N EW TECH NOTES
Nursing informatics practice in traditional hospital settings By Tina Dieckhaus, MSN, RN-BC, NE-BC, CPHIMS, FHIMSS
WHEN EXPLORING THE SCOPE of nursing informatics (NI) practice, it helps to remember the definition of NI. The key concepts are that NI is based on science and focuses on using data to contribute to nursing knowledge with the goal
of improving patient care.1 NI provides the information and tools healthcare professionals need to improve individual and population health. This article will review the scope of NI practice in a hospital setting.
Defining NI nurses In reviewing informatics nursing in the traditional hospital setting, it’s important to note that the American Nurses Association (ANA) describes an Informatics Nurse (IN) as one who has traditionally received
NI roles in the information systems department Role
Responsibility
Chief informatics officer (CIO)
It’s not a common role, but a few institutions have a nurse functioning in the CIO role. This nurse has a unique perspective when it comes to leadership and vision for clinical and business informatics needs. In order to be successful in the CIO role, he or she needs strong leadership and advice from nonclinical members (advisors) on the team because his or her experience is from the clinical perspective.
Director/manager for an The informatics nurse as a director or manager of an IS team provides the clinical experience and the IS clinical informatics team informatics vision to guide the team to meet the institution’s multidisciplinary informatics needs. Someone in this role may be responsible for prioritizing and budgeting for new projects and making sure the IT initiatives align with the institution’s strategic plan and initiatives. Analyst (systems analyst, clinical analyst, or nurse analyst)
Typically, the analyst is involved with developing and supporting the systems that are being used by the end user. Typically 60% to 70% of an analyst’s work is devoted to system support and maintenance while 30% to 40% of his or her time is used for system development and implementation.
Reengineering analyst
The primary focus of the reengineering analyst is process mapping. He or she typically maps out the current state of a given process, determines how the implementation of a new technology can affect that process, maps the future state, and then determines gaps that need to be addressed in the new process. This is very similar to the Failure Mode/Effect Analysis model used by quality and risk management teams to identify potential risk, but is specific to changes in technology.1
Project manager
The project manager ensures that technology projects are implemented on time and within budget. He or she focuses on mitigating risk to project timelines by making sure tasks are completed when due, executive sponsors are providing the institutional resources needed, and communication is directed to those involved or affected by the project to garner support and buy-in.
Training specialist
Occasionally, institutions will have a training specialist in the IS department whose focus is on the training needs of new staff and ongoing training needs for existing staff. These specialists may design webbased training for the institution, manage the Learning Management system, and focus on technical training for new staff and/or training for all staff as new projects are rolled out. Learning Mangament systems are the electronic systems used to manage or track education activities for staff. It’s used to sign up for classroom-based training, provide web-based training, and track individual educational efforts, which often allows users to print educational activities and track continuing education hours.
Analytics specialist
The analytics specialist serves the information needs of the leadership in the institution. Often, the data requirements are both business and clinical data. The analytics specialist can harness the data in various systems to help leadership answer questions or determine the narrative of a patient experience in the hospital.
Reference: 1. Institute for Healthcare Improvement. Failure Modes and Effects Analysis (FMEA) tool. http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx.
18 l Nursing2014 l October
www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
on-the-job training for his or her role or “a generalist who has had informatics experience, but does not have graduate level education on the subject.”1 The ANA describes an Informatics Nurse Specialist (INS) as “formally prepared at the graduate level in informatics or a related field.” What kind of factors predispose a nurse to pursue informatics roles? Often, these professionals are defined as “innovators” or “early adopters” based on the categories of Rogers’ Diffusion of Innovation Theory.2 Rogers, in this model, indicates that all staff fall somewhere in the bell curve of propensity for adopting technology. Adoption ranges from those who are innovators in the use of technology to those who are “laggards” or will wait as long as possible before adopting technology into their workflow.2 The ANA describes functional areas for INSs that are very similar to other areas of nursing. These include administration/leadership, analysis, compliance/regulation, consultation, education/professional development, policy development, and advocacy/research.1 The ANA also lists some of the tenets of NI practice, which include supporting clinical and nonclinical efforts of nurses and other healthcare professionals to improve the quality of patient care. Information or informatics methodologies alone don’t improve patient care; data and information, driving knowledge and wisdom through nursing informatics practice, is used by clinicians and mangers to improve care and patient outcomes.1 NI focuses on efficient and effective delivery of complete and accurate information to achieve quality outcomes.1 www.Nursing2014.com
NI roles in the nursing department Role
Responsibility
Chief nursing informatics officer (CNIO)
This is a relatively new role that’s being adopted by many institutions. The CNIO allows for NI influence at the institution’s executive level. The CNIO balances the input of the CIO, whose focus may be more technical or businessoriented in nature, and the chief medical informatics officer, whose focus is on the medical informatics needs of the institution. While providing a voice for patient care informatics needs, the CNIO is also focused on the regulatory oversight of clinical data.
Director/ manager of NI
Similar to the director or manager in the IS department, professionals in this role focus on providing vision or direction for the clinical team’s informatics initiatives. These professionals are often uniquely positioned to know the issues that the clinical team is experiencing and can influence the IS department or even “own” projects that are considered specific to the needs of the nursing team when the IS department focuses on broader institutional initiatives.
Nurse analyst
In the nursing department, the role of the nurse analyst can take a unique spin. Instead of being the primary design and build person for system implementation, the nurse analyst can focus on bridging system design with clinical process or workflow. The nurse analyst assists with policy development related to systems, and ensures that the patient care workflow is considered with system design, which can facilitate user adoption and accuracy in system utilization. The staff member in this role usually devotes significant effort to staff training.
Quality analyst
Similar to the analytics specialist in IS, the quality analyst in the nursing department focuses on obtaining and analyzing quality data to ensure evidence-based quality improvement plans are being implemented.
Looking for an INS The most common place to find an INS in the traditional hospital setting is in the Information Technology (IT) or Information Sciences (IS) department. The Healthcare Informatics Management Systems Society Nursing Informatics Workforce survey released in February, 2014 found that 53% of survey respondents reported to the IS/IT department compared with 30% reporting to the nursing department.3 See NI roles in the information systems
department and NI roles in the nursing department for details. Besides the IS and nursing departments, an INS may work in institutional risk management or the quality improvement department, given his or her dual expertise in both clinical care and data analysis. The same qualities may help the INS find a niche in the nursing research department, too. If a hospital has an NI team, its primary responsibility is to serve as the liaison between clinical care providers and the IS/IT departments. October l Nursing2014 l 19
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
N EW TECH NOTES
This team allows the IS/IT departments to concentrate on technical aspects of the role while the NI staff focuses on informatics support and user adoption. An NI team that exists in conjunction with other hospital informatics teams is typically made up of registered informatics nurses and/or INSs. The team augments the work of the other informatics groups in the hospital. The primary advantage of this structure is that the members of the NI team reporting through the clinical arm of the institution have already developed strong relationships with the clinical team, spend-
ing a lot of time with the users/ clinical nurses in order to understand the issues they’re facing. Combining experiences Given the national focus on evidencebased practice and quality outcomes, it’s an exciting time to be an INS in the hospital setting. Many opportunities are available for those interested in combining their clinical and technological experience with a desire to assist nurses in making sound clinical and business decisions as well as providing the best care to their patients. ■
4
REFERENCES 1. American Nurses Association. Nursing Informatics Scope & Standards of Practice. Silver Springs, MD: American Nurses Association; 2008:1, 17-18. 2. Boston University School of Public Health. Behavioral change models. Diffusion of Innovation Theory. 2013. http://sphweb.bumc.bu.edu/otlt/MPHModules/SB/SB721-Models/SB721-Models4.html. 3. Healthcare Information and Management Systems Society. HIMSS 2014 Nursing Informatics Workforce Survey: executive summary. 2014. http:// himss.files.cms-plus.com/FileDownloads/2014Nursing-Informatics-Workforce-Survey-ExecutiveSummary.pdf. Tina Dieckhaus is the director of Patient Care Services Informatics at St. Jude Children’s Research Hospital in Memphis, Tenn. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000453708.50823.ec
Get “In Touch” with Nursing’s Editor-in-Chief Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Read Linda’s thought-provoking blog and share your opinions on hot topics in nursing. Join the discussion at www.Nursing2014.com – just click on the “Featured Blog” box on the right.
20 l Nursing2014 l October
www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Nursing informatics practice in traditional hospital settings By Tina Dieckhaus, MSN, RN-BC, NE-BC, CPHIMS, FHIMSS
WHEN EXPLORING THE SCOPE of nursing informatics (NI) practice, it helps to remember the definition of NI. The key concepts are that NI is based on science and focuses on using data to contribute to nursing knowledge with the goal
of improving patient care.1 NI provides the information and tools healthcare professionals need to improve individual and population health. This article will review the scope of NI practice in a hospital setting.
Defining NI nurses In reviewing informatics nursing in the traditional hospital setting, it’s important to note that the American Nurses Association (ANA) describes an Informatics Nurse (IN) as one who has traditionally received
NI roles in the information systems department Role
Responsibility
Chief informatics officer (CIO)
It’s not a common role, but a few institutions have a nurse functioning in the CIO role. This nurse has a unique perspective when it comes to leadership and vision for clinical and business informatics needs. In order to be successful in the CIO role, he or she needs strong leadership and advice from nonclinical members (advisors) on the team because his or her experience is from the clinical perspective.
Director/manager for an The informatics nurse as a director or manager of an IS team provides the clinical experience and the IS clinical informatics team informatics vision to guide the team to meet the institution’s multidisciplinary informatics needs. Someone in this role may be responsible for prioritizing and budgeting for new projects and making sure the IT initiatives align with the institution’s strategic plan and initiatives. Analyst (systems analyst, clinical analyst, or nurse analyst)
Typically, the analyst is involved with developing and supporting the systems that are being used by the end user. Typically 60% to 70% of an analyst’s work is devoted to system support and maintenance while 30% to 40% of his or her time is used for system development and implementation.
Reengineering analyst
The primary focus of the reengineering analyst is process mapping. He or she typically maps out the current state of a given process, determines how the implementation of a new technology can affect that process, maps the future state, and then determines gaps that need to be addressed in the new process. This is very similar to the Failure Mode/Effect Analysis model used by quality and risk management teams to identify potential risk, but is specific to changes in technology.1
Project manager
The project manager ensures that technology projects are implemented on time and within budget. He or she focuses on mitigating risk to project timelines by making sure tasks are completed when due, executive sponsors are providing the institutional resources needed, and communication is directed to those involved or affected by the project to garner support and buy-in.
Training specialist
Occasionally, institutions will have a training specialist in the IS department whose focus is on the training needs of new staff and ongoing training needs for existing staff. These specialists may design webbased training for the institution, manage the Learning Management system, and focus on technical training for new staff and/or training for all staff as new projects are rolled out. Learning Mangament systems are the electronic systems used to manage or track education activities for staff. It’s used to sign up for classroom-based training, provide web-based training, and track individual educational efforts, which often allows users to print educational activities and track continuing education hours.
Analytics specialist
The analytics specialist serves the information needs of the leadership in the institution. Often, the data requirements are both business and clinical data. The analytics specialist can harness the data in various systems to help leadership answer questions or determine the narrative of a patient experience in the hospital.
Reference: 1. Institute for Healthcare Improvement. Failure Modes and Effects Analysis (FMEA) tool. http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx.
18 l Nursing2014 l October
www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
on-the-job training for his or her role or “a generalist who has had informatics experience, but does not have graduate level education on the subject.”1 The ANA describes an Informatics Nurse Specialist (INS) as “formally prepared at the graduate level in informatics or a related field.” What kind of factors predispose a nurse to pursue informatics roles? Often, these professionals are defined as “innovators” or “early adopters” based on the categories of Rogers’ Diffusion of Innovation Theory.2 Rogers, in this model, indicates that all staff fall somewhere in the bell curve of propensity for adopting technology. Adoption ranges from those who are innovators in the use of technology to those who are “laggards” or will wait as long as possible before adopting technology into their workflow.2 The ANA describes functional areas for INSs that are very similar to other areas of nursing. These include administration/leadership, analysis, compliance/regulation, consultation, education/professional development, policy development, and advocacy/research.1 The ANA also lists some of the tenets of NI practice, which include supporting clinical and nonclinical efforts of nurses and other healthcare professionals to improve the quality of patient care. Information or informatics methodologies alone don’t improve patient care; data and information, driving knowledge and wisdom through nursing informatics practice, is used by clinicians and mangers to improve care and patient outcomes.1 NI focuses on efficient and effective delivery of complete and accurate information to achieve quality outcomes.1 www.Nursing2014.com
NI roles in the nursing department Role
Responsibility
Chief nursing informatics officer (CNIO)
This is a relatively new role that’s being adopted by many institutions. The CNIO allows for NI influence at the institution’s executive level. The CNIO balances the input of the CIO, whose focus may be more technical or businessoriented in nature, and the chief medical informatics officer, whose focus is on the medical informatics needs of the institution. While providing a voice for patient care informatics needs, the CNIO is also focused on the regulatory oversight of clinical data.
Director/ manager of NI
Similar to the director or manager in the IS department, professionals in this role focus on providing vision or direction for the clinical team’s informatics initiatives. These professionals are often uniquely positioned to know the issues that the clinical team is experiencing and can influence the IS department or even “own” projects that are considered specific to the needs of the nursing team when the IS department focuses on broader institutional initiatives.
Nurse analyst
In the nursing department, the role of the nurse analyst can take a unique spin. Instead of being the primary design and build person for system implementation, the nurse analyst can focus on bridging system design with clinical process or workflow. The nurse analyst assists with policy development related to systems, and ensures that the patient care workflow is considered with system design, which can facilitate user adoption and accuracy in system utilization. The staff member in this role usually devotes significant effort to staff training.
Quality analyst
Similar to the analytics specialist in IS, the quality analyst in the nursing department focuses on obtaining and analyzing quality data to ensure evidence-based quality improvement plans are being implemented.
Looking for an INS The most common place to find an INS in the traditional hospital setting is in the Information Technology (IT) or Information Sciences (IS) department. The Healthcare Informatics Management Systems Society Nursing Informatics Workforce survey released in February, 2014 found that 53% of survey respondents reported to the IS/IT department compared with 30% reporting to the nursing department.3 See NI roles in the information systems
department and NI roles in the nursing department for details. Besides the IS and nursing departments, an INS may work in institutional risk management or the quality improvement department, given his or her dual expertise in both clinical care and data analysis. The same qualities may help the INS find a niche in the nursing research department, too. If a hospital has an NI team, its primary responsibility is to serve as the liaison between clinical care providers and the IS/IT departments. October l Nursing2014 l 19
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
N EW TECH NOTES
This team allows the IS/IT departments to concentrate on technical aspects of the role while the NI staff focuses on informatics support and user adoption. An NI team that exists in conjunction with other hospital informatics teams is typically made up of registered informatics nurses and/or INSs. The team augments the work of the other informatics groups in the hospital. The primary advantage of this structure is that the members of the NI team reporting through the clinical arm of the institution have already developed strong relationships with the clinical team, spend-
ing a lot of time with the users/ clinical nurses in order to understand the issues they’re facing. Combining experiences Given the national focus on evidencebased practice and quality outcomes, it’s an exciting time to be an INS in the hospital setting. Many opportunities are available for those interested in combining their clinical and technological experience with a desire to assist nurses in making sound clinical and business decisions as well as providing the best care to their patients. ■
4
REFERENCES 1. American Nurses Association. Nursing Informatics Scope & Standards of Practice. Silver Springs, MD: American Nurses Association; 2008:1, 17-18. 2. Boston University School of Public Health. Behavioral change models. Diffusion of Innovation Theory. 2013. http://sphweb.bumc.bu.edu/otlt/MPHModules/SB/SB721-Models/SB721-Models4.html. 3. Healthcare Information and Management Systems Society. HIMSS 2014 Nursing Informatics Workforce Survey: executive summary. 2014. http:// himss.files.cms-plus.com/FileDownloads/2014Nursing-Informatics-Workforce-Survey-ExecutiveSummary.pdf. Tina Dieckhaus is the director of Patient Care Services Informatics at St. Jude Children’s Research Hospital in Memphis, Tenn. The author has disclosed that she has no financial relationships related to this article. DOI-10.1097/01.NURSE.0000453708.50823.ec
Get “In Touch” with Nursing’s Editor-in-Chief Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Read Linda’s thought-provoking blog and share your opinions on hot topics in nursing. Join the discussion at www.Nursing2014.com – just click on the “Featured Blog” box on the right.
20 l Nursing2014 l October
www.Nursing2014.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
