Nursing Informatics

1. Nursing Informatics Ann Shepard, RNC, MSN Director, Customer Support Services Information Technology Mercy Medical Center-Des Moines

2. Objectives • Introduce Nursing Informatics • Certification for Nursing Informatics • Application of Nursing Informatics • Future of NI

3. How it all began…. • Late 1960’s first computer systems were implemented in hospitals • Computer nurses began to appear in hospitals • Excellent clinicians • Technically curious and willing to try new things

4. …or did it? The First Informatics Nurse? • “In attempting to arrive at the truth, I have applied everywhere for information, but scarcely an instance have I been able to obtain hospital records for any purposes of comparison. If they could be obtained, they would enable us to decide many other questions besides the one alluded to. They would show subscribers how their money was spent, what amount of good was really being done with it, or whether the money was not doing mischief rather than good.”

5. NI as a specialty • Disconnected parts • Roles, titles, and responsibilities varied • Definitions similar, conceptual models considered, research in varied directions, all good—standard languages • Panel assembled to help sort out the pieces

6. Definitions • 1989—Graves and Corcoran defined Nursing Informatics as • “Computer science, information science, and nursing science combined 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.” Image, p. 227

7. 1996—Turley defined Nursing Informatics as the intersection point with Nursing Science, Computer Science and Information Science. • 1995—Graves et al, began to incorporate knowledge as a product of the sciences into the definition.

8. National Center for Nursing Research • Began in 1988 • Noted scholars met to discuss priorities for nursing research • Dr. Gloria Bulechek, Dr. Judith Graves, Dr. Susan Grobe • Dr. Kathryn Hannah, Dr. Norma Lang, Dr. Judy Ozbolt, Dr. Wm Paisley, Elliott Roberts, Dr. Samuel Schultz, and Rita Zielstorff • Determined ‘Criteria for Promising Dimensions’ • Group discussed early needs for standardization of data sets, taxonomy to classify and allow for use of a common language • Developed seven focus areas for Nursing Informatics • NCNR 1993 • Reference available on line: http://www.nih.gov/ninr/research/vol4/Overview.html

9. American Nurses Association • Recognized as a specialty in 1992 • Defined NI, outlined roles and responsibilities and developed standards for practice. • Certification for generalist www.ana.org ANCC (American Nurses Credentialing Center)

10. American Nurses Association • 1994, Scope of Practice for Nursing Informatics • “Nursing Informatics is the specialty that integrates nursing science, computer science, and information science in identifying, collecting, processing, and managing data and information to support nursing practice, administration, education, research, and the expansion of nursing knowledge”.

11. ANA today • 2001, Scope and Standards of Nursing Informatics Practice • NI is an evolving field—expect change in definitions • Three categories of definitions • Technology focused • Conceptually focused • Role-Orientated To order or for additional info on the booklet: www.nursebooks.org (part of the ANA web site)

12. New Definition -- ANA • “Nursing Informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate date, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of 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 (2001)p. 17

13. Certification • Began in 1995 • First computer based exam—able to take at any time at any approved testing location • Knowledge expected of a NI generalist • Focus areas of knowledge—from the NCNR recommendations for focus

14. Exam Focus Areas • System Analysis and Design • System Implementation and Support • System Testing and Evaluation • Human Factors • Computer Technology • Information/Database Management • Professional Practice/Trends and Issues • Theories

15. System Analysis and Design • Conducting need and feasibility assessments • Process flow charting • Understanding requirements • Quality management and customer satisfaction concepts

16. System Implementation and Support • Project management strategies • Policies and procedures • Education and training • Communication • Vendor management • Customer expectations

17. System Testing and Evaluation • Will it do what we hoped it would for the costs we thought in the time frame we planned? • This is our strength--assessment • Design process • Testing the system • Reviewing output of the system—reports • Measurement of pre-system goals • Less time, more efficiently, legibility, accurate data, single entry, etc

18. Human Factors • Ergonomics • Right tool for the location, the care delivered, the care provider • Screen flow, use of data for decisions

19. Computer Technology • Understanding of the actual technology • Networks • Personal computers • Portable devices • Operating systems • Software

20. Information/Database Management • Understand database architecture—how data is stored and accessed • Nursing structure • Nomenclature/vocabulary • Taxonomies and Coding Schemes • ICD-P, CPT • Nursing Minimum Data Sets • NIC,NOC, NANDA,

21. Theories • Nursing Communication • Management Systems • Information • Computer • Behavioral • Change theory • Organizational behavior • Learning

22. Professional Practice/Trends and Issues • Ethics • Privacy • Roles of NI • Project Manager Researcher • Educator Consultant • Advocate/Policy Developer Product Developer • Decision Support / Outcomes Manager

23. Future of Nursing Informatics • Emerging roles • CIO, Entrepreneurs, Product Developers, Web design, Independent Consultants • Challenges • Integration of data—duplication often • Inability to access data for decision making • Unique distinctions between roles has not been defined--competencies

24. Questions?

25. References • American Nurses Association (ANA). (1996). The scope of practice for nursing informatics. Washington, DC: Author • American Nurses Association (ANA). (2001). Scope and standards of nursing informatics practice. Washington, DC: Author. • Graves, J.R. & Corcoran, S. (1989). The study of nursing informatics. Image, 21(4), 227-231. • Graves, J.R., Amos. L.K., Huether, S., Lange, L., and Thompson, C.B. (1995). Description of a graduate program in clinic nursing informatics. Computers in Nursing,13, 60-70.

26. National Center for Nursing Research (NCNR). (1993). Nursing informatics: Enhancing patient care: A report to the NCNR priority expert panel on nursing informatics/national center for nursing research. NIH Publication No. 93-2419. Bethesda, MD: U.S. Department of Health and Human Services. • Turley, J.P. (1996). Toward a model for nursing informatics, Image, 28(4), 309-313.