Nursing Informatics on the Move
By Jo-Ann M. Belanger RN ADN, BSN, MSN Student
Belanger, J. (February, 2006). Nursing informatics on the move. Online Journal of Nursing Informatics (OJNI), 10, (1) [Online]. Available at http://ojni.org/10_1/belanger.htm
In every aspect of patient care nurses constantly, assess, diagnose, determine the appropriate action and evaluate and communicate it. Nursing Management depends on acquiring information. With the increasing use of nursing informatics, nurses will be better able to use computer technology as a way to decrease costs, increase patient nurse interactions and decrease redundancy of documentation. Nursing informatics will help the healthcare industry to stay marketable in a changing world.
Nursing Informatics on the Move
Nurses are constantly assessing, diagnosing, planning, intervening, evaluating and communicating nursing care. Nursing Management depends on acquiring information, analyzing, interpreting, and generating relevant statistics and information. Not surprising, nurses spend a large portion of their time on the mechanics of gathering, recording, and communicating data.
Nursing informatics is an established and growing area of specialization in nursing. All nurses employ information technologies in their practice. Informatics nurses are key people in the design, development, implementation, and evaluation of those technologies and in the development of the knowledge underlying them. Information is power and critical to making decisions. In the course of daily work, this link between information and decision-making may not be obvious; nonetheless, it is there. Nursing is a cognitive profession; the core of nursing takes place in our minds. It is the thinking that occurs before physical action. Assessment (data collection), diagnosis (or interpretation of assessment data), and planning are cognitive components of nursing. Implementation of a plan is the visible operationalization of this thinking. Evaluation of a plan’s implementation is another form of assessment and decision-making. The collection of data about a situation is guided by a nurse’s knowledge: Knowledge built from formal education and from experience. The decisions a nurse makes are guided by his or her knowledge, as well as extended informational updates. Nursing informatics can aid nurses by helping them to obtain important data for their patients and help them make guided decisions in regards to patient care (Saba, & McCormick, 2001).
A classic study of three New York Hospitals found that registered nurses spend an average of 36-94 percent of their time handling information, and those in administrative positions spend the most time (Executive Summary, 2004). Such findings spurred hospital administrators to try computer-based information systems as a means to control costs and improve care by reducing the time nurses spend on paper work. These findings helped to free nurses up to provide direct client services. Nursing informatics in the work place takes on many shapes and informational venues. Computer based charting on-line, updates for continuing education, and extended computer data bases are offered by hospitals providing the most up to date research. Nursing informatics is cutting edge technology for patient care (Executive Summary, 2004).
In 1850, it was possible for all the medical knowledge known to the Western World to be put into two large volumes. One person could read and assimilate all of this information. Today, if physicians read two journal articles every day, by the end of the first year they would be 800 years behind in their reading (Thede, 2003).
Nursing informatics was first defined as the use of computer technology to support nursing, including clinical practice, administration, education, and research. This reflects one of the earliest definitions of nursing informatics, Scholes and Barber (1980) state that nursing informatics is the “application of computer technology to all fields of nursing” (Hebda, Czar & Mascara, 2001). In subsequent years, the definition of nursing informatics includes the information that nurses use to make client care decisions. Graves and Corcoran (1989) further refined the definition to include a “combination of computer science, information science, and nursing science designed 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” (Hebda, et. al, 2001 p.3).
The first generation of nursing information systems was designed to speed paperwork and communication. In general, the systems accomplished this by transferring information to the computer, what nurses had done on paper and by telephone. These systems replaced paper records, filing cabinets, and pneumatic tubes. Although this was helpful and effective in reducing the time spent on documentation and communication it did not address many of the fundamental issues for nurses’ use of data, information, and knowledge to guide effective care (Executive Summary, 2004).
Nursing informatics in the past focused on information management and decision making as a prime requisite of healthcare since healthcare became a province of professionals. In the 19th century and the first half of the 20th century, healthcare in the United States was a charitable community-based effort to care for sick and needy (Thede, 2003). It focused on episodic, acute care that was provided in stand-alone healthcare facilities. People often were born, raised and died in the same community; there health records were in one physician’s office and one hospital where that physician practiced. There was little need to share information since one physician generally provided all of the care.
Until 1948, primary care remained in the home. With the development of the Hill-Burton Act of 1948, money was provided for the building of hospitals and promoted a catalyst for change in healthcare. In the 1960’s, Medicare and Medicaid provided reimbursement for services to many individual patients and the health insurance industry grew. This provision of funding allowed many new innovations: new drugs, advanced surgical procedures, new technologies and equipment, and sophisticated diagnostic procedures. All of which led to the development of medical specialties, each treating a different part of the patient and creating its own records for that patient (Thede, 2003).
It is not unusual to find a patient being treated by several physicians at the same time. These physicians share little information; they may duplicate tests or prescribe medications that are not compatible with those prescribed by another physician. The current healthcare system relies primarily on paper records that are oriented to episodes and providers (Thede).
During the past four decades the U.S. government has played a major role in the development and promotion of telehealth through various agencies. Although interest waned as funds were depleted in the 1980’s, technological advancements made it a more attractive prospect. Federal monies and Agriculture Department’s 1991 Rural Development Act laid the groundwork for bringing the information superhighway to rural areas for education and telehealth purposes (Hebda, et. al, 2001).
The most aggressive development of telehealth in the United States has been by NASA and the military. NASA provided international telehealth consults for Armenian earthquake victims in 1989, while more recently the military has been working on several projects to feed medical images from the battlefield to physicians in hospitals for improved treatment of casualties (Hebda, et. al, 2001).Present
Clearly, nurses and all other healthcare professionals have to learn new skills and approaches in order to leave the substitution stage of technology integration and enter the transformation stage. The learning process and the widespread use that follows are covered by the term informatics (Ball, Hannah, et. al, 2000). Although the history of nursing informatics extends only some twenty years, the field is advancing rapidly as a scientific discipline and has significant implications for patient care (Executive Summary, 2004). The American Nurses Association (ANA) (1994) defined a more recent definition of nursing informatics. It is as follows: “ the development and evaluation of applications, tools, processes, and structures which assist nurses with the management of data in taking care of patients or supporting the practice of nursing”(Hebda, et al, 2001, p. 3). As research in nursing informatics evolves, it has become apparent that the issues are far more complex than reducing time spent on paper work. The high-intensity generation, management, processing of data, and knowledge are integral components of nursing care. Informatics gives nurses the means to carry out these aspects of care efficiently and effectively to improve outcomes for patients. Providing advanced means in informatics will require broader and deeper research in this field. An exploration must be conducted of the information needs and “fundamental issues for nurses’ to use the data, information, and knowledge to guide care” (Executive Summary, 2004).
Managed care and consumer demands for quality are a driving force in healthcare delivery. Limits to what providers can charge and capitated reimbursement plans that provide coverage for a particular diagnosis at a set rate force institutions to increase efficiency in order to maintain profitability. Downsizing, acquisitions, and mergers represent attempts to increase efficiency. Other methods include automation and cross-training personnel. Simply put, downsizing means that fewer people do more work, unfortunately, the clinician also faces higher client acuity levels in many managed care scenarios. Acquisitions and mergers also allow providers to extend their ability to reach participants by offering a more comprehensive set of services and encouraging clients to stay within their healthcare network. The advantages to these mergers may minimize problems from multi-computer systems, increase efficiency, help administration to utilize information technology, and contain healthcare costs (Hebda, et. al, 2001).
There is a need for healthcare providers to manage information in an integrated manner in order to provide quality care in a cost-effective way has never been greater. Nursing informatics is a growing area of specialization in nursing. All nurses employ information technologies in their practice. Informatics nurses are key players in the design, development, implementation, and evaluation of those technologies and in the development of the knowledge underlying them. Nursing informatics practice focuses on the representation of nursing information and its management and processing within the health community (Ball, Hannah, Newbold & Douglass, 2000).
Nursing informatics impacts nurses today. Today, evolving standards of practice increase the nurse’s accountability. The malpractice crisis has strengthened accountability an increased emphasis on complete and detailed nursing documentation. Changes in reimbursement methods are affecting nursing care delivery. Cost containment and consumerism place additional pressures on not only the individual nurse but also the entire nursing profession (Ball, et. al 2000).
External forces continue to create internal pressures affecting the nursing environment, hospital operations remain task oriented, systems do not promote practitioner’s accountability, and paperwork requirements. The need for automated and intelligent database analysis, is receiving increase attention as healthcare enterprises and payers struggle to make sense of the tremendous amounts data that extensive resources are being spent to capture (Saba, McCormick, 2001).Future Nursing Informatics
Nursing informatics has arrived, and the baby has started to walk. In the process, nursing informatics has introduced new challenges and opportunities along with new computer applications. For nurses, it has created new roles and a new vision of the nursing profession. Nurses are becoming programmers and systems analysts (Ball, et. al, 2000).
Nursing informatics is a growing field for advancement, and offers many potential areas for cost containment. Nursing informatics and managed care, make telehealth an attractive tool to save healthcare dollars: Telehealth may provide savings in the following areas: improved access to care, allowing clients to be treated earlier and with fewer interventions. Clients may receive treatment in their own community where services cost less, improving quality of care and improved continuity of care through convenient follow-up. Telehealth applications vary greatly and include client monitoring, diagnostic evaluations, decision support systems, storage and dissemination of records for diagnostic purposes, image compression for efficient storage and retrieval, research, voice recognition for dictation and education of healthcare professionals and consumers. Many providers expect that telehealth will revolutionize healthcare. It promises to improve speed and accuracy of communicating with medical providers to gather information and address concerns. Nursing informatics and Telehealth will continue to grow and become commonplace (Hebda, et al, 2001).Conclusion
Nursing informatics has experienced many changes over the last 20 years. Nursing informatics continues to be a growing field for technological advancement in healthcare delivery. It promotes changes in information services to patients and healthcare providers. With the changes in nursing informatics, nurses will be better able to use computer technology as a way to decrease costs, increase patient nurse interactions and decrease redundancy of documentation. Nursing informatics will help the healthcare industry to stay marketable in a changing world.
Ball, M. Hannah, K. Newbold, S. & Douglas.(2000) Nursing informatics: Where caring and technology meet (3 rd Ed.). NY: Springer-Verlag.
Executive summary [electronic version].http://ninr.nih.gov/ninr/research/vol4/Execsum.html Retrieved August 20,2004.
Hebda, T., Czar, P. Mascara, C. (2001). Handbook of informatics for nurses and health professionals. NJ: Prentice Hall.
Saba, V, & McCormick, K. (2001). Essentials of computers for nurses: Informatics for the new millennium (3 rd Ed.). NY: McGraw-Hill.
Thede, L.(2003) Informatics and nursing opportunities & challenges (2nd Ed.). Philadelphia: Lippincott Williams & Wilkins.
Jo-Ann M. Belanger RN, ADN, BSN, MSN Student
Ms. Belanger is a student in the MSN program at Saint Joseph's College in Standish, Maine. She has been a nurse for 18 years. Ms. Belanger worked at a hospital Cardio-pulmonary unit for 8 years, per-diem agency work intermittently and currently works in long term care taking care of people with mental retardation.