By Jeff Kabachinski, MS-T, BS-ETE, MCNE
Even though nursing informatics (NI) has been around for years—becoming an essential element of health care along the way—it is still not always considered a mature function, profession, or a community of practice. This month, our column looks at why this may not be the whole story. In addition, the intention of discussing this topic is to shine a light on something that goes on around biomeds every day. With a little insight, we can help nursing take advantage of NI as an expert system to bring the best that health care can provide to the patient. Conceptually, NI also can lighten the nursing documentation load to allow more time in direct health care delivery—more time with the patient. In one form or another, NI has been around a long time and has recently seen a resurgence as electronic health record (EHR) system use rises. It is time to take another look at NI.
The term NI is where information science, computer science, and providing health care interconnect. Add to the definition all the ways needed to optimize the acquiring, storing, retrieving, and using health care information, and you are getting closer. The official definition from the American Nursing Association (ANA) follows:
“Nursing Informatics (NI) is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology.”
Nursing Informatics: Practice Scope and Standards of Practice, ANA 2008.
|Nursing informatics is where information science, computer science, and providing health care interconnect, along with all the ways needed to optimize health care information.|
With the recent focus on EHR systems, there has been a knowledge explosion causing a transformation in providing health care. This has brought more pressure to the EHR system and to NI to reorganize and streamline processes and improve efficiency. This pressure only adds to the daily workload of the practitioner. The American Medical Informatics Association estimates that these practitioners spend as little as 15% on direct patient care but 50% on documentation. Information management naturally brings extra steps to the nursing practice. However, NI can bring the documentation/information to the point of care to help in health decisions. It is called evidence-based clinical practice. A well-designed NI system serves to bring together evidence-based clinical practice ideas from proven outcomes with clinical judgment to help provide effective and efficient health care.
Nursing informaticians, also known as nursing informaticists, can help ensure that systems support such a scenario. Their ability to work bilingually with IT as well as nursing helps to prevent costly mistakes by:
- Making sure the chosen EHR system works with the nurses’ current workflow.
- Making sure that the design of screens fit the nursing needs for documentation and use.
- Making sure that any associated education hits the specific needs of the nursing staff.
- Choosing suitable and preferred workflows.
- Outlining maintenance with system optimization based on nursing input.
By using clearly documented information, nursing informaticians can see what care has been provided and what care has yet to be provided, the care plan’s outcomes and responses, and current patient status. This new information is combined with other evidence-based clinical practice information to provide for future and new plans of care. Nursing informaticians then ensure that new plans of care are communicated and coordinated with all other clinical disciplines. This includes events like coordinated discharge planning, and education on transitions of care to the home.
Specialists in the Field
The ANA in 1992 acknowledged the position of a nursing informatics specialist. By 1995 it established a certification path via a credentialing exam. By November of that year, the American Nursing Credentialing Center was providing the exam. The ANA also defined three levels of an NI program by 2001 in its Practice Scope and Standards of Practice. The first level is the beginning nurse, then the experienced nurse, and on to informatics nursing specialist. The prerequisite list includes a baccalaureate degree at a minimum, an active and licensed RN with 2 years minimum experience, and at least 2,000 hours completed within the last 3 years as a practicing nursing informatician. There are several replacement prerequisites for different nursing backgrounds.
Nursing staff, to a large extent, has always been a collector and provider of medical information to other clinicians and consumers (patients and their families). These days, nursing staff needs to be computer savvy, as so much of what they do is via a network terminal or networked laptop. Nursing also continues to be enhanced by new technologies with nursing informaticians ensuring that the new technologies enhance the patient’s health care. After all, greater nursing satisfaction leads to greater patient satisfaction. 24×7 February 2013 Networking column
Jeff Kabachinski, MS-T, BS-ETE, MCNE, has more than 20 years of experience as an organizational development and training professional. He is the director of technical development for Aramark Healthcare Technologies in Charlotte, NC. For more information, contact
Some Examples of Nursing Informatics in Action
Nursing informatics (NI) and the nursing specialists in this area can assist in providing patients with the best health care available. The practicing nursing informatician has roles in administration in leadership and management, analysis, compliance, and as consultants. They coordinate, facilitate, and integrate. They also work in professional development and education, policy development, and research and evaluation. Among the top 10 staffing needs from a survey done by HIMSS from 2011 are clinical informaticist, network and architecture support, systems integration, clinical champions, and IT security. The survey went on to identify where a lack of qualified candidates exists, which included clinical informatics, network professionals, and system security. The same survey also points out that more than 50% of nursing informaticians report to IT, and about a third report to nursing. Below you will find some examples of nursing informatics.
Using technology—Nurses are active users of technology:
• They want devices that are integrated, portable, and wireless that can provide translations and are smart devices.
• They want technology that can provide better efficiencies, higher quality, and safe outcomes.
• Nursing documentation that provides reports.
• For staff scheduling.
• eMar, or the electronic medication administration record, that works with bar codes to impact patient safety by ensuring the correct medication is administered.
• 1950s: NI gets its start when computers first start to make the scene. As early as 1949, the first informatics professional organization was established in Germany. NI starts to make an impact in the US via dental projects using available digital electronic computers. The United States Air Force (USAF) also gets involved by using its computers to get involved with medical projects. The USAF also encourages nonmilitary agencies to get involved, mostly in footing the bill for such work. By 1959, a widely read science magazine article jump-starts health care community interest in using computer techniques in their work.
• 1960s: NI starts to make an appearance in universities that offer educational programs in Europe. The National Institutes of Health (NIH) spends more than $40 million (1960s dollars) between 1960 and 1964 to start up several biomedical research centers. The use of IBM mainframe computers was also being used to quantify human movement to help in the design of prostheses. Using such large computers helped to understand how human movement varies by age and body type.
Around 1965, Massachusetts General Hospital Utility Multi-Programming System (MUMPS) was written to support using multiple users on the memory-challenged computer equipment of the time. MassGen in Boston was one of the research projects supported by the NIH in exploring biomedical computing. MUMPS was a milestone in that with very terse code it was able to make the most of the hardware-limited computers of the time, allowing direct database applications supporting a multiple number of jobs running at the same time. This was in 2,048-byte memory partitions! Even 8-bit CPUs and 16K or 64K of available memory space were able to be used for multiple concurrent jobs. Its code was five to 10 times smaller than any other available at that time.
• 1970s: NI researching starts in Poland and the US. MUMPS continues to be the most common programming language for clinical operations. In 2004, the VA hospital system began using a version of MUMPS to support its Veterans Health Information Systems and Technology Architecture (or VistA) program—its electronic medical record system. It allows patients’ records to be reviewed and updated at any of the more than 1,000 VA facilities.