NURSING INFORMATICS AND HEALTHCARE POLICY

1. NURSING INFORMATICS AND HEALTHCARE POLICY

2. HEALTHCARE POLICY AND NURSING INFORMATICS AS A SPECIALTY • Nurses have contributed to the purchase, design, and implementation of IS since the 1970s. • In 1992, the American Nurses Association (ANA) recognized NI as a specialty. • Attempts in 1989 to be recognized as a specialty failed, but political forces within ANA supported the requests when it was repeated in 1992.

3. To be acknowledged as a specialty with nursing, informatics had to demonstrate a differentiated practice base, identify the existence of educational programs in the field, show support from nationally recognized organizations, and develop a research agenda. Nursing Informatics (NI) -The term NI first appeared in the literature in the 1980’s. -The definition of NI has constantly evolved since that time, molded by the maturation of the field and influenced by health policy.

4. NI was defined as the combination of nursing, information, and computer sciences to manage and process nursing data into information and knowledge for use in nursing practice. • A specialty that integrates nursing science, computer science, and information science to manage and to communicate data, information, and knowledge in nursing practice.

5. The domain of NI is focused on data and it’s structures, information management, and the technology, including database, needed to manage information effectively • Also include significant use of theory from linguistics, human-machine interface, decision science, cognitive science, communication, engineering, library science and organizational dynamics.

6. DIFFERENTIATED AND INTERDISCIPLINARY PRACTICE • As the document emphasizes, NI brings an added dimension to nursing practice that focuses on knowledge and skill in information and information management techniques. • NI practice differentiates itself from other areas of nursing practice but emphasizes its interaction with informatics disciplines such as mathematics, statistics, linguistics, engineering, computer science and health informatics.

7. NI has been described as one example of a specific domain of informatics that falls under a broader umbrella of health informatics • Other examples of domain- specific informatics practices are medical informatics, dental informatics and consumer informatics

8. PREPARATION FOR SPECIALTY PRACTICE • To become a specialty, it was necessary for NI to show that educational programs are available to prepare nurses to practice in the field. • Between 1988 and 1992 the Division of Nursing (DN), Health and Human Services Administration (HRSA), funded two Master’s NI programs, University of Maryland and University of Utah and one doctoral program in NI at the University of Maryland.

9. Finally, in 1997, an NI specialty program was implemented at Duquesne University in Pittsburgh • The field of NI has slowly expanded since 1992.

10. HEALTHCARE POLICY IMPACT ON NURSING INFORMATICS PRACTICE NURSING SHORTAGE AND NURSING INFORMATICS • Nursing has experienced a number of shortages in recent history. • It is predicted that the shortage will result in a large deficit of nurses • Unless something is done the shortage will rise from 6% in 2000 to 29% in 2020, or more than 800,000 nurses short of the number needed

11. To cover these new positions and replace retiring nurses 1.1 million more nurses are needed by 2012. • Nursing organizations have been actively advocating for increased federal funding to expand programs and increase loans, scholarship, and incentives to attract more young people into nursing. • In 2002 the AAN Commission on Workforce launched a multiphase project to develop IT

12. that will help support nurses in their day-to-day Work, thereby reducing the demands of their jobs. *Given the average age of nurses is 45.2, technology devices would enable some nurses to stay in their careers longer.

13. PATIENT SAFETY AND NURSING INFORMATICS • The IOM determined that adverse events (injuries caused by medical management) occurred in 2.9 and 3.7% of admission • Among other strategies the report recommended the implementation of computerized physician order entry (CPOE) systems to reduce medication errors. • A follow-up report, strengthens the arguments for using technology to improve patient safety.

14. Proposals to increase patient safety with IT have been made by a variety of groups. • The National Alliance for Health Information Technology (NAHIT) is a partnership of diverse healthcare leaders who are working to influence the use of technology to improve the patient safety, quality and efficiency.

15. NATIONAL INFORMATION INITIATIVES AND NURSING INFORMATICS • Clinical information systems (CIS) were introduced in some form during the 1970s and informatics professionals have discussed the need for system improvement, integration, and wider dissemination since that time. • Escalating healthcare costs and the availability of improved and cheaper CIS are additional driving forces.

16. An additional IOM report states even more emphatically that electronic medical records, using standard data elements, are a critical tool to improve patient safety • On April 27, 2004, Pres. George W. Bush issued an executive order “ Incentives for the Use of Health Information and Technology and Establishing the Position of the National Health Information Technology Coordinator.

17. Components of the order are (1) establish a national health information technology coordinator position; (2) work to develop a nationwide interoperable health IT infrastructure; and (3) develop, maintain, and direct implementation of strategic plan to guide implementation of interoperable health IT in both public and private sectors.

18. NATIONAL HEALTH INFORMATION INFRASTRUCTURE • Another national initiative that will impact NI is the National Health Information Infrastructure (NHII). This voluntary initiative, involving a three-stage process over 10 years, is intended to improve the effectiveness, efficiency and overall quality of health and healthcare in the US. • The vision and process for building the NHII is outlined in a report “Information for Health Information Infrastructure released in Nov. 2001

19. NHII calls for comprehensive knowledge based networks that integrate clinical, public health and personal health information to improve decision making by having information available to providers.

20. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) • HIPAA was passed in 1996 and is intended to improve public and private health programs by establishing standards to facilitate the efficient transmission of electronic health information (Public Law,104-191, 1996) • HIPAA preempts state law and payer-specific variations of data standards; and mandates input from private, standard-setting organization.

21. The law also designates financial setting penalties for noncompliance with standards related specific transactions. • To avoid further duplication of effort, the law requires the DHHS to adopt standards from those already approved by private standards-setting organizations. • HIPAA has a significant impact on informatics; IT must be designed to comply with Title II of the act.

22. NATIONAL AGENDA FOR NURSING INFROMATICS • The DN, HRSA is responsible for settg national policy to guide the preparation of the nursing workforce, including preparation in the area of NI. • The DN recognized the importance of information management and technology long before the title NI was used to describe the field of practice and has funded projects focused in this area since 1972. • Although the DN supported NI projects, the nursing workforce has continued to be deficient in informatics skills.

23. As a result, in 1997 the DN convened the National Nursing Informatics Work Group (NNIWG) to make recommendations to the National Advisory Council for Nurse Education and practice. • The first strategic direction of NI is to include core informatics knowledge and skill in all undergraduate, graduate, and continuing education programs. • The second strategic direction of NI is to increase the number of nurses with specialized skils in informatics. Having more opportunity to complete advanced informatics preparation has increased the number of NI specialists in practice, but more are needed.

24. A third strategic direction of NI is to enhance nursing practice and education through informatics projects. • The fourth strategic direction for NI is to improve faculty skills in NI so that they in turn can promote the development of informatics competency in students.

25. TELEHEALTH AND NURSING INFORMATICS • Telehealth is the use of electronic information and telecommunications technologies to support long distance clinical healthcare, patient and professional health-related education, public health, and health administration • There has been a significant disconnection between telehealth and informatics. Telehealth organizations such as te American Telemedicine Association are largely separate from informatics organizations, such as AMIA; the two entities need to become better aligned or promote development to seamlessly document telehealth events.

26. Informatics nurses need to help to integrate telehealth technologies and IS so that patient encounters became part of the computerized patient record and informatics issues such as standards and language are systematically addressed. • Informatics nurses need to become involved in telehealth and inform other nurses about uses of telehealth technologies