by Jason T. Shuffitt, DNP FNP-BC
Director of Rural Health Professions Program
Clinical Assistant Professor
College of Nursing
The University of Arizona
and Judith Effken, Senior Editor
Shuffitt, J. & Effken, J. (June 2012) Threading Informatics throughout Doctor of Nursing Practice (DNP) Curricula. Online Journal of Nursing Informatics (OJNI), 16 (2), Available at http://ojni.org/issues/?p= 1691
Increasing patient acuity coupled with the complex nature of the healthcare system together contribute to clinical decision errors that injure approximately 1 out of every 25 hospitalized patients and contribute to more than 48,000 deaths each year (Institute of Medicine [IOM], 2006). The lack of a comprehensive clinical picture of the patient is cited most often as contributing to these preventable errors. But it’s not only physicians who are affected. Advanced practice nurses (APNs) constantly make critical clinical decisions using limited clinical data. Better management of clinical data across the healthcare continuum could help, but only if advanced practice nurses are educationally prepared to, not only utilize, but also help design the required health information technology (HIT).
HIT is expected to enhance quality of care, increase healthcare safety, and provide cost effective health services for patients. HIT also is expected to facilitate evidence-based medicine which, in turn is expected to improve care delivery and patient outcomes (Blumenthal & Tavenner, 2010). Based on these anticipated outcomes, the Center for Medicare Services (CMS) incentivizes providers who incorporate health information technology into their practice. However, a minimum threshold of use must be met (Department for Health and Human Services [DHHS], 2010). If providers fail to meet these criteria, they lose access to several financial and clinical incentives.
Today’s healthcare information systems are purportedly designed to make care more efficient, improve patient outcomes, and maximize financial compensation for the care delivered. However, these systems frequently do not interface with one another and often fail to deliver clinical information in a manner consistent with safe clinical care delivery (Adams, Adams, Thorogood, & Buckingham, 2007; Blumenthal & Tavenner, 2010). As a result, clinicians make care delivery decisions every day without knowledge of the full clinical picture. The lack of HIT integration contributes to medical errors that could be prevented through the development of an integrated and interoperable health record system (Blumenthal & Tavenner, 2010; Department of Health and Human Services, Agency for Healthcare Research and Quality [AHRQ], 2011; Office of National Coordinator for Health Information Technology, 2008). Furthermore, current HIT systems are not designed so that doctorally-prepared advanced practice nurses can use the data generated to critically analyze and monitor the quality of care outcomes or the effect of their practice and quality initiatives on those outcomes.
Advanced Practice Nurses prepared with the Doctor of Nursing Practice (DNP) degree could be key to our ability to improving HIT design, as well as implementing more efficient and effective care delivery processes through improved HIT integration and understanding of informatics principles, analytical techniques, and system lifecycle design principles. However, APNs with DNP degrees will not be prepared to take on this challenge until DNP programs provide their students with more than a cursory knowledge of healthcare informatics.
The DNP degree is a practice-focused doctorate which is considered the terminal degree in advanced nursing practice (American Association of Colleges of Nursing [AACN], 2006; Hathaway, Jacobs, Stegbauer, Thompson, & Graff, 2006). The Essentials of Doctoral Education for Advanced Nursing Practice contains eight standards for DNP curricula; but only one specifically addresses information systems and technology related to patient care and the transformation of healthcare (AACN, 2006). Therefore, most DNP programs simply include a single, cursory informatics course in their curriculas to meet the standard (The National Organization of Nurse Practitioner Faculties, 2011). The lack of greater emphasis on informatics education in DNP programs is problematic, given the information management challenges these practicing APNs will encounter due to our fragmented HIT systems.
DNP programs need to develop innovative and creative ways of integrating healthcare informatics throughout the curriculum (Grossman & McGinnis, 2010). We recommend that programs move beyond offering a single informatics course to a more systematic integration of informatics principles and applications throughout nonclinical and clinical coursework. For example, curricula could include a foundational healthcare informatics theory course that examines the history, development, and role of healthcare informatics theory in care delivery, as well as database modeling principles. This course would be complemented by an organizational systems theory course. These two courses would provide the necessary linkages between informatics theories and organizational theories related to clinical care delivery. The courses would provide students with a basic healthcare informatics foundation on which they could then synthesize the requirements for an information system to support their own clinical practice
Principles learned in the foundational courses also can be integrated into clinical care delivery courses. For example, the health assessment course could easily include a module on developing an electronic history and physical clinical information database and clinical alert display criteria. This content would facilitate integration of database principles within a clinical context. Courses related to disease diagnosis and treatment could include modules related to clinical care delivery data capture and why these data points are necessary to analyze clinical outcomes. A clinical residency capstone course could be developed that draws on foundational healthcare informatics courses which would include integration and evaluation of electronic health record systems and handheld clinical decision devices for improvement of clinical care delivery.
In summary, health information technology (HIT) can play a vital role in assisting DNP- prepared nurses to manage health promotion and prevention, as well as acute episodic illnesses, for diverse patient populations. Well designed HIT has been shown to facilitate standardized patient centered care delivery, increase information access and exchange, improve care delivery efficiency, monitor outcome based decision-making, and encourage dynamic utilization of up-to-date patient health information. If DNP-prepared nurses are to improve clinical care delivery, they must be well-versed in healthcare informatics. Gone are the days in which a cursory informatics course is sufficient in DNP programs. These clinicians are on the frontline of care delivery and must have not only the knowledge and skills necessary to provide competent and quality clinical care but also the ability to manage care effectively in an information-centric and ever evolving complex healthcare system. Therefore, it is essential that DNP programs examine their healthcare informatics curricula and begin to integrate informatics throughout the curricula.
Adams, A., Adams, R., Thorogood, M., & Buckingham, C. (2007). Barriers to the use of e-health technology in nurse practitioner-patient consultations. Informatics in Primary Care, 15, 103-109.
American Association of Colleges of Nursing. (2006, October). The essentials of doctoral education for advanced practice nurses (White Paper). Retrieved from http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf
Blumenthal, D., & Tavenner, M. (2010, August 05). The meaningful use regulation for electronic health records. The New England Journal of Medicine, 363(6), 501-504.
Department for Health and Human Services. (2010). Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule. Washington, DC: U.S. Government Printing Office.
Department of Health and Human Services, Agency for Healthcare Research and Quality. (2011). Funding opportunity announcement: Understanding clinical information needs and health care decision making processes in the context of health information technology (IT) (PA11-198). Washington, DC: U.S. Government Printing Office.
Grossman, C., & McGinnis, J. (2010). Digital infrastructure for the learning health system: The Foundation for Continuous Improvement in Health and Health Care. Washington, DC: National Academies Press.
Hathaway, D., Jacobs, S., Stegbauer, C., Thompson, C., & Graff, C. (2006). The practice doctorate: Perspectives of early adopters. Journal of Nursing Education, 45(12), 487-496.
Institute of Medicine. (2006). Preventing medication errors. Washington, DC: National Academies Press.
Office of National Coordinator for Health Information Technology. (2008). Defining key health information technology terms. Washington, DC: U.S. Government Printing Office.
The National Organization of Nurse Practitioner Faculties. (2011, April). Nurse practitioner core competencies (Educational Standards). Retrieved from http://www.nonpf.org/associations/10789/files/IntegratedNPCoreCompsFINALApril2011.pdf
Proofed by Paula Lane