NURSING INFORMATICS AND HEALTHCARE POLICY

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NURSING INFORMATICS AND HEALTHCARE POLICY
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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.

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• 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 1980s.
• -The definition of NI has constantly evolved
  since that time, molded by the maturation of the
  field and influenced by health policy.

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• 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.

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• The domain of NI is focused on data and its
  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.

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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.

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• 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

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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 Masters NI programs,
  University of Maryland and University of Utah and
  one doctoral program in NI at the University of
  Maryland.

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

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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

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• 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

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• 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.

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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.

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• 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.

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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.

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• 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.

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• 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.

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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

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• 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.

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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.

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• 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.

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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.

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• 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.

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• 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.

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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.

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• 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