Nursing Informatics: Policy & Growth

Policy

• Is a course of action that guides present and future decisions.
• Healthcare policy guides the implementation of solutions for population health needs at the local, state, and national levels.

Growth of Nursing Informatics

• The number of informatics programs for nurses has significantly increased, producing more informatics nurse specialists.
• Information Technology (IT), Information Systems (IS) and informatics have become a central focus in healthcare.

Nursing Informatics as a Specialty

• Nurses are involved in the purchase, design, and implementation of IS since the 1970s.
• In 1992, the American Nurses Association (ANA) recognized Nursing Informatics (NI) as a specialty.
• To achieve recognition as a specialty, nursing informatics had to demonstrate a differentiated practice base, identify educational programs, and develop a research agenda.

Definition of Nursing Informatics

• Before, NI combined nursing information and computer sciences to manage and utilize nursing data for knowledge.
• Now, the definition has broadened, NI integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.

Differentiated and Interdisciplinary Practice

• NI enhances nursing through information management skills and knowledge.
• NI practice is unique but linked to other informatics fields like mathematics, statistics, linguistics, engineering, computer science, and health informatics.

Domain Specific Informatics Practices Examples

• Medical informatics
• Dental informatics
• Consumer informatics
• Practicing in an interdisciplinary team is essential in the NI community and the "Vocabulary Summit” held annually at Vanderbilt University since 1999 spearheaded by Judy Ozbolt is a one good example of interdisciplinary work.

Preparation for NI Specialty Practice

• Showing the availability of educational programs to prepare nurses in the field was necessary to become a specialty.
• The Division of Nursing (DN) under the Health Resources and Services Administration (HRSA) created two Master's and one Doctoral program in NI at the University of Maryland.
• An NI specialty program opened at New York University in 1997, followed by Duquesne University in 1998.
• Identifying a research focus was set as a criteria for a specialty.
• Representation by at least one organization became the final requirement for a specialty.

Healthcare Policy Impact on Nursing Informatics

• Nursing Shortage: Nursing has experienced several shortages recently, linked with Nursing Informatics.
• An older nursing workforce is a factor.
• There is a higher ratio of older associate degree graduates.
• More attractive career opportunities for women contribute to the shortage.
• Decreased interest in nursing is caused by difficult work environments.
• Without intervention, the nursing shortage may increase from 6% in 2000 to 29% in 2020, leading to over 800,000 nurses needed.
• The Bureau of Labor Statistics predicts registered nurse positions will increase by 600,000 between 2002 and 2012.
• Replacing retiring nurses and covering new positions requires 1.1 million more nurses by 2012.
• The healthcare industry could face a major crisis without intervention.

Patient Safety and Nursing Informatics

• The 1999 IOM report, "To Err is Human: Building a Safer Health System," had a significant impact on healthcare
• Adverse events in hospital occur in between 2.9 and 3.7% admissions.
• It was estimated that between 44,000 and 98,000 patients die each year from medical errors in U.S. hospitals.
• A follow-up report strengthens the argument for using technology to improve patient safety.
• Surveys show that patient safety concern is the biggest driver IT California law 1875, passed in 2003, pressures hospitals to use IT to reduce errors.
• The Leapfrog Group, comprising Fortune 500 companies, promotes Computerized Practitioner Order Entry (CPOE) to improve patient safety.

National Alliance for Healthcare Information Technology (NAHIT)

• It aims to improve patient safety, quality, and efficiency using technology.
• The group focused on consensus-based standards, collaboration, government awareness, and best practices.

Executive Order on Health Information Technology

• On April 27, 2004, President George W. Bush issued an executive order “Incentives for the Use of Health Information Technology Coordinator” with the potential to impact healthcare nationwide

Executive Order Components

• Establishing a national health information technology coordinator position.
• Developing a nationwide interoperable health infrastructure.
• Establish a strategic plan to guide the use of interoperable health IT in public and private sectors.
• Interoperable health IT aim to reduce medication errors, improve quality, and increase value in healthcare.

Guidelines for an Interoperable Infrastructure

• Appropriate information at the point of care to aid medical decisions.
• High-quality, evidence-based medical care delivery.
• Reduced healthcare costs.
• Available information to encourage competition.
• Health information exchange.
• Secure and protected health information.
• In June 2004, a bipartisan House caucus formed to support policies increasing IT acceptance by offering financial incentives to healthcare providers.

American Association of Retired Persons (AARP)

• 35 million members supporting electronic prescribing rules and CPOE adoption
• CPOE increasingly represent Computerized Practitioner Order Entry, particularly within AARP.
• Informatics professionals are needed to aid healthcare workers to push for the implementation of CPОЕ.

Health Insurance Portability and Accountability Act (HIPAA)

• Passed in 1996 to improve public and private health programs by establishing standardized electronic health information transmission.
• HIPAA overrides state laws and payer variations in data standards, while standard setting through private organizations.
• IT needs to be designed to comply with Title II of HIPAA.
• All HIPAA requirements were expected by May 23, 2008.

HIPAA Timetable

• October 16, 2002: Electronic Healthcare Transactions and Code Sets
• April 14, 2003: Privacy
• October 16, 2003: Electronic Healthcare Transactions
• April 14, 2003: Privacy-small health plans
• July 30, 2004: Employer Identifier Standard
• April 21, 2005: Security Standard
• August 1, 2005: Employer Identifier Standard
• April 21, 2006: Security Standards-small health plans
• May 23, 2007: National Provider Identifier
• May 23, 2008: National Provider Identifier
• CMS expects to publish rules for a national health payer identifier and claims attachments format in November 2004.
• The HIPAA privacy rule, published in December 2000, took effect on April 14, 2001.

National Agenda for Nursing Informatics

• The National Advisory Council for Nurse Education and Practice (NACNEP) made five assumptions to guide NI initiatives.
• Learners include students, faculty, and clinicians.
• NI requires an interdisciplinary approach with partnership and collaboration.
• Focus efforts on disadvantaged and underserved populations.
• Align initiatives with government funding priorities.
• Encourage collaboration among federal agencies and private entities.
• The Secretary of DHHS set five key directions for informatics in education and practice in the NACNEP report:
  • Educating nursing students and practicing nurses in informatics.
  • Prepare nurses with informatics skills.
  • Enhance nursing practice and education through informatics projects.
  • Preparing faculty in informatics.
  • Increase collaborative efforts in NI.

Telehealth and Nursing Informatics

• Telehealth services have existed for about 50 years, however it still is an underutilized tool,
• Telehealth-utilizes electronic information and telecommunications for remote healthcare, education, and administration.

Factors Advancing Telehealth Innovation

• Decreasing costs of telecommunication technologies.
• Decreasing costs of telehealth devices and applications.
• Resolutions of interoperability issues.
• Convergence of telehealth, telecommunications, IT, and the Internet.
• Specialized tools are generally outside the influence of groups like the AMA and the Advanced Medical Technology Association.
• There have been significant disconnections between telehealth and informatics.
• Both telehealth and IT face challenges regarding acceptance, licensure, and reimbursement.
• Documentation of telehealth events has often been separate from IS.
• Reimbursement, licensure, and security were key issues preventing telehealth adoption, as noted in a 1997 report to Congress.
• Telehealth and informatics professional groups have developed in isolation from each other.
• Informatics nurses need to get involved in telehealth uses of technologies.