experts following Vaught's case.

Michael Cohen, president emeritus of the Institute for Safe Medication Practices, and Lorie Brown, past president of the American Association of Nurse Attorneys, each said it is common for nurses to use an override to obtain medication in a hospital.

But Cohen and Brown stressed that even with an override, it should not have been so easy to access vecuronium.

"This is a medication that you should never, ever, be able to override to," Brown said. "It's probably the most dangerous medication out there."

Cohen said that in response to Vaught's case, manufacturers of medication cabinets modified the devices' software to require up to five letters to be typed when searching for drugs during an override, but not all hospitals have implemented this safeguard. Two years after Vaught's error, Cohen's organization documented a "strikingly similar" incident in which another nurse swapped Versed with another drug, verapamil, while using an override and searching with just the first few letters. That incident did not result in a patient's death or criminal prosecution, Cohen said.

Maureen Shawn Kennedy, the editor-in-chief emerita of the American Journal of Nursing, wrote in 2019 that Vaught's case was "every nurse's nightmare."

In the pandemic, she said, this is truer than ever.

"We know that the more patients a nurse has, the more room there is for errors," Kennedy said. "We know that when nurses work longer shifts, there is more room for errors. So I think nurses get very concerned because they know this could be them."
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).

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As a nurse faces prison for a deadly error, her colleagues worry: Could I be next?

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Four years ago, inside the most prestigious hospital in Tennessee, nurse RaDonda Vaught withdrew a vial from an electronic medication cabinet, administered the drug to a patient and somehow overlooked signs of a terrible and deadly mistake. The patient was supposed to get Versed, a sedative intended to calm her before being scanned in a large, MRI-like machine.