501 Nursing Informatics: Today s Emerging Roles Offer Innovative Solutions for Tomorrow

1. 1 #501 Nursing Informatics:� Today�s Emerging Roles Offer Innovative Solutions for Tomorrow Christine (Tina) Lund, MSN, RN, NEA-BC Diane Ocean, MSN, RN Kathryn Sapnas, PhD, RN, CCRN, CNOR �����������������������

2. 2 HOUSE KEEPING This will be a 90 minute class Restrooms are located� Please turn off Cell Phones or place on vibrate If you must answer a call, please leave the room. No questions during the presentation please! Questions written on the 3X5 card will be answered at the conclusion of the presentation. For questions not answered, the question and the answer will be available on the web. Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.Before we get started we need to take care of some Housekeeping issues. Restrooms are located.. If you have any questions please write them on the 3X5 card provided. Answers to your questions will be posted on the VEHU website. So please check the website when you return home.

3. 3 Presentation Outline Introduction: Tina Lund VA Role & Contributions of Nursing Informaticists: Diane Ocean Kathryn Sapnas Wrap-up: Tina Lund

4. 4 Learning Objectives Describe the scope and standards for nursing informatics. Describe the role of nursing informaticists in the VA. Describe general contributions to clinical and administrative health operations. List specific examples of how VA facilities have leveraged concrete benefits from utilizing Nursing Informaticists.

5. 5 Definition of Nursing Informatics �Nursing Informatics is 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 the integration of data, information, knowledge, and wisdom 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 Scope and Standards of Nursing Informatics Practice, 2008, pg 1)

6. 6 Definition of Nursing Informatics (2) Nursing informatics is using technology, research, and professional experience to manage nursing data, information, and knowledge to improve practice and deliver better health care. Simpson, Roy (2006). In H. A. Park, P. Murray,& C. Delaney, C. (Eds.). Consumer-Centered Computer-Supported Care for Healthy People. Amsterdam, Netherlands: IOS Press, p 5

7. 7 Functional Areas of Nursing Informatics : ANA Scope and Standards of Practice Administration, leadership and management Analysis Compliance & integrity management Consultation Coordination, facilitation, & integration Development Educational & professional development Policy development & advocacy Research evaluation

8. 8 American Nursing Informatics Association ANIA started 1992 -first opportunity for informatics nurses in So California to meet and network.� Non-profit organization with members across the US sharing common interests in informatics. ANIA's Mission is to provide networking, education and information resources that enrich and strengthen the roles of nurses in the field of informatics.� ANIA's 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.

9. 9 HIMMS 2005 Nursing Informatics Survey Role of the Nurse Informaticist -Understand the challenges -Evaluate workflow process and implications -Influence system design -Optimize information/communication tools -Address integration/interoperability Source: HIMMS 2005 Survey of the impact of Health Information Technology on the Role of Nurses and Interdisciplinary Communication

10. 10 HIMMS: What is Nursing Informatics? Presentations, publications and surveys on the functions of the nurse informaticist: http://www.himss.org/ASP/topics_FocusDynamic.asp?faid=243 Nursing and Informatics for the 21st Century: An International Look at Practice, Trends and the Future - Book (2/8/2008) Nursing Informatics 2007 Workforce Survey - Who Are We Now? - Survey Result (2/8/2008) Nursing Informatics 2004 Workforce Survey - Who are we? - Survey Result (2/8/2008) Nursing Informatics 101 - Presentation (2/8/2008) An Emerging Giant: Nursing Informatics - Other Pubs (11/13/2007)

11. 11 HIMSS 2007 Nursing Informatics Survey Nursing Informatics Job Titles 14% �clinical analysts� 14% �informatics nurse specialist� or �nursing informatics specialist� 9% �consultant� 40% identified �other� Director of Clinical Informatics, Clinical Informatics Coordinator, Clinical Systems Analyst, Clinical Informatics Specialist

12. 12 Nursing Informatics Certification ANCC � 23% Informatics Nurse http://www.nursecredentialing.org/ CPHIMS � 3% Certified Professional in Healthcare Information and Management Systems http://www.himss.org/ASP/CertificationHome.asp Other � 9% None � 55%

13. 13 Alliance for Nursing Informatics & the TIGER Initiative In 2007, ANI became the enabling organization for the TIGER (Technology Informatics Guiding Education Reform) initiative The TIGER initiative seeks to better prepare practicing nurses and nursing students to use technology and informatics to improve the delivery of patient care Phase one of TIGER engaged stakeholders to create a common vision of ideal EHR-enabled nursing practice Phase two of TIGER will facilitate collaboration among participating organizations to achieve the vision www.tigersummit.com

14. 14 Diane Ocean, MSN, RN

15. 15 Two Basic Topics What can I (an Informatics Nurse) do for you, a Nurse Executive? What can you do for me?

16. 16 A Day in the Life of a Nurse Admitting a patient Admission Assessment in computer Placing orders Requesting consults Sending data to VANOD Resolving clinical reminders These things involve a computer as well Take V/S Give medications Consent for surgery Make the bed

17. 17 A Day in the Life continued What if the computers are down? Use the computer! CPRS downtime BCMA downtime Computers are INTEGRAL to bedside practice

18. 18 What Can I Do For You? Workload statistics Performance monitoring Performance Improvement projects Identification of problem areas Before & After data Regulatory compliance

19. 19 What Can I Do For You? How many new orders written on Ward X in a day? How many medications given on Ward X in a week? Nurses bypassing BCMA by using Manual Medication Entry Show me all restraint orders for the past month List patients in the hospital for >24 hours without a VANOD skin assessment

20. 20 What Can I Do For You? TJC IG CARF CMS OSHA IHI Baldrige Magnet The Secretary Grey�s Anatomy

21. 21 What Can I Do For You? Documenting patient education Incorporated into daily charting MRSA swabs Ordered during Admission Assessment VANOD skin assessment Changed the directions to be more facility-specific

22. 22 What Can I Do For You? New applications The job isn�t over when the software is implemented Monitoring local usage Reporting to Oversight bodies Training

23. 23 What Can I Do For You? New employees Student nurses Updates Annual education/competency Ongoing reminders

24. 24 What Can I Do For You?

25. 25 What Can I Do For You? Software work groups Beta testing Maybe even Alpha testing? For the brave among you National presentations Oversight boards

26. 26 What Can I Do For You? Keep an ear to the ground Precepting You fill in the blank!

27. 27 What Can You Do For Me? Keep me in the loop Make your priorities clear to me Support the highest possible level of computer access Conferences Other learning opportunities Muscle prn

28. 28 Kathryn G. Sapnas, PhD, RN, CCRN, CNOR Chief Nurse, Research & Informatics Miami VA Healthcare System

29. 29 Objectives To describe the historical development and system redesign needed in creating a a department of Nursing Informatics (NI). To identify the linkage of NI, quality & safety and NI�s role in the ANCC MagnetTM journey. To highlight the leadership role in Nursing Informatics and relationship to care delivery.

30. 30 �Innovation distinguishes between a leader and a follower.� Steve Jobs �A leader has the vision and conviction that a dream can be achieved. He inspires the power and energy to get it done� Ralph Nader

31. 31 Miami VA Healthcare System Urban tertiary academic medical center with outpatient primary and specialty care; acute, critical, long term, psychiatric, spinal cord injury & rehabilitation care beds. VA Medical Care Complexity Group 1a (MCG1a). 10 locations of outpatient clinics that cover a 250 mile area across south Florida. Nursing has 585.98 FTEE and a 65.5% RN staff mix.

32. 32 Safety, Quality and Informatics

33. 33 VHA Nursing Strategic Plan 2008-2012 National Nursing goals: Nursing Practice Transformation Evidence-Based Practice Excellence in Leadership Workforce Management Interconnected & Interdependent Critical Programs: Informatics & Technology Data Management Research Advanced Practice

34. 34 Miami�s Journey to Excellence New senior leadership team was put in place that included a new hospital Director and a Chief Nurse Executive, and Chief Nurse for Research & Education Strategic vision was set and organization began a journey to excellence Concurrent efforts toward Baldrige, Carey & MagnetTM designation

35. 35 Miami VA Nursing Informatics Team

36. 36 Overview of Miami Nursing Informatics Strategy: Build Nursing Informatics (NI) leadership, infrastructure & support for nursing administration, practice, education and research. NI Vision: To become a model of integrated Nursing Informatics practice for VHA that provides accurate and useful information that will drive decisions for nursing and patient care. To develop and disseminate knowledge to improve the care of our veterans. NI Mission: To collect, validate, & interpret quality data, while assessing and evaluating processes. To enable dissemination of information to administration that supports management decisions about staffing and nursing care. Finally, to conduct NI research.

37. 37 Miami VA Nursing Informatics Provide information technology consultation & assessment Hardware - Network communication (wired/wireless) Software - Wireless infrastructure Conduct scheduled life cycle & technology assessments Provide information management service VANOD & NDNQI coordination Administrative dashboards, update & report production Staffing effectiveness reports Performance improvement, nursing quality improvement metrics and analysis Administrative dashboard development, Assure data validity & reliability Consultation for Nursing, IRMS, and other healthcare system departments

38. 38 Miami VA Nursing Informatics Leadership role in BCMA, CPRS, and HIT systems coordination Ergonomic, human factors & workflow assessment Project management services encompassing health information technology implementations Computer orientation & training on new upgrades in both CPRS and BCMA Conduct research supporting evidence-based practice Strategic NI Goal: Move to another level of service from a less reactive problem solving team to a more proactive and visionary group which can better service all parts of nursing service with equal attention to priority issues and goals.

39. 39 Domains of NI Practice System Lifecycle Human Factors Information Technology Information Management Professional Practice Models and Theories

40. 40 Functional Areas of Nursing Informatics Survey conducted by Sensmeier & Weaver 776 respondents Top 3 most frequent roles reported System Implementation (45%) System Development (41%) Liaison (32%) (HIMSS, 2007)

41. 41 Why Develop an NI department? Historical absence of administrative or informatics infrastructure Disparate data sources and reports Multiple manual reports that were not reconciled No formal process for data validation No formal process to assess data accuracy Under resourced Nursing Management team Culture change with new executive management style

42. 42 Where and How We Began Organization /Departmental Assessment Multidisciplinary team building and capacity building Nursing FTEE reallocated and Nursing Informatics structure was identified. Assessment of data sources, structure, merging multiple data sources, assessing data accuracy and validity, representation and analysis.

43. 43 Where and How We Began Nursing-sensitive administrative and clinical indicators outcome assessment was identified early in 2004. ProClarity purchased in late 2004; data sources were identified, data structure assessed, data extraction cubes were built. Reports initially identified were: staffing costs, overtime, 1:1 care, and nursing demographics. By 2006, Nurse Managers began using the dashboards to manage resources.

44. 44 IRMS Data Management Nursing Pharmacy Fiscal Biomedical Engineering Quality Management Patient Safety CACs DSS

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47. 47 NI Leadership Role Evidence-Based Practice Computer literacy skills Information literacy skills Project Management skills Change Management skills Process Management skills Information management and communication Data analysis Trending & forecasting Resource Planning, Utilization & Evaluation Technology Assessment Administration Safety & quality Make judgments based on data trends & patterns Consultant Innovator

48. 48 NI Departmental Re-design 2004 Nursing Education Reconceptualize program Nursing Informatics Develop Infrastructure Recruit competent NI staff Field assessment of BCMA technology Performance Improvement Assess data integrity Research Develop evidence-based approach to practice, education and administration

49. 49 Miami Nursing Positions 1 Chief Nurse Informatics & Research Nurse Educator FTEEs (3) were converted to create NI department 3 Nurse Informaticists 1 Clinical Nurse Analyst 1 Staff Analyst (GS Series 343) Traditional ADPAC role is integrated into all NI positions. Department also coordinates continuous readiness activities & performance improvement, and provides on-going education and staff professional development.

50. 50 Years 2004 - 2005 - 2006 Develop Staffing Effectiveness Reporting Proclarity Data Repository Develop Nursing Recruitment database and reports Nursing Data Operations Committee Develop procedures for DEMPS staff deployment and user access Develop and Implement Nursing Disaster Technology Assessment Implementation of Critical Care HIT Develop Nursing Administrative Dashboards

51. 51 Natural History�.Disasters 2004-2005

52. 52 ? ?? ?

53. 53 Disaster Nursing Informatics

54. 54 Nursing Informatics Technology Assessment

55. 55 BCMA 2005-2006 Phase 1 (2005) Build multidisciplinary team Implement effective project management principles Carefully select point of care technology Assess medication administration workflow Assess point of care medication administration technology Implement innovations to improve BCMA process Phase 2 (2006) Systematically evaluate newly purchased mobile medication workstations (MMW) Continuously improve BCMA process

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57. 57 2006 Join NRC Picker Patient Satisfaction Survey Enter NDNQI RN Satisfaction survey Develop data collection process Implement VetPro on-line Credentialing Develop and test nursing overtime database BCMA Cart formal evaluation Staffing and statistical workload analysis

58. 58 Miami VAHC System Issues

59. 59 Nursing Certified Timesheets & Public Law

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61. 61 2007 BCMA Cart Upgrade Wireless network assessment VANOD RN Satisfaction on-line survey coordination Skin templates deployment Work Injury Nursing Network management structure developed Developed On-line nursing continuing education modules Refine nursing contingency plan for �down-time�

62. 62 Regulation and Governing Bodies Continuous Readiness The Joint Commission Department of Veterans Affairs Office of the Inspector General (OIG) Department of Veterans Affairs Combined Assessment Program (CAP) Commission on Accreditation of Rehabilitation Facilities (CARF) 

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64. 64 Leverage Technology for Continuous Readiness �Push� Electronic Education on NPSGs supported �Just-in-Time� Training and education sessions

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66. 66 HANDS pre-implementation strategic planning Wireless network upgrade - Pending Redesign CPRS Nursing Initial Assessment - Work in Progress Data collection on additional NDNQI indicators VANOD skin re-assessment monitoring Develop skin champions Assist in ONS Developing Ambulatory Workload Measure for Facility Workload Report E-proficiency implementation - Pending Critical Care �PICIS� Nursing Handoff Tool Developing staff driven measurement of clinical effectiveness

67. 67 Summary NI/CNE dyad partnership critical to visionary nursing Leadership Strong NI/CNE dyad assures immediate and future needs of patients and staff are supported Recognition of Nursing Informatics team value in support of clinical excellence is crucial to any healthcare organization�s success Quality, safety & excellence provide the framework rationale to support a dynamic Nursing Informatics infrastructure

68. 68 Implications Evaluation of the organization�s current Informatics infrastructure should be conducted Annually Anytime upgrades are made As patient populations served change As care delivery programs change

69. 69 Leadership Pearls DREAM, DARE, AIM to be an INNOVATOR Keep abreast of �latest greatest� technology trends Assess newest technology for �fit� and potential applicability in the clinical environment Leverage technology to improve quality, safety & nursing outcomes as you continue the ongoing journey toward innovation and clinical excellence

70. 70 Summary NI/CNE dyad partnership critical to visionary nursing Leadership Strong NI/CNE dyad assures immediate and future needs of patients and staff are supported Recognition of Nursing Informatics team value in support of clinical excellence is crucial to any healthcare organizations success Quality, safety & excellence provide the framework rationale to support a dynamic Nursing Informatics infrastructure System redesign process to develop a Nursing Informatics infrastructure supports data-driven decision making and performance improvement

71. 71 Conclusions Conduct a NI gap analysis Assess current state of Nursing Informatics infrastructure Conduct an organizational IT gap analysis Evaluate quantity and expertise of healthcare facility IT staff- technical and clinical Identify budget requirements & recruit personnel Identify technology and software needed to support clinicians and Nursing Informatics staff

72. 72 Implications Ongoing evaluation of the organization�s current Informatics infrastructure should be conducted: Annually Anytime upgrades are made As patient populations served and programs change Nursing leadership must be sensitive to the importance of planning for adequate budgetary resources and impact on nursing care delivery Personnel Hardware Software Wireless infrastructure

73. 73 References

74. 74 References

75. 75 References Graves, J. & Corcoran, S. (1989). The study of nursing informatics, IMAGE, 21(4), 227-230. Nannus, B. (1992). Visionary leadership. Jossey-Bass, Inc: San Francisco, CA. Sapnas, K.G. (2007). Visionary nurse executive leadership using informatics as a tool. Department of Veterans Affairs, VA Electronic Health University, Presented July 18, 2007, Marriott World Center, Orlando, FL Sapnas, K.G., Ward-Presson, K. Mangery-Curcio (2007). Nursing Informatics and Disasters: Developing a Disaster Focused Technology Assessment. Paper delivered at International Council of Nurses Meeting, Yokohama, Japan, June 1, 2007 Sapnas, K.G., Martin, W., Shelton, T., Hope, K., Ward-Presson, K. (2007). Wireless networks and point of care technology: implications for interdisciplinary collaboration. Computers, Informatics, Nursing. Computers Informatics Nursing, 25(5),308-309. Technology Informatics Guiding Education Reform. Retrieved July 10, 2007 from https://www.tigersummit.com/uploads/TIGERInitiative_Report2007_bw.pdf Ward-Presson, K., Sapnas, K.G., Mangery-Curcio, S. (2006). Disaster Nursing Informatics: Are you ready? Paper delivered at University of Maryland, 16th Summer Institute in Nursing Informatics, July 22, 2006, Baltimore, MD Veterans Health Administration, VHA National Nursing Strategic Plan 2008-2012, Office of Nursing Service, Washington, DC

76. 76 Wrap-up The emerging role of Nursing Informatics Roles & responsibilities Key contributions The future of Nursing Informatics

77. 77 Questions?