Transcript Chapter 10: Nursing Informatics and Healthcare

Chapter 11:
Nursing
Informatics and
Healthcare
Policy
By: Fredirich T. Bernante
Objectives
1.
2.
3.
Consider the implications of policy on
nursing informatics (NI) as a specialty.
Identify the impact of national trends
and events that focus on information
and information technologies on NI
practices.
Discuss telehealth and NI.
Introduction
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To practice effectively in today’s continually
changing healthcare environment, informatics
professionals need to be aware of existing and
proposed healthcare policy.
Policy- a course of action that guides present and
future decisions. Healthcare policy is established on
local, state, and national levels to guide the
implementation of solutions for the populations health
needs.
The number of informatics programs for nurses has
significantly increased, preparing more informatics
nurse specialists to practice in the field, and a number
of trends and events have placed information
technology (IT), information systems (IS), and
informatics at a center of attention in healthcare.
Healthcare Policy and Nursing
Informatics as a Specialty
 Nurses
have contributed to the purchased,
design, and implementation of IS since the 1970s
and in 1992, the American Nurses Association(
ANA) recognized NI as a specialty.
 To be acknowledged as a specialty within
nursing, informatics had to:
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Demonstrate a differentiated practice base
Identify the existence of educational programs in
the field.
Develop a research agenda. Healthcare Policy
and Nursing Informatics as a Specialty
The Definition of NI
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Before: NI was defined as the combination of nursing
information, and computer sciences to manage and
process nursing data into information and knowledge for
use in nursing practice.
Now: NI is described more broadly as a specialty that
integrates nursing science, computer science, and
information science to manage and communicate
data, information, and knowledge in nursing practice.
NI facilitates the integration of data, information, and
knowledge to support patients, nurses, and other
providers in their decision-making in roles and settings
thru the use of information structures, information
processes and IT.
Differentiated and
Interdisciplinary Practice:
NI brings an added dimension to nursing
practice that focuses on knowledge and skill in
information management techniques. NI
practice differentiates itself from other areas of
nursing practice but emphasizes its interaction
with informatics disciplines such as
mathematics, statistics, linguistics, engineering,
computer science, and health informatics.
Differentiated and Interdisciplinary Practice
Other Ex. Of Domain Specific
Informatics Practices:
 Medical
informatics, Dental informatics
Consumer informatics. NI community
believes it is essential to practice within an
interdisciplinary team and a one good
example of interdisciplinary work is the “
Vocabulary Summit” held annually at
Vanderbilt University since 1999
spearheaded by Judy Ozbolt.
Preparation for Specialty
Practice
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To become a specialty, it was necessary for NI to
show that educational programs are available
to prepare nurses to practice in the field.
The Division of Nursing (DN), Health Resources
and Services Administration (HRSA) founded two
Master’s NI programs and one Doctoral program
in NI at the University of Maryland.
In 1997 an NI specialty program open at New
York University and in 1998 a specialty program
was implemented at Duquesne University at
Pittsburgh. Preparation for Specialty Practice
Healthcare Policy Impact On
Nursing Informatics Practice
 Nursing
Shortage and Nursing Informatics
Nursing has experienced a number of shortages
in recent history.
 An older nursing workforce, A higher ratio of
older associate degree graduates The
availability of more attractive career
opportunities for women decreased interest in
nursing as a career difficult work environments.
Nursing Shortage
 Unless
something is done the shortage will rise from
6% in 2000 to 29% in 2020 or more than 800,000
nurses short of the number needed.
 The Bureau of Labor Statistics(BLS) is predicting
registered nurse positions will increase more than
600,000 between 2002 and 2012.
 To cover these new positions and replace retiring
nurses 1.1 million more nurses are needed by 2012.
Although these numbers differ it is clear that
without intervention the healthcare industry is
headed for a major crisis in the nursing workplace
Solution to Shortage
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Schools and colleges of nursing have shortened
program lengths and instituted accelerated program
for those who already hold a baccalaureate degree in
an attempt to increase nursing workforce numbers.
Nursing organizations have been actively advocating
for increased federal funding to expand programs and
increase loans, scholarships, and incentives.
In 2002 the AAN Commission on Workforce launched a
multiphase project to develop IT that will help support
nurses in their day to day work.
Phase 1:
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interdisciplinary, creative thinkers were assembled to
determine how technology could be use to facilitate
nurses’ work.
Bradley(2003) indicated that technology solutions
should improve existing care processes and
outcomes, increase access thru the use of portable
handheld devices, incorporate Internet capability to
overcome distance barriers of care and improve
access to knowledge acquisition.
These authors also advocate for using bar-coding of
medications, use of speech recognition, and fine
tuning the user interface of systems to support nurses
Phase 2
 As
Phase 2 of the AAN technology project
began, staff nurses from three hospitals in Virginia
and California were asked to identify or verify
the most difficult aspects of their practice and
how technology would improve those tasks.
 As the project continues, systems will be
designed, implemented, and tested to
determine their effect on nurses’ work.
 It is up to NI specialists to help design and
implement IT systems that will finally assists nurses
in their practice and to validate the results thru
research.
Patient Safety and Nursing
Informatics
 The
IOM report issued in 1999, To Err is Human:
Building a Safer Health System has had a chilling
and lasting effect on healthcare.
 Using data from two studies with large numbers of
hospital admissions as a basis of analysis, the IOM
determined that adverse events occurred in 2.9
and 3.7% of admissions.
 When these percents were applied to the number
of U.S. hospital admissions it was estimated that
between 44,000 and 98,000 patients die each
year from medical errors.
Crossing the Quality Chasm: A
New Health System for the 21st
Century
 strengthens
the argument for using technology
to improve patient safety. Surveys confirm that
concern for patient safety is the biggest factor
driving IT California law 1875, passed in 2003,
applies pressure to hospitals to install IT to help
healthcare professionals reduce error.
 The Leapfrog Group, comprised of Fortune 500
companies and other large healthcare
purchasers list CPOE as a strategy for improved
patient safety.
The National Alliance for
Healthcare Information
Technology(NAHIT)
a
partnership of diverse healthcare leaders who
are working to influence the use of technology
to improve patient safety, quality, and
efficiency.
 During the next few years, this group plans to
focus on the following:
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consensus based standards, multi organizational
collaboration ,
an informed government, and
best practices knowledge for system
implementation.
National Informatics Initiatives
and Nursing Informatics
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Executive Order for National Interoperable
Information System As indicated earlier, patient safety
is one of the driving forces in increased clinical
automation.
National events have placed IS at the forefront of
health policy. The impact of the fist two IOM reports
on patient safety has been discussed.
An additional IOM report Patient Safety states even
more emphatically that electronic medical records,
using standard data elements, are a critical tool to
improve patient safety. National Informatics Initiatives
and Nursing Informatics
President’s Information
Technology Advisory
Committee (PITAC)
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A 2001 report from the President’s Information
Technology Advisory Committee (PITAC) highlighted
key issues in IT.
PITAC indicated that the United States lacks broadly
disseminated and accepted national vision for IT in
healthcare and recommended the appointment of a
senior IT person to provide strategic leadership.
On April 27, 2004, President George W. Bush issued an
executive order “Incentives for the Use of Health
Information Technology Coordinator” that has the
potential to impact every healthcare entity, provider,
and NI professional in the United States( Executive
Order 2004)
Components of the Order:
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Establish a national health information technology
coordinator position.
Work to develop a nationwide interoperable health
infrastructure
develop, maintain , and direct implementation of a
strategic plan to guide implementation of
interoperable health IT in both public and private
sectors. The interoperable health IT should reduce
medication errors, improve quality, and produce
greater value for healthcare expenditures.
CPOE
(COMPUTERIZED PHYSICIAN ORDER ENTRY)
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The Center for Medicare and Medicaid Services
(CMS) has issued a final rule on physician self-referrals
that creates exceptions for technology items or
services furnished to physicians to enable their
participation in a community wide health IS The
American Association of Retired Persons(AARP), 35
million members strongly supports mandatory
electronic prescribing rules and federal efforts to
increase adoption of CPOE.
Interestingly, CPOE increasingly stands for
computerized practitioner order entry, language
used by AARP
National Health Information
Infratructure:
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Another national initiative that will impact NI is the National
Health Information Infrastructure(NHII).
This voluntary initiative, involving a three stage process over
10 years, is intended to improve the effectiveness, efficiency,
and overall quality of health and healthcare in the United
States.
NHII calls for comprehensive knowledge-based networks
that integrate clinical, public health and personal health
information to improve decision making by having
information available to providers.
Secretary Thompson announced that the first part of a
national health IT plan would be delivered at the
conference by the National Coordinator for Health IT.
Conference tracks included personal health, governance,
incentives, standards and architecture, confidentiality,
ethics, privacy and access, measuring progress population
health, and clinical research.
Health Insurance Portability
and Accountability Act
(HIPAA):
 HIPAA
was passed in 1996 and is intended to
improve public and private health programs
by establishing standards to facilitate the
efficient transmission of electronic health
information.
 HIPAA preempts state law and payer specific
variations of data standards; mandates input
from private, standard setting organizations.
How HIPAA Impacted
Informatics
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IT must be designed to comply with Title II of the act.
All of the requirements of HIPAA are expected to be
in placed by May 23, 2008 Timetable :
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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
HIPAA Regulations
 The
privacy rule and other HIPAA regulations
are having tremendous impact on health
informatics, including NI. For example, under
HIPAA patients must be permitted to review
and amend their medical records Informatics
nurses are responsible for understanding and
helping to implement HIPAA regulations.
National Agenda for Nursing
Informatics:
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The DN, HRSA, is responsible of the nursing workforce,
including preparation in the area of NI.
During the 1970s, funding efforts focused on increasing
awareness of the need for IS that could be used to
support nursing practice and developing a nursing
language that could be applied to public health
settings.
Funding during the 1980s and early 1990s enabled four
different educational models to be develop for NI, two
models focused on specialty practice incorporated NI
skills into administration and community health
programs.
Cont’d
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As a result, in 1997 the DN convened the National
Nursing Informatics Group (NNIWG) to make
recommendations to the National Advisory Council
for Nurse Education and Practice (NACNEP) for
setting the nation’s nursing informatics agenda.
NNIWG members were experts in decision support,
distance education, informatics education, IS,
language and taxonomies and telecommunications.
Experts were then ask to suggest initiatives that would
offer solutions for the identified informatics needs.
Five Assumptions
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There are five assumptions considered by NACNEP to
be a basis for all further discussion of NI initiatives:
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5.
Learners are students, faculty and clinicians
NI must be considered within an interdisciplinary
context of partnership and collaboration.
Efforts should target disadvantaged and underserved
populations.
Initiatives should be responsive to other government
funding priorities
Collaborations among federal agencies and between
federal and private entities is neccesary .
5 Key Directions for Informatics
in Nursing:
 Five
key directions for informatics in nursing
education and practice were recommended to
the Secretary, DHHS in the NACNEP report
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2.
3.
4.
5.
Educate nursing students and practicing nurses in
the core informatics content
Prepare nurses with specialized skills in informatics
Enhance nursing practice and education thru
informatics projects
Prepare nursing faculty in informatics
Increase collaborative efforts in NI.
Telehealth and Nursing
Informatics
 Telehealth
services have been provided for about
50 years but telehealth remains an underutilized
tool for nursing and NI.
 Telehealth- is the use of electronic information
and telecommunication technologies to support
long-distance clinical healthcare, patient and
professional health-related education, public
health, and health administration.
Factors Advancing Telehealth
Technology Innovation:
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Decreasing costs of telecommunication technologies
Decreasing costs of telehealth devices and
applications
Resolutions of interoperability issues
Convergence of telehealth and telecommunications
technologies, IT, and the Internet. Unfortunately
telehealth provides sush specialized tools it falls outside
of the influence of groups like the AMA and the
Advanced Medical Technology Association
Telehealth Cont’d
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In addition there has been a significant disconnections
bet. telehealth and informatics. This is especially true in
view of the fact that both telehealth and information
technologies face barriers of acceptance,
reimbursement and licensure.
Efforts are being made to close the gap but until
recently, documentation of telehealth events has
frequently been independent of or isolated from IS. In
a 1997 report to Congress, the 3 major issues of
reimbursement, licensure, and security were
implicated in preventing widespread adoption and
use of telehealth
Telehealth Cont’d
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On the other hand the National Council of State
Boards of Nursing(NCSBN) has implemented a model
recognition in which nurses obtain a state based
license that is nationally recognized and locally
enforced.
The Balanced Budget Act passed in 1997 mandated
the first reimbursement policy of telehealth services for
Medicare recipients. The Medicare, Medicaid and
SCHIP Benefits Improvement and Protection Act of
2000 changed some of the reimbursement policies.
Telehealth and informatics professional groups have
developed in isolation from each other. Informatics
nurses need to become more involved in telehealth
and inform other nurses about uses of telehealth
technologies
THE END.
Thank you.