The Data-driven Nurse
With investments in health IT snowballing, healthcare organizations are realizing that nurses, the largest workforce in the U.S., must cooperate fully to realize the potential gains. The nursing informatics specialty is just emerging and growing pains are to be expected as nursing informaticists find their niche in the transformed healthcare landscape.
Mark Sugrue, RN, a consultant with Pricewaterhouse Coopers, uses this as the foundation of the nursing informatics definition he gives to clients. Hardware, software and other tangible technical assets of health IT are “just a small piece of what informatics is,” he says. Nursing informatics is about combining expertise of the three sciences cited in the ANA definition to derive best practices for evidence-based care.
The proliferation of health IT tools has required virtually all nurses to familiarize themselves with their use and to develop basic technological competencies, but using health IT tools doesn’t make a nursing informaticist, according to Stephanie Poe, RN, DNP, the chief nursing informatics officer (CNIO) and director of nursing, clinical quality at the John Hopkins Hospital in Baltimore.
“It’s information management, which extends beyond using a computer,” she says. “It’s marrying information management with clinical care and recognizing how they relate to and support one another.” Put more simply, nursing informaticists are defined by their bilingual abilities; they’re able to understand the languages of both the IT and nursing departments.
“Technology can be scary, especially if you’re not familiar with the lingo,” says Susan Stafford, MBA, MPA, RN, associate CNO of nursing informatics and quality at the Cleveland Clinic’s Zielony Nursing Institute in Cleveland. “Having someone who can understand the IT language and translate it into something that a staff nurse can understand is important.”
Possessing those competencies is becoming a requirement for all nurses, according to Melissa Barthold, RN, MSN, an internal IT consultant at the University of Mississippi Medical Center in Jackson.
“There are always going to be nursing informatics specialists, but nursing informatics competencies are something that every nurse has to have with the advent of health IT products and EHRs,” she says. “The technology is going to be as essential a part of patient care as the stethoscope or heart monitor.”
Today, the informatics team at the hospital is comprised of the CNO, CIO and clinical analysts from nursing, pharmacy and resipiratory therapy. Additionally, Medical Center Health System employs about 200 clinical super-users who work across all shifts to troubleshoot and assist staff and physicians with clinical IT systems. They report to the computerized interdisciplinary documentation (CID) experts, clinical staff with advanced informatics competencies who are sometimes pulled off of staffing duties to focus on IT initiatives. One CID expert works in unique specialty areas, such as critical care or acute care.
“We’re working with the informatics team to review the system, identify problem areas and update the system,” says McAllister. “Healthcare is still in its early stages, so the growing pains have been a little awkward.”
The Cleveland Clinic has had nursing informatics in practice for decades. The facility created the nursing information systems department in 1988, formally established it in 1993 and renamed it the nursing informatics department in 2006.
The department is comprised of 22 people—12 nursing informaticists and four registered nurses tasked with creating health IT guides for their colleagues. Nursing informatics liaisons work in each hospital to assist staff nurses, identify workflow problems and suggest changes, which are addressed at monthly meetings between the liaisons and nursing informatics department.
Each facility’s nursing informatics efforts is different. For example, although some of its nurses are specifically trained by the organization’s EHR vendor to gain competencies with the system, the University of Mississippi Medical Center’s informatics team includes only one nurse, Barthold, and there’s no designated leadership for nursing informatics.
This is in spite of what seems to be a large amount of support, at least among nursing informaticists, for implementing the CNIO role in healthcare organizations. CNIOs possess specialized knowledge that other nursing administrators either don’t possess or shouldn’t be expected to possess.
“There wasn’t always a lot to know about health IT,” says Barthold. “Now, this has changed drastically. It’s difficult to expect a nursing administrator to know everything about administration and everything about health IT that nursing informaticists know.”
As the CNIO for John Hopkins, Poe reports to both CNO and CIO, and she has a collaborative relationship with the CMIO. She is responsible for strategic and operational leadership in the development, deployment, re-engineering and integration of clinical IT systems. Some of her specific duties include maintaining the quality, safety and operational integrity of clinical IT systems and integrating quality improvement and regulatory standards into clinical IT systems. She also is the director of clinical quality for nursing, which she says makes sense since quality improvement is so intrinsically tied with IT systems now, especially with meaningful use requirements.
In its infancy, nursing informatics is making a bold promise to use clinical and IT knowledge to improve quality, reduce costs and increase access, but it has barely begun to crawl and barriers such as workforce shortages, scope of practice prohibitions and technical challenges will make standing difficult.
If anyone can overcome these barriers, it’s nurses, says Stafford. “We’re with the patients 24 hours a day, seven days a week. We never close. That puts us in a unique position to understand the continuity of care that’s required for quality patient outcome and using technology will help us leverage experience and information into good organizational decisions.”
Nursing informatics defined
The American Nurses Association (ANA) first recognized nursing informatics as a specialty in 1994 and has since published “Nursing Informatics: Practice Scope and Standards of Practice” three times. The most recent edition, published in 2008, defines nursing informatics as “a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice.”Mark Sugrue, RN, a consultant with Pricewaterhouse Coopers, uses this as the foundation of the nursing informatics definition he gives to clients. Hardware, software and other tangible technical assets of health IT are “just a small piece of what informatics is,” he says. Nursing informatics is about combining expertise of the three sciences cited in the ANA definition to derive best practices for evidence-based care.
The proliferation of health IT tools has required virtually all nurses to familiarize themselves with their use and to develop basic technological competencies, but using health IT tools doesn’t make a nursing informaticist, according to Stephanie Poe, RN, DNP, the chief nursing informatics officer (CNIO) and director of nursing, clinical quality at the John Hopkins Hospital in Baltimore.
“It’s information management, which extends beyond using a computer,” she says. “It’s marrying information management with clinical care and recognizing how they relate to and support one another.” Put more simply, nursing informaticists are defined by their bilingual abilities; they’re able to understand the languages of both the IT and nursing departments.
“Technology can be scary, especially if you’re not familiar with the lingo,” says Susan Stafford, MBA, MPA, RN, associate CNO of nursing informatics and quality at the Cleveland Clinic’s Zielony Nursing Institute in Cleveland. “Having someone who can understand the IT language and translate it into something that a staff nurse can understand is important.”
Possessing those competencies is becoming a requirement for all nurses, according to Melissa Barthold, RN, MSN, an internal IT consultant at the University of Mississippi Medical Center in Jackson.
“There are always going to be nursing informatics specialists, but nursing informatics competencies are something that every nurse has to have with the advent of health IT products and EHRs,” she says. “The technology is going to be as essential a part of patient care as the stethoscope or heart monitor.”
Organizing informatics teams
Medical Center Health System, a 402-bed regional medical center in Odessa, Texas, hired its first nursing informatics specialists in 2006. Since then, the facility has expanded its informatics team, used its nursing informatics specialists in various roles and placing them under the purview of different departments, says Marlene McAllister, RN, MSN, CNO of Medical Center Health System.Today, the informatics team at the hospital is comprised of the CNO, CIO and clinical analysts from nursing, pharmacy and resipiratory therapy. Additionally, Medical Center Health System employs about 200 clinical super-users who work across all shifts to troubleshoot and assist staff and physicians with clinical IT systems. They report to the computerized interdisciplinary documentation (CID) experts, clinical staff with advanced informatics competencies who are sometimes pulled off of staffing duties to focus on IT initiatives. One CID expert works in unique specialty areas, such as critical care or acute care.
“We’re working with the informatics team to review the system, identify problem areas and update the system,” says McAllister. “Healthcare is still in its early stages, so the growing pains have been a little awkward.”
The Cleveland Clinic has had nursing informatics in practice for decades. The facility created the nursing information systems department in 1988, formally established it in 1993 and renamed it the nursing informatics department in 2006.
The department is comprised of 22 people—12 nursing informaticists and four registered nurses tasked with creating health IT guides for their colleagues. Nursing informatics liaisons work in each hospital to assist staff nurses, identify workflow problems and suggest changes, which are addressed at monthly meetings between the liaisons and nursing informatics department.
Each facility’s nursing informatics efforts is different. For example, although some of its nurses are specifically trained by the organization’s EHR vendor to gain competencies with the system, the University of Mississippi Medical Center’s informatics team includes only one nurse, Barthold, and there’s no designated leadership for nursing informatics.
The CNIO
While nurses are using health IT tools and hospitals are integrating nursing informatics into delivery models, only 8 percent of providers reported having a designated CNIO compared with 30 percent who reported having a CMIO, based on the results of the 2011 nursing informatics workforce survey conducted by the Healthcare Information and Management Systems Society (HIMSS).This is in spite of what seems to be a large amount of support, at least among nursing informaticists, for implementing the CNIO role in healthcare organizations. CNIOs possess specialized knowledge that other nursing administrators either don’t possess or shouldn’t be expected to possess.
“There wasn’t always a lot to know about health IT,” says Barthold. “Now, this has changed drastically. It’s difficult to expect a nursing administrator to know everything about administration and everything about health IT that nursing informaticists know.”
As the CNIO for John Hopkins, Poe reports to both CNO and CIO, and she has a collaborative relationship with the CMIO. She is responsible for strategic and operational leadership in the development, deployment, re-engineering and integration of clinical IT systems. Some of her specific duties include maintaining the quality, safety and operational integrity of clinical IT systems and integrating quality improvement and regulatory standards into clinical IT systems. She also is the director of clinical quality for nursing, which she says makes sense since quality improvement is so intrinsically tied with IT systems now, especially with meaningful use requirements.
The future of nursing
Nursing education programs will need to do more to provide future nurses with informatics competencies, says Sugrue. “We need to prepare the next generation of nurses to work in an information-driven environment and informatics plays a large part in that,” he adds.In its infancy, nursing informatics is making a bold promise to use clinical and IT knowledge to improve quality, reduce costs and increase access, but it has barely begun to crawl and barriers such as workforce shortages, scope of practice prohibitions and technical challenges will make standing difficult.
If anyone can overcome these barriers, it’s nurses, says Stafford. “We’re with the patients 24 hours a day, seven days a week. We never close. That puts us in a unique position to understand the continuity of care that’s required for quality patient outcome and using technology will help us leverage experience and information into good organizational decisions.”