Nursing Informatics (eBook)

Kathryn J. Hannah, PhD, RN, is President of Hannah Educational & Consulting Services, Inc. and Professor, Department of Community Health Sciences, Faculty of Medicine, at the University of Calgary, both in Calgary, Alberta, Canada. Dr. Hannah is the Senior Editor of Springer’s Health Informatics Series.Marion J. Ball, Ed.D, is Vice President of Clinical Informatics Strategies at Healthlink, Inc. and Professor at Johns Hopkins University School of Nursing, both in Baltimore, Maryland, USA. Dr. Ball is the Co-Editor of Springer’s Health Informatics Series.Bonnie Wesorick, RN, MSN, is the Founder and CEO of the Clinical Practice Model Resource Center (CPMRC) in Grand Rapids, MI. Bonnie is the Chairperson of the CPMRC Associate Consortium. Her innovative work around CPMRC's mission to co-create and sustain the best places to practice and the best places to receive care has brought healthcare providers from around the world together.

Nursing Informatics 2
Copyright Page 3
Foreword I 4
References 5
Foreword II 7
Information Technology as a Tool 7
Factors 8
Collaboration 9
Context 9
Series Preface 11
Preface 12
Sections and Chapters 14
References 15
Acknowledgments 16
Contents 22
Contributors 25
Section I:Nursing Informatics: On the Move 28
Setting the Stage 28
Charting the Course for Change 29
Building and Using Social and Intellectual Capital 30
Networking for Advancement 30
References 30
1: Nursing Informatics: Transforming Nursing 32
Health Reform and HIT 32
The Institute of Medicine: Breaking the Ground 33
Outcomes 34
Costs 35
HIT and the TIGER Initiative 37
References 38
2: Strategies for Culture Change 40
Introduction 40
Culture, Caring, and Technology 42
Culture 42
Caring and Technology 44
Approaches to Culture Change 45
Culture Change Through TIGER Initiative 45
Culture Change Through Education 47
Culture Change in the Context of Organizational Change 49
Culture Change Framed by Theoretical Models 51
Social (Cultural) Change Through Innovation and Disruption 52
Conclusion 56
References 58
3: TIGER Collaboratives and Diffusion 62
Intellectual and Social Capital 62
Knowledge Management and Leadership 64
The TIGER Initiative 65
The TIGER Summit 66
Management and Leadership 66
Education 67
Communication and Collaboration 67
Informatics Design 68
Information Technology 68
Policy 68
The TIGER Summit Report 70
TIGER Phase II 70
Collaborative Team Results 71
TIGER Impact 72
Nursing Informatics Community 72
Practice Specialty Community 72
Nursing Leadership Community 73
Educational Community 73
Vendor Community 74
Lessons Learned 74
Conclusion 76
References 77
4: Networking Advancing Nursing Informatics 78
People Resources 78
Organizational Resources 78
Conferences 81
Electronic Resources 82
Nursing Informatics History Project 82
TIGER 82
Daily e-news Bulletins 82
Nursing Informatics Web Sites 83
Informatics Literature 83
Suggested Reading 83
Section II:Workforce Imperatives 85
Education and Faculty Development 86
Competencies 86
Academic Programs 87
Staff Development and Continuing Education 87
Leadership 87
Collaboration 88
References 89
5: Education and Faculty Development 90
Introduction 90
TIGER’s Education and Faculty Development Collaborative 92
Faculty Development and Education Collaborative Objectives 92
National League for Nursing 93
For Nurse Faculty 94
For Deans/Directors/Chairs 94
For the National League for Nursing 95
American Association of Colleges of Nursing 96
Baccalaureate Essential IV: Information Management and Applicationof Patient Care Technology 96
Essential IV: Information Systems/Technology and Patient Care Technology for the Improvement and Transformation of Health Care 97
Accreditation Bodies 97
Associate Degree Nursing Committee 98
State Boards of Nursing 99
State Initiatives 100
Minnesota TIGER 100
North Carolina 100
Massachusetts 101
California 101
Health Services Resources Administration (HRSA) 101
Innovators in Nursing Education 103
Summary 104
References 104
6: Competencies: Nuts and Bolts 106
Approach and Strategy 107
Standards Set 1: Basic Computer Competencies 108
Standards Set 2: Information Literacy 110
Standards Set 3: Information Management 111
The Way Forward 114
Appendix 114
Clinical Information Management Competencies 114
References 116
7: Updated Academic Programs 118
Academic Preparation in Nursing Informatics 118
Evolving Definition of Nursing Informatics 119
Specialty Attributes of Nursing Informatics 119
Nursing Informatics Practice 121
Informatics Nurse Specialist Role 122
Nursing Informatics Competencies 122
Nursing Informatics Education 123
Continuing Education in Nursing Informatics 124
Courses in Nursing Informatics 125
Master’s Specialization in Nursing Informatics 125
Master’s Programs with Nursing Informatics Concentrations and Minors 128
Doctoral Specialization in Nursing Informatics 128
Postgraduate Fellowships 129
Nursing Informatics Education in the Future 130
Summary 130
Update on Academic Programs 130
Updated Definition of Nursing Informatics 131
Nursing Informatics as a Specialty 131
Nursing Informatics Practice 131
Nursing Informatics Competencies 132
Nursing Informatics Education 132
Continuing Education in Nursing Informatics 132
Courses in Nursing Informatics 133
Nursing Informatics Education in the Future 134
Summary 134
References 134
8: Continuing Education and Staff Development 137
Introduction 137
The Need 138
National Nursing Organization Viewpoints 138
The TIGER Survey 139
Other National Surveys 141
Case Studies: Who Is Doing What, Where, and How 142
Weekend Immersion in Nursing Informatics 142
An Academic Health Center 142
Cleveland Clinic 143
Lancaster General Hospital 144
Summa Health System 145
St. Vincent Mercy Medical Center 147
Tenet Healthcare: Creating a Training Team 149
Training Team 150
Learning Gap Analysis Computer Skills Assessment150
Training Delivery Methods 151
Training Schedules 151
Super User Training 151
Success Criteria 152
Outcomes: Quality of Care, Patient Safety, and Operational Issues 152
Recommendations for Successful Clinical Systems Training Approaches 153
Conclusion 154
References 155
9: Leadership Collaborative 156
Overview 156
Industry and National Imperatives 157
Involvement of Nurse Leaders 158
Background: The Tiger Leadership Collaborative Vision 158
Nursing Leadership Development Programs 160
Academic Graduate Programs for Nursing Administration with Informatics Education 160
Organizational Fellowship Programs for Nurse Executive Education and Mentorship 161
Health Industry Network Programs for Nursing Management Education 161
Technology Vendor-Sponsored Programs for Nursing Leadership 161
Self-Education Opportunities for Nurse Executives and Managers 162
Informatics Competencies 162
Education Is Essential 162
Nursing Informatics Competencies Models 163
Basic Computer Skills 164
Virtual Communication Tools 165
Information Literacy 165
Information Management 166
Expanded Competencies for Nurse Leaders 167
Magnet Program Collaboration 170
Nursing Leadership Survey 171
Methodology 171
Results 171
Survey Recommendations 172
Charge Nurse Role 172
Director/Manager Role 172
Chief Nurse Executive and Dean Roles 173
Leadership Development Needs 175
AONE’s Technology Task Force 175
References 175
10: Challenging Leadership Status Quo 178
CNOs and Other Nursing Leaders Must Become Acutely Knowledgeable About IT Systems’ Ability to Support Patient Care 179
Nursing Must Embrace a Universal Approach to Nomenclature and Taxonomy 181
Nurse Executives Should Recast Their Strategic Vision to View Information Technology as a Tool to Help Nursing Do its Job Bett 181
Only Nursing Can Architect How the Comprehensive Process of Patient Care Should Flow 181
Nurse Executives’ Understanding of IT Should Span from System Development Through to Maintenance and Migration, Ending at Obso 182
Nurse Executives Need to Know How to Exploit the Power Inherentin Relational Databases 184
Nurse Executives Must Fully Understand and Appreciate the Differences Between Research Analysis and Operational Analysis 184
Engage in the Technology Acquisition and Utilization Process Early and Often to Balance the Organization’s Business Drivers wit 185
Know How Organizational Changes, Yours and Theirs, Can Impact IT Systems 185
Fully Understand Total Cost of Ownership (TCO) to Project with Accuracy 185
Understand the Entrepreneurial Mindset 186
Reference 188
11: Bridging Technology: Academe and Industry 189
Simulations 190
Healthcare Informatics 192
Informatics and Simulation in Nursing Education 194
Integrating Informatics and Simulation in a BSN Nursing Program 195
Assessment 195
Diagnosis 196
Implementation 197
Second Life 198
Micro Sim™ 198
Evaluation 198
Incorporating a Clinical Information System (CIS) into Simulations 199
Case Study: Johns Hopkins University School of Nursing and Eclipsys Corporation 200
Semester One: Principles and Applications of Nursing 201
Semester One: Health Assessment 204
Other Technical Challenges 207
Nursing Implications and Conclusion 209
References 209
Section III:Infrastructure, Adoption, and Implementation 211
Nursing and ‘Meaningful Use’ 211
The National Informatics Picture 212
Standards and Interoperability 213
Usability and Clinical Design 213
Evidence-Based Clinical Decision Support 213
Transformation 214
References 214
12: The Evolving National Informatics Landscape 215
Introduction 215
Statistics and Trends Driving Health Care Transformation 215
Unsustainable Spending 215
Nursing Shortage 216
Lack of Disaster Preparedness and Planning 216
Growing Health Care Consumerism 216
Emerging Telehealth 217
Transparency of Health Care Information and Cost 217
Health Information Technology Adoption: A National Priority 217
Federal Momentum and Activities 218
The Federal Government’s Role in HIT Adoption 219
Office of the National Coordinator 219
Governance: Federal, State, and Local Activities 220
Policy 220
Technology 221
The Nationwide Health Information Network (NHIN) 221
Health Information Technology Committee (now that HITSP is no longer active) Standards Panel (HITSP) 221
Adoption 222
Certification Commission for Health Information Technology (CCHIT) 222
Other Federal Partners 223
Opportunities for Nurses to Engage 223
How to Get Involved 224
National eHealth Collaborative 224
Health Information Technology Policy and Standards Committee 224
Certification Commission for Health Information Technology 225
The Recovery Act of 2009 (Public Law 111-5) 225
A Final Word 227
References 227
13: Standards and Interoperability 228
What Is a Health IT Standard? 229
What Does Interoperability Mean? 231
The National Health IT Agenda 231
The Standards Adoption Process 232
The Role of Nursing 234
Understanding the Benefits of Standards and Interoperability 235
Call to Action 236
Opportunities for Involvement 237
References 238
14: Usability and Clinical Application Design 239
What Is Usability? 240
Specific Definitions 241
The Significance of Usability for Products and Systems 242
Usability Goals 243
What Is Clinical Application Design? 243
Literature Review and Framework 245
Literature Review and Analysis Process 245
Recommendations 247
Recommendation 1: Determine Clinical Information Requirements 247
Recommendation 2: Design Safe and Usable Clinical Information Technology 249
Recommendation 3: Conduct Usability Evaluations 251
Recommendation 4: Construct the Foundations in Human Factors 254
Case Studies 256
Best Practice Exemplars 257
Challenging Case Studies 257
Case Study 1: A Usability and Clinical Application Design Challenge 258
Case Study 2: A Usability and Clinical Application Design Exemplar 259
References 260
15: Evidence-Based Clinical Decision Support 262
Evidence-Based Practice: More Than a Buzz Word? 262
Why is Evidence-Based Practice a Priority in Health care Today? 264
Current Reality: Understanding the Challenges 265
Individual Clinician Practice: Time Constraints 265
Individual Clinician Practice: Skill Level and Readiness 266
Individual Clinician Practice: Attitude Toward EBP 266
Organizational Culture and Infrastructures 266
Implementation Models for Evidence-Based Practice 267
Health Quality Initiatives and Supporting Organizations 267
Health Information Technology Advancement 269
Evidence-Based Practice Tools and the Use of Technology 270
Evidence Retrieval Systems 271
Website Searches 271
Clinical Practice Guidelines 271
Clinical Information Systems 273
The Role of Nursing: A Call to Action 275
References 276
Section IV:Future Perspectives 278
Personal Health Record and Management of Personal Health 278
Innovation at the Point of Care: Smart Systems 279
Innovation at the Point of Care: Extending Care 279
Nursing Leadership: Critical to Success 280
Personalized Medicine and Comparative Effectiveness Research 280
TIGER Virtual Learning Environment 281
TIGER Phase III 281
16: Personal Health Record: Managing Personal Health 283
Consumer Empowerment and Technology 283
Consumer Trends, Behaviors, and Expectations 284
Health Literacy in the U.S. Population 286
Major Literature Resources and Milestone Contributors 286
Health Literacy Defined 287
Health Policy to Promote Health Literacy 288
Business and Service Provider Collaborative Programs 290
Nurses’ Role in Health Literacy and Consumer Empowerment 290
Emergence of the PHR in Health Policy 292
PHR’s Historical Evolution 293
PHR Advocacy by Foundations and Consumer Groups 294
Why ePHRs Are an Empowering Technology 295
Patient Safety 295
Education and Decision Support 295
Assistive Reminders 296
Communication and Support Services 296
Integration with the Electronic Health Record 296
Currently Available ePHR Products 297
Costs to the Consumer 297
Use and Usage 298
Barriers to Use and Acceptance 298
Innovations 299
Standards and Usability Principles for ePHRs 300
Sources on ePHR Standards and Certification 300
Nurses’ Role in Promoting Use of ePHRs 301
Nursing Informatics and Consumer Health Informatics 302
Summary 302
References 303
17: Disruptive Innovation: Point of Care 308
Vision and Value of Clinician Support via a Smart POC System 309
The Future of Information Technology 312
A Model for Health Care Success 313
Roadmap to the Successful Medical Home 316
References 319
18: Extending Care: Voice Technology 320
Speech-Based Applications in Health Care 321
Front-End and Back-End Speech Recognition 321
Speech Recognition and Electronic Medical Records 321
Wireless Call Systems 321
Documentation, Information Retrieval, and Paging All in One 322
Benefits of Voice-Assisted Care 322
What’s Driving the Move Toward Voice Technology at the Point of Care? 323
Driver 1: The Trend to Electronic Records 323
The Role of Nurses and Nursing Informatics 324
The Needs of Nurses 324
Keys to Adoption of Innovations 326
Driver 2: Person-Centered Care and Associated Culture Change 326
Driver 3: Governmental and Regulatory Demands 327
Glycemic Control 328
Reduction in Falls/Trauma 329
Decrease in Catheter-Associated Urinary Tract Infections (UTIs) 329
Driver 4: Patient/Consumer Perception of Health Care 329
Form Factor 330
Recognition Accuracy 330
Workflow 330
Connectivity 331
Privacy 331
Standards and Integration 331
Voice in Action: Case Studies 331
The Boston Home11 332
St. John Specialty Care Center28 332
Butler Memorial Hospital 333
Summary 333
References 334
19: Nursing’s Contribution: An External Viewpoint 337
At the Core of Performance Improvement 338
Broad Industry Trends Converging: Nursing Informatics at the Nexus 339
When EMR Use Facilitates Care Quality Improvement 340
Performance Improvement Methodologies and IT: Hand-in-Glove 342
Organizations with a Strong Clinical Leadership–IT Leadership Link 343
Into the Future 344
20: Transforming Care: Discovery Enabled by Health Information Technology 347
Background 347
What Is Personalized Medicine? 348
How is Genomic Science Translated to Practice? 350
Some Key Stakeholders in Personalized Medicine 351
What is Comparative Effectiveness? 352
What Is Comparative Effectiveness Research? 352
Some Key Stakeholders in Comparative Effectiveness 354
The Critical Importance of Health Information Technology 354
References 356
21: Local Global Access: Virtual Learning Environment 358
Introduction 358
Demonstration Exemplars 359
Observable Exemplars 360
Trialable Exemplars 360
Learn-While-Doing Exemplars: Academic Education Solutions 361
Simulation Exemplars 361
Current Trends in Technology Demonstration 362
The TIGER Virtual Demonstration Center Pilot 362
Using Technology in Nursing Education 363
Classroom Setting 363
Virtual Setting 364
Simulation Laboratory Setting 364
Clinical Setting 366
Future of Virtual Demonstrations 366
Scenario 1: Current Technology 366
Scenario 2: Short-Term Future Technology 367
Scenario 3: Future Technology 368
Conclusion 368
Section V:Global Initiatives 370
Terminology Development in Canada and Beyond 371
View of Europe from Germany 372
Nursing Informatics Evolution in Brazil 372
Training in Taiwan 372
References 373
22: Invisibility to Visibility: Capturing Essential Nursing Information 374
Introduction 374
Determining Nursing Data 375
Environmental Forces Impacting Health Information Development 377
Data Standards 378
Types of Controlled Languages 379
Determining Nursing Data Standards 381
Issues 384
Implications of Nursing Data 384
References 386
23: Health Telematics Europe 389
Diversity of European National Healthcare Systems 389
Informatics Supporting Patient Care 392
eHealth Initiatives in Europe 392
eHealth Standards 396
From eHealth to Nursing Documentation Systems 398
Informatics Supporting Nursing Management, Leadership, and Policy 400
Nursing Informatics in Education and Training 404
Nursing Informatics in the Pre- and Postregistration Phase of Nurses 404
eLearning/Blended Learning 405
Summary and Outlook 406
Appendix A: Some Nursing Informatics Workings Groups in European Countries 408
Appendix B: Major European Conferences in the Nursing Informatics Domain 408
References 408
24: Evolution: Nursing Informatics in Brazil 415
Evolution of Nursing Informatics in Brazil 416
Practice, Research, and Education in Nursing Informatics 418
Lessons Learned 422
Future Directions 423
References 423
25: Taiwan Model: Nursing Informatics Training 425
More than Computer Competency 425
Evolving NI Need and Acting with Leading Role 426
Guiding Learning Map 428
Great Solutions: Two Stories 435
New Design for the Touchscreen-Based Interface Future 435
New Tool for Meeting Unlimited Documentation Needs 436
Summary 436
References 442
Appendix 443
Index 482