Technology Trends for Nursing by xzu70465

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									Enhancing Clinical Practice and
   Patient Safety Through
        Technology




    Colorado Healthcare Information and
       Management Systems Society
            November 11, 2005
             Denver, Colorado
     Nursing Informatics:
Creating Value with Innovation


Joyce Sensmeier MS, RN, BC,
     CPHIMS, FHIMSS


        Vice President, Informatics
        Healthcare Information and
       Management Systems Society
               Objectives
Describe the top 3 job responsibilities
performed by nurse informaticists
List the top 3 business issues that will impact
healthcare in the next two years
Examine the potential impact of an electronic
health record system on care delivery
Identify the national initiatives that will impact
the role of nurse informaticists
Describe the objectives of the Alliance for
Nursing Informatics
Definition of Nursing Informatics
A specialty that integrates nursing science,
computer science, and information science
to manage and communicate data,
information, and knowledge in nursing
practice.


ANA, 2001
Goal of Nursing Informatics

             To improve the health of
             populations, communities,
             families and individuals by
             optimizing information
             management and
             communication.

             ANA, 2001
 Nursing Informatics Roles

Project Manager
Consultant
Educator
Researcher
Product Developer
Decision Support/Outcomes
Manager
Advocate/Policy Developer
                            ANA, 2001
  Nursing Informatics Roles
Change agent applies to all
Practice can be interdisciplinary
Emerging roles
  Entrepreneurs developing products
  Managing an independent practice
  Consulting
  Business owners
  Chief Information Officers
                              ANA, 2001
       Most valued skills

Leadership           Flexibility
Communication        Creativity
People skills        Ability to deal with
Business knowledge   change
Management           Change management
Project management   Politically astute
Partnering           Application knowledge
Consensus building
                     Hersher Associates, 1998
  2004 HIMSS Nursing Informatics Survey
         Nursing Background
                  ICU                                      24%

            Med/Surg                                     22%

 Multiple Departments                              15%

                Other                        10%

Emergency Department                    7%

      Operating Room                6%

            Maternity              5%

            Pediatrics        3%

         Home Health          3%

           Informatics        3%

  Quality Improvement    1%

    Case Management      1%

      Physician Office   0%
                                                                 6
  2004 HIMSS Nursing Informatics Survey
          Workplace Setting

           Hospital                     51%


       Vendor Firm                16%

     Health System
                                13%
        (Corp).

    Consulting Firm        6%


             Other         5%


  Academic Setting         5%


Government/Military    3%


   Ambulatory Care    1%

    Payor/Managed
                      1%
         Care                                 6
2004 HIMSS Nursing Informatics Survey
   Top Three Job Responsibilities
      Implementation                               67%


          Systems
                                             52%
        Development

Liasion/Communicator                   32%


    Quality Initiatives          25%


Informatics Education           23%


   Systems Selection      16%


   Nursing Education      16%


   Strategic Planning     15%

                                                         6
   Major Drivers for Healthcare Providers

   Financial: flat or declining          Resources: Physician and
         reimbursement,                 nurse recruitment, retention,
     rising overhead costs                  productivity issues



                              Healthcare
Regulation/compliance:                         Purchaser pressures:
 HIPAA, JCAHO, CMS            Providers        Pay for performance,
changing rules and laws      (and their IT        patient safety
                            Departments)

          Technology:                   Consumer demands:
     drug discovery, device               choice, control,
     technology, genomics                 communication
                  and beyond

Shifting focus
 Economy recovers
 HIPAA fears diminishing
 Focus on making applications work
 together
 National interest in Healthcare IT
 Institute of Medicine Report
              2000
To Err is Human:
Building a Safer
Health System
44,000-98,000 deaths
each year are related
to preventable
medical errors
Patient Safety: Achieving a New
       Standard for Care

               Report describes a
               detailed plan to facilitate
               the development of data
               standards applicable to
               the collection, coding,
               and classification of
               patient safety information

                             IOM, 2004
   Four Essential Elements
Electronic Health Records (EHRs)
Clinical Decision Support
Computerized Provider Order Entry
Secure, Private, Interoperable
    -> Health Information Exchange

   Lower Costs, Fewer Errors, Higher Quality
   • President’s Information Technology Advisory Committee (PITAC) Draft
     Report , April 13, 2004
   2004 State of the Union
          Address
“By computerizing health records, we
 can avoid dangerous medical mistakes,
 reduce costs and improve care.”

            President George W. Bush
            January 20, 2004
      And the beat goes on…..

 “ …. most Americans will have electronic
  health records within the next 10 years”

President George W. Bush April 26, 2004
In a public address to the American Association of Community
Colleges, the President outlined a plan whose goal is to assure
better delivery of healthcare in the United States.
                    And on…..
  “The federal government, states and
   industry will have to collaborate in order to
   achieve a health care system made up of
   interoperable local regional networks”

HHS Secretary Michael Leavitt May 4, 2005
In a public address at the National Association of State CIO’s
mid-year conference in Washington, DC
Framework for Strategic Action
President Bush’s April 27th executive order called for
the creation of the Office of the National Coordinator
of Health Information Technology (ONCHIT)

The Framework for Strategic Action was released by
HHS Secretary Tommy Thompson and newly
appointed National Coordinator of Health Information
Technology, David Brailer, MD, PhD at the NHII
Summit in July, 2004
Framework for Strategic Action
Report includes:
 12 strategies to achieve four major
 goals
 Information from DoD, VA, and OPM on
 how their areas can advance the
 adoption of HIT
 A catalog of identifiable federal HIT
 programs
 http://www.hhs.gov/onchit/framework/
           Four Major Goals
1.   Inform Clinical Practice
       Incentivize EHR adoption
       Reduce risk of EHR investment
       Promote EHR diffusion in rural & underserved
2.   Interconnect Clinicians
       Foster regional collaborations
       Develop a national health information network
       Coordinate federal health information systems
           Four Major Goals
3.   Personalize Care
       Encourage use of PHRs
       Enhance informed consumer choice
       Promote use of telehealth systems
4.   Improve Population Health
       Unify public health surveillance architectures
       Streamline quality and health status monitoring
       Accelerate discovery and dissemination
    The Community (AHIC)
A federally-chartered Commission
convened in October, 2005
Chairperson, HHS Sec. Michael Leavitt
Will recommend ways to make health
records digital and interoperable; and,
Assure privacy & security of health records
are secure
All work to be performed smoothly and led
by the marketplace
The Community’s Breakthroughs
 Consumer Empowerment
   My Personal Health Record, My Medication History,
   My Health Record Locator, and My Registration Info
 Health Improvement
   eRx; Quality Monitoring & Reporting; Chronic Disease
   Monitoring; Immunization Records; and, an Employee
   Empowerment Tool
 Public Health Protection
   ER Info Network; Bio-Surveillance & Pandemic
   Surveillance; Adverse Drug Event Reporting &
   Notification
     HHS Health IT Strategy
               American Health Information Community
                    Led by HHS Sec. Mike Leavitt

                     Office of the National Coordinator
                               Project Officers



     Standards       Compliance              NHIN         Privacy/Security
   Harmonization     Certification         Prototype         Solutions
    Contractor        Contractor          Contractors        Contractor




Continuous Interaction with Multiple Public and Private Stakeholders
Continuous Interaction with Multiple Public and Private Stakeholders
   Impact on Healthcare IT

Technology trends can no longer
develop in a void
Systems must connect with each other
  Organizational
  Local
  National
  Global
Public/Private partnerships needed
N/A
  Electronic Health Record

Electronic Health Records are needed that
maximize the amount of information
available to healthcare providers
  While not creating new work flow or cost
  issues

   • President’s Information Technology Advisory
     Committee Draft Report, April 13, 2004
       The EHR … defined
“The Electronic Health Record (EHR):
 Is a secure, real-time, point-of-care, patient-
 centric information resource for clinicians
 Aids clinicians’ decision making by
   Providing access to patient health record
   information where and when they need it, and
   By incorporating evidence-based decision
   support….”

 Source: HIMSS Electronic Health Record
 Definitional Model Version 1.0 2004
        The EHR … defined
The Electronic Health Record (EHR)
 Automates and streamlines the clinician’s
 workflow
   Closes the loop in communication and response
   that may result in delays or gaps in care
Supports the collection of data for uses other
than direct clinical care
   Billing &quality management
   Outcomes reporting & resource planning
   Public health disease surveillance & reporting

 Source: HIMSS Electronic Health Record
 Definitional Model Version 1.0 2004
       HL7 Electronic Health Record
       System Functional Model
  Functions
                     Direct Care: EHR-S functions used for
  Direct Health    providing direct health care to, or direct self-
  Care Delivery           care for, one or more persons.
  D 1.0
  D 1.1
  D 1.2                 Supportive: EHR-S functions that most
  Supportive          frequently use existing EHR data to support
  Functions
  S 1.0
                     the management of health care services and
  S 1.1                              organizations
  S 1.2
  Information
  Infrastructure
                            Information Infrastructure: Critical
  I 1.0                   backbone elements of Security, Privacy,
  I 1.1                  Interoperability, Registry, and Vocabulary.
  I 1.2

Courtesy HL7 EHR Special Interest Group
           A look ahead
Today: Healthcare IT becomes part
of the national political agenda
2004-06: Grants, studies, demo projects
2004-06: Push for standards adoption
2004-06: Pay-for-performance pilots
2006-08: Monetary incentives including
differential reimbursement for IT use
2010: Clinical IT becomes part of the
“standard of practice”
      The Promises of Digitization
   Financial: flat or declining             Resources: Physician and
         reimbursement,                    nurse recruitment, retention,
             Costs
     rising overhead costs                          Productivity
                                               productivity issues
             Revenue                                Satisfaction



Regulation/compliance:                            Purchaser pressures:
 HIPAA, JCAHO, CMS            Healthcare          Pay for performance,
                                                      Accountability
changing Compliance
         rules and laws       Providers              patient safety
         Variation                                    Quality


          Technology:                  Consumer demands:
     drug discovery, device              choice, control,
        Diffusion of Innovation
     technology, genomics                Informed choice
                                         communication
        Appropriateness                  Convenience
           National Initiatives
Regional Health Information
Organization (RHIO)
Federation
  Collaboration in setting realistic
  expectations for the exchange of
  health information


Tiger Team
  Technology Informatics Guiding
  Educational Reform
  National Summit in collaboration
  with IOM
            Survey Background
HIMSS Nursing Informatics Task Force concern -
     Is communication ‘lost in translation’?
   Survey developed             −   Findings categorized
      Literature review
                                −   Construct validity
      Developed interview           achieved thru expert
      guide                         panel interviews
      Focus group session       −   Validated with NI Task
      Analysis of transcripts       Force members
      Theme patterns            −   Final document used to
      identified                    develop survey
         Geographic Distribution




1700 Respondents
       HIT Applications in Use
            HIT applications in general use
100%

90%
                                        Alerts
80%                                     Audio conferencing tools
                                        Bar-code Med Administration
70%                                     CPOE
                                        Electronic Plan of Care
60%
                                        EMAR
50%                                     Electronic documentation
                                        Off site fetal monitoring
40%
                                        PACS
30%                                     Patient Results
                                        Remote access for physicians
20%                                     Wireless telephones
                                        Other
10%

 0%
Purpose

The Alliance for Nursing Informatics
 strives to speak with one voice on
 nursing informatics issues and
 opportunities of national import
   Founded in 2004
   Unprecedented coming together of all known
   nursing informatics organizations in the U.S.
Alliance for Nursing
Informatics

 Is a collaboration of organizations
 Represents a unified voice for nursing
 informatics
 Provides the synergy and structure
 needed to advance the efforts of nursing
 informatics professionals
 Supports improvement of the delivery of
 patient care
Objectives

 Foster further development of a unified
 voice for nursing informatics and provide a
 forum for its expression
 Provide a single point of connection
 between nursing informatics individuals
 and groups, and the broader nursing and
 healthcare community
Objectives

 Provide a mechanism for transforming care,
 developing resources, guidelines and standards
 for nursing informatics practice, education,
 scope of practice, research, certification, public
 policy, terminology, best practice guidelines,
 mentoring, advocacy, networking and career
 services
 Support individual membership in the affiliated
 nursing informatics organizations
Membership
    ANI membership consists of
 organizations who focus entirely on
    nursing informatics or have a
component that focuses specifically on
         nursing informatics.
AMIA        American Medical Informatics Association
            Nursing Informatics Working Group
ANIA        American Nursing Informatics Association
ASCI        Alabama Society for Clinical Informatics
BANIC       Boston Area Nursing Informatics Consortium
CARING      Capital Area Roundtable on Informatics in Nursing
CSRA-CIN    Central Savannah River Area Clinical Informatics Network
CHIN        Connecticut Healthcare Informatics Network
CONI        Carolina Nursing Informatics????
DVNCN       Delaware Valley Nursing Computer Network
HINJ        Health Informatics of New Jersey
HIMSS       Healthcare Information and Management Systems Society
            Nursing Informatics Task Force
INFO        Informatics Nurses From Ohio
MINING      Minnesota Nursing Informatics Group
MNRS        Midwest Nursing Research Society
NCNA CONI   North Carolina State Nurses Assoc. Council on NI
NISCNE      Nursing Information Systems Council of New England
PISUG       Perinatal Information Systems User Group
PSNI        Puget Sound Nursing Informatics
SCINN       South Carolina Informatics Nursing Network
UNIN        Utah Nursing Informatics Network

ANA         American Nurses Association (Liaison)
ANI is jointly sponsored by AMIA
   and HIMSS who provide the
 infrastructure and staff support
    necessary to support ANI
             initiatives.
Benefits

 Computers Informatics Nursing Journal
 Certification – ANCC
 Audio-conference – May 11, 2005
 HIMSS Summer Summit –June 6-7, 2005
 AMIA NI Symposium – October 22, 2005
 HIMSS NI Symposium – February 12, 2006
 Other sponsorships
IT Innovations Transforming Today’s
          Nursing Practice
          October 22, 2005
 Technology's Role Nursing Shortage
 Vision to Reality - Innovative Solutions
    PDAs, BidShift & more
 Vision to Reality: Innovative Solutions
 Methods & Tools to Evaluate the Impact of IT on Practice
 Making Evidence Based Practice a Reality
Nursing Informatics Symposium 2006
           San Diego, CA
         February 12, 2006
           www.himss.org
Activities

  National, State and Regional Initiatives
  PITAC
  Office of the National Coordinator of
  HIT meeting
  TIGER Team Project
  HITSP
  Computers, Informatics Nursing
  ANCC - discount
          Beyond Digitization:
          Care Transformation


              Enhanced       More Timely
              Presentation   Information




                                  Quantum Leaps in
Deeper
                                  Caregiver-Patient
Observation
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