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In 1992, the American Nurses Association’s (ANA) Congress of Nursing Practice supported the recommendation of the Council on Computer Applications in Nursing to officially recognize nursing informatics (NI) as a nursing specialty. The ANA currently defines NI as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice (American Nurses Association [ANA], 2008).
The purpose of this paper is to discuss the current use of healthcare information technology (HIT) in the acute care setting by interviewing a nurse working in HIT and analyze its impact on the professional nursing practice. The Interview Jayne Thompson, RN, BC, MSN is employed at Memorial Medical Center in Springfield, Illinois as a Clinical Application Support Specialist. Memorial Medical Center, is a 504 bed, Magnet designated, level one trauma center located in Central Illinois and the flagship hospital of the Memorial Health System, which is comprised of four hospitals and affiliated with Southern Illinois University School of Medicine.
A one-hour interview with Jayne was scheduled and held on March 13th 2013 at 7:00 AM in her office. Interviewee Jayne has worked at Memorial Medical Center for twenty-five years and began her career as a staff nurse on the cardiac surgery unit where she developed a passion for nursing research. This led to a position as a research nurse for the Prairie Education and Research Cooperative (PERC) in Springfield, IL where she coordinated clinical trials on cardiac stents.
As a research nurse, Jayne’s need for gathering and sharing data spurred an interest in healthcare informatics and in 2008 she enrolled in Walden University’s Masters degree program in Healthcare Informatics. Upon graduation in 2010 Jayne moved into her current position as Clinical Application Support Specialist. In 2012 she completed her certification in Nursing Informatics. Jayne’s responsibilities include ensuring the effective performance of the computer information system, Cerner, which is used within the Memorial Health System.
She sees her role as a liaison between nursing and information technology (IT) to guarantee that nursing is represented in decisions that impact clinical systems in the acute care setting. Jayne gathers end users’ (users for which the product is designed) concerns, suggestions and, criticisms regarding the workflow process and brings them to the attention of the IT department. Together they build, trial and implement computer system changes, which are then taken back to the end user. Education and Training
The American Nurses Credentialing Center (ANCC) describes an informatics nurse specialist (INS) as a master’s prepared nurse. In order to qualify to take the ANCC exam, a nurse must be, at minimum, bachelor’s prepared (nursing or other related field of study), complete a minimum number of hours of work experience and graduate study. Currently two designations for certification in NI are available through the ANCC. Nurses certifying with a baccalaureate degree or higher degree in nursing use the designator RN, BC while nurses certifying with a degree in a related field, i. . computer sciences use the designator RN, C. (Hunt, Sproat, & Kitzmiller, 2004). The nurse, new to an informatics role needs to become familiar with current definitions, literature and know the scope and standards of the profession as established by the ANA (ANA, 2008). Following the completion of her MSN, Jayne needed her role as Clinical Application Support Specialist further defined based on the scope of responsibilities and relationships expected for the proposed implementations of the Cerner system. Challenges
Jayne sees advancing evidence based nursing (EBN) as one of the biggest challenges facing nursing. The INS must focus on converting available data information into practical, accessible information that can enlighten practice. This is accomplished through alerts and computerized decision support (CDS), which make evidence-based guidelines available at the point of care (Simpson, 2007) Finding the best tools and methods for managing vast amounts of information requires the INS to develop methods for storing data, in both the short and long term and garnering information and knowledge eeded to support clinical practice, research and education. A second challenge facing the INS is the cost of delivering health care. Health care costs are a burden to society as a whole and likely to increase along with the number of uninsured individuals (McCormick et al. , 2007). Of concern is a shortage of registered nurses projected to spread across the country between 2009 and 2030 (American Association of College of Nursing [AACN], 2012). The INS serves as a liaison with nursing and IT in developing technology and providing educational programs necessary to support care delivery.
The goal is to optimize the existing and projected nursing workforce and ensure continuing quality of care amid the anticipated nursing shortages. Role of Information Systems “Informational systems (IS) deal with the development, use and management of an organization’s information technology (IT) infrastructure” (McGonigle & Mastrian, 2012, p. 29). As an INS, Jayne acknowledges that nurses spend the majority of their time providing direct care to patients and hope that an EHR will increase this patient-interaction time and consequently the quality of care delivered.
Conversely, providing care requires the documentation of clinical information as an inherent aspect of routine care and is essential from both professional and legal standpoints. Nurses, according to Jayne consider an IS to be efficient if the system reduces their documentation time, even if the time savings do not translate into better patient care. Developing and introducing a new aspect of an IS for clinical practice can be frustrating, according to Jayne who often sees healthcare professionals preferring to work in silos (operating in isolation from others), rather than collaborating with other professionals in related fields of practice.
Information comprises a wide range of aspects including patient-specific data, research information and procedure information. IS offer tremendous opportunities to enhance clinical practice and appropriateness of care and to increase efficiency and effectiveness in healthcare organizations (Oroviogoicoechea, Elliott, & Watson, 2008). It is important to develop and refine functional ISs that meet the needs of today’s healthcare industry while evolving to handle future demands of the healthcare community. Role of Privacy
Patients cite privacy, together with security, as their issues of greatest concern about electronic records. The ANA Code of Ethics for Nurses with Interpretive Statements mandates that nurses protect a patients right to privacy and confidentiality (American Nurses Association [ANA], 2010). The use of an electronic health record (EHR) makes it difficult for an unauthorized person to gain access. According to Jayne, the IT department serves as the gatekeeper for data security. Within the Memorial Health System a provider needs a login name and a password to access the Cerner EHS.
Additionally, Cerner maintains an audit trail, required by the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA), that documents who has accessed individual records, as well as what part of the record was viewed. Firewalls and antivirus software protect the organization from hackers and viruses, encryption of data exiting the health system is essential since under (HIPPA) if data is stolen but encrypted the organization is exempt from fines. Physical access to computers and software is a foundation of computer security.
Placement of computer monitors, privacy screens and a 30-second time-out feature prevent inadvertent viewing of protected health information (PHI). Greatest Learning EHRs have a huge impact on nursing documentation. Although nurses are the largest group of end-users they have had minimal input in the design of EHRs. The INS works synergistically with nursing and IT to design and implement documentation software, which is integrated into the clinical workflow and functions optimally in clinical practice.
If this collaboration does not occur, “the frustrations of nurses may lead to an ‘EHR–practice gap’ similar to the long-existing ‘theory–practice gap’, or nurses may alter their clinical practice to fit in with rigid systems, thereby losing the heart and soul of nursing as a profession” (Stevenson, Nilsson, Petersson, & Johansson, 2010, p. 70). To ensure that the essence and complexity of nursing are not lost, the INS must be aware of the clinical needs of the nurse and the benefits of the IS which best supports patient care.