501 Clinical Software: Tools of the Health Trade Visionary Executive Leadership with Nursing Informatics as the Tool

1. 501 Clinical Software: Tools of the Health TradeVisionary Executive Leadership with Nursing Informatics as the Tool Kathryn G. Sapnas, PhD, RN, CCRN, CNOR Christine A. Gregory, RN, MS, MBA, FACHE Brenda S. Stidham, RN, MSPH

2. Nursing Informatics (NI)Kathryn G. Sapnas, PhD, RN, CCRN, CNORChief Nurse Research, Informatics & EducationMiami VA Healthcare System

3. Information Age - Natural Evolution Florence Nightingale (1842) was recognized as first Nurse Informaticist for her use of data that created information used to develop knowledge & improve health. • Modern Nursing • Information Age • Patient Safety • Point of Care Technology

4. Evolution Nursing Informatics MANAGEMENT PROCESSING DATA INFORMATION KNOWLEDGE • Definition: “combination of computer science, information science, and nursing science designed to assist in the management and processing of nursing data, information, and knowledge to support the practice of nursing and the delivery of nursing care. ”(p. 227)Graves and Corcoran (1989)

5. Nursing Informatics Specialty • 1st ANA Scope and Standards of Practice was expanded Graves & Corcoran (1989) definition • Specialty NI first identified in 1992 & supporting nursing: • Practice • Education • Research • Administration • Focus on “management & communication of nursing information within the broader context of health informatics” • NI is a specialty that contributes to advance of nursing knowledge (ANA Scope & Standards of Nursing Informatics Practice, 2001 p.1)

6. Nursing Informatics…..Defined “The use of information technologies in relation to those functions within the purview of nursing, and that are carried out by nurses when performing their duties. Therefore, any use of information technologies by nurses in relation to the care of their patients, the administration of health care facilities, or the educational preparation of individuals to practice the discipline is considered nursing informatics (p. 3).“ (Turley, 1996)

7. Current ANA NI Definition 2001 ANA Scope & Standards for NI Practice: “…a specialty that integrates nursing science, computer science,and information science to manage and communicate data, information and knowledge in nursing practice. Nursing informatics facilitates integrationof data, information and knowledge to support 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”. • ANA 2007 revised NI definition pending • To include the concept of “wisdom”,reflectingcomplexity and human intellectin transforming data to knowledge .

8. Nursing Informatics Competencies Informatics Nurse Specialist skills common to Nurse Executive skills • Computer literacy skills • Information literacy skills • Project management skills • Information management and communication • Make judgments based on data trends & patterns • Consultant

9. Evolution Nursing Informatics MANAGEMENT PROCESSING DATA INFORMATION KNOWLEDGE • (Graves and Corcoran, 1989)

10. Model of Visionary Nursing Leadership PROCESS STRUCTURE OUTCOMES NURSING PRACTICE DELIVERY

11. Model of Visionary Nursing Leadership MANAGEMENT PROCESSING STRUCTURE PROCESS DATA INFORMATION KNOWLEDGE OUTCOMES (Adapted from Graves & Corcoran, 1989)

12. Leadership & Informatics Cuts across all ONS strategic goals

13. ONS Mission • The Office of Nursing Services (ONS) provides leadership, guidance and strategic direction on all issues related to nursing practice and nursing workforce for clinical programs across the continuum of care and across the spectrum of care delivery sites that impact our veterans. • Visionary nursing leaders use “informatics as a tool” to guide and influence improvements in patient safety, satisfaction and outcomes with nursing recruitment, recognition and retention efforts.

14. Nurse IV Practice Implements technology solutions to assess, design & measure programs Quality of Care… Identifies outcomes Leads PI teams Designs practice changes to improve & evaluate outcomes Resource Utilization Manages resources Ethics Data protection Performance Measures Education/ Career Development Research Collaboration Collegiality Nurse V Practice Communication Coordination Evaluation HDPM – creativity Quality of Care… - Data-driven decision making -Evaluates outcomes -Benchmarks -Forecasts -Uses satisfaction indicators Performance Measures Assess, Analyze, Predict, Respond Education/ Career Development Resource Utilization Ethics Research Collaboration Collegiality Nursing Informatics & VA Nursing Qualification Standards

15. VA Nurse Executive Practice and American Nursing Association (ANA) Scope & Standards NI Examples - Nurse Executive Role • Incorporate technology solutions into safe and efficient patient care delivery and nursing workflow • Communicate across and within services • Assess workflow and patient throughput systems • Implement technology- Clinical information systems, & patient-centered information systems, equipment • Data-driven decisions in evaluating staff and program performance, as well as patient outcomes • Forecast resources based on trends • Assure ethical and moral solutions for data and information security

16. ANA Scope & Standards Nursing for Informatics Practice • 6 Domains of NI Practice • System Lifecycle • Human Factors • Information Technology • Information Management • Professional Practice • Models and Theories

17. Domains of NI Practice • System Life Cycle • Plans • Analysis • Design • Implementation & Testing • Evaluation, Maintenance & Support • Human Factors • Ergonomics • Software user interface

18. Domains of NI Practice • Information Technology • Hardware • Software • Communication • Data Representation • Security • Information Management • Data • Information • Knowledge

19. Domains of NI Practice • Professional Practice • Roles • Trends & Issues • Ethics • Models and Theories • Foundations in Nursing Informatics • Nursing & Healthcare data sets, classification systems, & nomenclatures • Related theories & sciences

20. Specialty NI Organization & Certification American Nursing Informatics Association (ANIA) • Mission is to provide networking, education and information resources that enrich and strengthen the roles of nurses in the field of informatics. • Purpose is to provide professional networking opportunities for nurses working in healthcare informatics and a forum for the advancement of nursing and nursing professionals in informatics. http://www.ania.org

21. Nursing Administrative Specialty American Organization of Nursing Executives (AONE) - Vision is to “shape the future of health care through innovative nursing leadership”. - Mission is to “ represent nurse leaders who improve health care”. Members are leaders in collaboration and catalysts for innovation.  

22. Hallmarks of AONE Leadership Core Businesses: Education & Leadership Development Public Policy Advocacy Career Development Information Resources Local Chapters Research Values: Creativity Excellence Integrity Leadership Stewardship Behaviors: Futurist Synthesizer Partner Convener Provocateur Designer Broker

23. AONE Strategic Plan • Design of Future Healthcare Delivery Systems • Design • Implementation • Evaluation • Leverage human, technological and financial resources • High quality, safe & patient-centered AONE technology related initiative developed a resource to assist Nurse Executives in technology acquisition implementation.

24. Technology Informatics Guiding Educational Reform TIGER SUMMIT 2006: A collaboration of “thought leaders” & stakeholders invited to create an actionable plan that will prepare nurses to practice in an increasingly automated health care environment 

25. TIGER Summit Collective Vision • 10-year vision with "vision statements" for each of 7 “pillars” of the plan in the ideal, future state • 3 year actionable plan • 7 pillars (domains) identified: - Policy - Culture - Information Technology - Management & Leadership -Education - Informatics Design - Communication & Collaboration

26. TIGER…a 10 year VISION https://www.tigersummit.com/

27. Assumptions •  The "practice" of nurses is in reference to "point of care" services that nurses provide across the continuum of care (home, hospital, ambulatory, long-term care, etc.) 2)  The "education" of nurses is in reference to all nursing preparation (all degree preparation and specific role preparation, e.g., Advance Practice Nurses). https://www.tigersummit.com/uploads/TIGERInitiative_Report2007_bw.pdf

28. Management & Leadership Key Actions: To champion & support informatics integration into the day-to-day practice of nurses and student education through: • Creating Shared Vision • Courageous Leadership, • Direction and Support Vision Statement:Revolutionary leadership that drives, empowers, and executes the transformation of healthcare.

29. Communication & Collaboration Key Actions: • Organize stakeholders & establish, disseminate, & support vision, core values, & goals • Benchmark, measure, & report criteria documenting communication & collaboration outcomes Vision Statement:Standardized, person-centered, technology-enabled processes to facilitate teamwork & relationships across care continuum

30. Informatics Design Key Actions • Include multidisciplinary end-users in integration/incorporation & design of intuitive, affordable, usable, responsive, evidence-based informatics across care continuum • Develop guidelines for integrating informatics infrastructure • Design systems that promote the mining and use of data for analysis, clinical decision-making, and measurement to improve the quality of care. • Create and implement multidisciplinary, multilingual standards. Vision Statement:Evidence-based, interoperable intelligence systems that support education and practice to foster quality care and safety.

31. Culture Key Actions • National campaign to promote multidisciplinary value of technology that supports an accepting culture. • Include HIT in every strategic plan, mission and vision statement. • Evaluate current processes & redesign as needed. • HIT use embraced (and value articulated) by executives, deans, all personnel (including point-of-care clinicians), staff & students. • Establish multidisciplinary teams embracing shared vision & push for broad technology integration across entire system. • Develop mutual respect among clinicians who may bring different skills and knowledge (ex: "two-way mentoring”). • Culture supports/promotes HIT adoption & discourages "workarounds"; is non-punitive. Vision Statement:A respectful, open system that leverages HIT across multiple disciplines in an environment where all stakeholders trust each other to work together toward the goal of high quality and safety.

32. State of VA Nursing Informatics • Realignment of Technology Goal Group • Clinical Databases CPRS, BCMA enhancements • Patient-Centered Informatics (My Health e-Vet) • VANOD • Performance Measures • Bar Code Medication Administration • Bar Code Expansion • Disaster Informatics Technology Assessment

33. Data-Driven Decision-Making for the Nurse ExecutiveChristine A. Gregory, RN, MS, MBA, FACHEAssociate DirectorPatient Care Services/Nurse ExecutiveVA Central Iowa Health Care System

34. Data-Driven Decision Making • Two Focus Areas Today: • Budgeting and Costs • Workforce Issues

35. Part One: Budgeting • Opportunities for Data-Driven Decision Making • Communication Tool

36. Budget Preparation Process • Corporate Strategy Development • Making Projections • Operational Planning

37. Cost Concepts and Control • Four cost-behavior skill sets needed: - Asset Valuation - Managerial Control - Decision Making - Volume

38. Monitoring • Ongoing process with a variety of tools that capture actual performance to goals • Managers are expected to explain all variances

39. Financial Context • Put data into a financial framework for better understanding: - Basic accounting concepts and language of accountants - Assessments of the financial health of the organization and how that is affecting area of responsibility - Familiarity with common indicators used in financial analysis

40. Putting theories to work: • Four skill sets needed in data-driven decision making: • 1. Obtaining the data (the data miner) • - A data miner is a human interface between raw numbers and the decision maker • - Miners focus on integrity, quality, objectivity, and completeness of data • - Software options available to miners: VSSC Website, national and VISN Proclarity Cubes, Crystal Reports

41. Putting theories to work: • Skill Sets Continued…… • 2.Understanding and establishing context (the subject matter expert) • - Subject matter experts like Nursing ADPACS or Nurse Managers work with the miner to validate data • 3. Sharing and presenting the data • - Most software tools like Proclarity and Crystal interact with Excel to publish concise, automatically updated reports • - Sharepoint is new alternative to websites; can provide strict access, discussion boards, and contact with a wide audience in one application

42. Putting theories to work: • Skill Sets Continued…… 4. Translating numbers to information and action: the decision maker Let’s get started with the real data: - Tracking direct and controllable costs is key function of nurse execs: One good example (or your worst nightmare): Overtime!

43. Understanding Data: Start with the Big Picture • Nursing overtime at the national to local level

44. Understanding Data: Drilling Down Visn 23 Proclarity cubes allow us to examine each unit’s budget and patient activities. Nurse Managers and service line directors receive these reports monthly.

45. Using Data in the Budget Process • Earlier, we said financial managers also look at past performance to predict the future, as part of the corporate budgeting process. • Access to accurate, consistent data with varying levels of detail is essential • Requires teamwork between data miners in various departments; creates a merger of customized data

46. Using Data in the Budget Process For example, Central Iowa uses several electronic sources to publish an overall facility snapshot, including an overall nursing measure. Several data miners collaborate on this project.

47. Using Data in the Budget Process Service line leaders can drill down from the master dashboard to this document. This nursing data is obtained through Proclarity VISN 23 Cubes and is automatically updated bi-weekly.

48. Sharing the Data • Sharing data is essential! • - Miner and subject-matter expert share with decision-maker to add strength to eventual decisions or actions • - Decision-maker shares with front-line staff to support rationales for decisions made, encourages buy-in and teamwork • - Several options available for sharing mechanism: • Proclarity briefing books on VISN servers • Excel workbooks on facility shared drives • Sharepoint: CIH’s mechanism of choice

49. Sharing the Data at the VISN Level

50. Sharing the Data at the VISN Level NEs can drill down from the Sharepoint home page to a document library with folders for each facility. Each folder holds Excel documents still linked to their Proclarity data source for easy, automatic update each month. Data includes patient activity, staff and payroll information. Only Nurse Execs in V23 can access these folders.