nursing informatics: a new role

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N ursing informatics is a new career: "a combina- tion of computer science, information science, and nursing science designed to assist in the man- agement and processing of nursing data, informa- tion, and knowledge to support the practice of nursing and the delivery of nursing care. ''1 Three nurses present their experiences and thoughts on this role and its relationship to emergency nursing. The nurses are Cheryl D. Parker, RN, MSN, CEN (CP), Brian Duggan, RN, MSN, CEN (BD), and Vicky Bradley, RN, MS, (VB). 1. Briefly describe your current role in nursing inforlnatics. CP: As a nursing informatics (NI) and ED specialist, and management consultant, I have the opportunity to work with the health care delivery system in many settings, ranging from smaller community facilities to large university-affiliated medical centers. During the past year, I have worked literally coast to coast, assisting health care providers in any way my skills and knowledge were useful--from selecting clinical information systems to developing multimedia edu- cation. BD: Initially I was hired to manage all the clini- cal systems in two hospitals. The laboratory system administrator and the transcription systems admin- Vicky Bradley is director, Nursing Informatics, University of Kentucky Hospital, Lexington, Kentucky. When this article was written, she was systems coordinator,Emergency Department and Operating Room. She is the 1996 president of the Emergency Nurses Association Foundation and a member of the Emergency Nurses Association Uniform Data Set task force (E-mail address: vmbradle%[email protected]). Cheryl Parker is a man- agement consultant, Superior Consultant Company, Inc., Southfield, Michigan, and president-elect of the Washington State ENA (E-mailaddress: [email protected]). Brian Duggan is a project analyst for a large physician practice network, and a mem- ber of the 1996 ENA Informatics Committee. When this article was written, he was the clinical systems consultant, Mercy Hospital, Charlotte, North Carolina (E-marl address: brian.duggan@mercy- clt.hospital.org). Reprints not available from authors. J Emerg Nurs 1996;22:605-8. Copyright 9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/62/77984 istrator report to me. My primary goal was to usher in a new, hospital-wide clinical information and docu- mentation system. In that role, I helped define a clin- ical system and our hospital information systems strategic plan and lead a selection team at the Health Information and Management Systems Society (HIMSS) convention. Recently my role has been that of consultant for all ancillary and nursing depart- ments for process analysis and system selection and implementation. Some of the systems include: I have worked literally coast to coast, assisting health care providers in any way my skills and knowledge were useful--from selecting clinical information systems to developing multimedia education. E-mail, group scheduling, film tracking, mammogra- phy quality assurance, Acute Physiology and Chronic Health Evaluation (APACHE) ICU, transcrip- tion, automated ED log, and automated drug distrib- ution system (Pyxis). My favorite project is building a hospital-wide Intranet. It provides point-and-click access to end- less resources on the Internet, as well as internal policies and procedures, patient education materi- als, routine orders, medication reference, and med- ication education materials. We plan to add graphed laboratory values and radiology transcription results soon. VB: In the emergency department I am respon- sible for maintaining and enhancing our homegrown patient tracking system. For Operating Room (OR) Services, I am the project coordinator for installation December 1996 605

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Page 1: Nursing informatics: A new role

N urs ing informatics is a n e w career: "a combina- t ion of compute r sc ience, informat ion science,

and nu r s ing sc ience de s igned to ass is t in the man- a g e m e n t and process ing of nu r s ing data, informa- tion, and knowledge to suppor t the prac t ice of n u r s i n g and the delivery of nu r s ing care. ''1 Three

nu r ses p resen t their exper iences and thoughts on this role and its re la t ionship to e m e r g e n c y nurs ing. The nur ses are Cheryl D. Parker, RN, MSN, CEN (CP), Brian Duggan, RN, MSN, CEN (BD), and Vicky Bradley, RN, MS, (VB).

1. Briefly describe your current role in nursing inforlnatics. CP: As a n u r s i n g informat ics (NI) and ED specialist , and m a n a g e m e n t consul tant , I have the oppor tuni ty to work with the heal th care delivery sys t em in m a n y set t ings, r ang ing from smaller c o m m u n i t y facilities

to large universi ty-affi l iated medica l centers . During the pas t year, I have worked literally coast to coast, a ss i s t ing health care providers in any way my skills and knowledge were use fu l - - f rom se lec t ing clinical informat ion sys tems to developing mul t imed ia edu- cation.

BD: Initially I was hired to m a n a g e all the clini- cal sys tems in two hospitals. The laboratory sys tem adminis t ra tor and the t ranscr ip t ion sys tems admin-

Vicky Bradley is director, Nursing Informatics, University of Kentucky Hospital, Lexington, Kentucky. When this article was written, she was systems coordinator, Emergency Department and Operating Room. She is the 1996 president of the Emergency Nurses Association Foundation and a member of the Emergency Nurses Association Uniform Data Set task force (E-mail address: vmbradle%[email protected]). Cheryl Parker is a man- agement consultant, Superior Consultant Company, Inc., Southfield, Michigan, and president-elect of the Washington State ENA (E-mail address: [email protected]). Brian Duggan is a project analyst for a large physician practice network, and a mem- ber of the 1996 ENA Informatics Committee. When this article was written, he was the clinical systems consultant, Mercy Hospital, Charlotte, North Carolina (E-marl address: brian.duggan@mercy- clt.hospital.org). Reprints not available from authors. J Emerg Nurs 1996;22:605-8. Copyright �9 1996 by the Emergency Nurses Association. 0099-1767/96 $5.00 + 0 18/62/77984

istrator report to me. My pr imary goal was to usher in

a new, hospi ta l -wide clinical information and docu- me n t a t i on sys tem. In tha t role, I helped define a clin- ical sys tem a nd our hospital information sys tems strategic p lan and lead a select ion t eam at the Health In fo rmat ion a n d M a n a g e m e n t Sys t ems Socie ty (HIMSS) convent ion . Recent ly my role has b e e n that of consu l t an t for all ancillary and nu r s ing depart- m e n t s for p rocess analys is a nd s y s t e m se lec t ion

a nd implementa t ion . Some of the sys tems include:

I have w o r k e d l i terally coas t to coast , a s s i s t i n g hea l th care providers in any w a y m y ski l ls and k n o w l e d g e w e r e u s e f u l - - f r o m s e l e c t i n g cl inical information s y s t e m s to deve loping mul t imedia educat ion .

E-mail, group schedul ing, film tracking, mammogra -

phy qua l i ty a s su rance , A c u t e Physio logy a n d Chronic Health Evaluat ion (APACHE) ICU, t ranscrip- tion, a u t oma t e d ED log, and au toma ted drug distrib- u t ion sys tem (Pyxis).

My favorite project is bu i ld ing a hospi ta l-wide Intranet . It provides po in t -and-c l ick access to end- less resources on the Internet , as well as in terna l policies and procedures , pa t i en t educa t ion mater i - als, rout ine orders, medica t ion reference, and med- ica t ion educa t ion materials. We plan to add graphed

laboratory values and radiology t ranscr ip t ion results soon.

VB: In the e m e r g e n c y d e p a r t m e n t I am respon- sible for m a i n t a i n i n g and e n h a n c i n g our homegrown pa t i en t t racking system. For Opera t ing Room (OR) Services, I am the project coordinator for instal lat ion

December 1996 605

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JOURNAL OF EMERGENCY NURSING/Bradley, Parker, and Duggan

Vicky Bradley, RN, MS, works with the ED patient tracking system and the operating room computer system.

of an OR computer system. I am a member of the nursing manapement group in both departments and act as an informatics consultant on various depart- ment projects.

2. How do you spend most of your time? CP: I help health care providers with their initiatives involving t h e clinical aspect of emergency nursing, clinical information systems, information technology, and education. Such initiatives might include clinical information systems planning, selection, and imple- mentation; clinical process redesign; and the design, development, and presentation of educational pro- grams. An interesting recent project was the design and development of an interactive, multimedia com- puter-based training package for using the Physician Order Entry system.

BD: I have reached a happy mix of technical and clinical consulting throughout the hospital. Thus I spend a lot of time meeting with task forces and indi- viduals charged by their superiors to solve process problems. I do process analysis and redesign, and recommend and implement solutions. I spend a good bit of time on the phone talking people through their

Cheryl Parker, RN, MSN, CEN, is a nursing informatics and ED specialist.

issues and assisting them in choosing a plan. From a technical standpoint, I have become the de facto Windows 95 expert and support the expansion of Windows 95 in our network.

VB: t spend most of my time writing or working with information services (IS) to develop reports for various ED committees and design enhancements to our ED patient tracking system. In the OR, I have been in the initial stages of implementation, which has included coordination of detailed interface spec- ifications with other hospital systems, coordination of hardware installation, and building of the software database (e.g., entering all OR staff, equipment, trays, rooms).

3. What projects have you worked on in the emergency setting? CP: I keep up-to-date on the state of information sys- tems that serve the ED setting. Recently I had the oppor- tunity to assist providers with preparation for relocation to a new facility, as well as with evaluation of the ED information systems that would best meet their needs.

BD" My role is not specifically geared toward the emergency department, but I have created an auto- mated ED log and coordinated installation of an auto- mated drug distribution system.

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Bradley, Parker, and Duggan/JOURNAL OF EMERGENCY NURSING

Table 1 Nursing informatics resources

Certification in Nursing Informatics American Nurses Credentialing Center (800)284-CERT Internet Web s i tes HIMSS home page--ht tp: / /www.himss .org American Medical Informatics Association (AMIA),

Nursing informatics workgroup-- http://www.amia.org

Susan K. Newbold, RN, MS, Home Page-- ht tp: / /wwwnursing.ab.umd.edu/s tudents /~snew- bold

Books Ball M J, Hannah K J, Newbold SK, Douglas JV.

Nursing informatics: where caring and technology meet. 2nd ed. New York: Springer-Verlag, 1995.

Hannah K J, Ball M J, Edwards MJE. Introduction to nursing informatics. New York: Springer-Verlag, 1994.

Saba VK, McCormick KA. Essentials of computers for nurses. 2nd ed. New York: McGraw-Hill, 1996.

Zimmerman M, Duggan B, Penner M, Parker C, Keep N. Emergency department clinical information systems: a guide to selection and implementation. Park Ridge (IL): Emergency Nurses Association. 1996.

VB: We added a feature for our n e w emergency res idency program that allows the res idents to log their procedures and any complicat ions that occur. A

monthly report is to be genera ted to demons t ra te the types of pa t i en t s cared for as part of their ED experi- ence. I created a report on EKG turnaround t imes for the director w h e n the respi ra tory d e p a r t m e n t a s s u m e d the role of performing EKGs. Another report for the tr iage commi t t ee listed all pa t ien ts who wait- ed longer t han 15 m i n u t e s to be triaged. I worked with IS to create a radiology tu rna round t ime report from the order entry system, and worked wi th IS to add the abili ty to correct ED charges onqine. The

e m e r g e n c y d e p a r t m e n t has m a n y projects tha t they would like to do bu t are l imited by the lack of IS sup- port. IS has m a n y major projects to i m p l e m e n t

th roughout the inst i tut ion, so their t ime is at a pre- mium. I s p e n d a fair a m o u n t of t ime ob ta in ing admin- istrat ive suppor t for p roceed ing with projects tha t require IS resources.

4. What emergency nurse skills have helped you in this new role?

CP: The in terpersonal and negot ia t ion skills, as well as the adaptabi l i ty I ga ined dur ing my years as an

e m e r g e n c y nurse, have b e e n of great value as an NI specialist .

Brian Duggan, RN, MSN, CEN, consults with nursing departments on process analysis and system selection and imple- mentation.

BD: This role requires a broad clinical base. I have to be able to talk intel l igent ly with every clinical special ty and role, from phys ic ians to nurses to ther- apis ts and every ancillary service. Emergency nurses are able to assess s i tua t ions quickly and in a logical manner , a r equ i r emen t for process analysis.

The success fu l informat ics nu r se is proactive, diplomatic , a nd not easily i n t i m i da t e d by physi- cians, adminis t ra tors , or other "big shots." The mos t valuable t h i ng a nu r se can b r ing to the role is an abil i ty to drill down to the e s s e n c e of problems and propose creat ive solutions. The b igges t m i sconcep - t ion non- in fo rma t i c s nu r se s have is tha t compute r s are mys te r ious and p r o g r a m m i n g is for "rocket sci- entis ts ." You don ' t have to learn to program to be able to def ine wha t n e e d s to h a p p e n in cer ta in s i tu- ations. It all comes down to pla in c o m m o n sense, a trait tha t mos t e m e r g e n c y nu r se s have in a bun -

dance . VB: I use tr iage skills to develop priorities for my

t ime and for projects. It helps to be able to juggle mul- tiple projects all at the same time. Being familiar wi th m a n y clinical special t ies has b e e n an asset, because most projects involve other depa r tmen t s and profes-

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JOURNAL OF EMERGENCY NURSING/Bradley, Parker, and Duggan

sionals. Plus, t he abi l i ty to coord ina te t e a m efforts he lps to a ch i eve pro jec t goals.

5. How did you become involved in nursing informatics? CP: Over the years , I en joyed u s i n g the c o m p u t e r to m a n a g e informat ion, c o m m u n i c a t e via E-marl, and genera l ly to m a k e m y life more orderly and m a n a g e - able. A l though I w a s involved in hosp i ta l pro jec ts s u c h as m a i n t a i n i n g the ED d i s c h a r g e sys tem, I w a s

T h e b i g g e s t m i s c o n c e p t i o n n o n - i n f o r m a t i c s n u r s e s h a v e is t h a t c o m p u t e r s are m y s t e r i o u s a n d p r o g r a m m i n g is for "rocket s c i e n t i s t s . " You d o n ' t h a v e to l earn to p r o g r a m to b e a b l e to d e f i n e w h a t n e e d s to h a p p e n in c e r t a i n s i t u a t i o n s .

not a w a r e t ha t nu r s ing in format ics w a s truly a spe- c ia l ty w i t h i n nurs ing. W h e n I rea l ized the re w a s a w a y to c o m b i n e m y k n o w l e d g e and love of comp u t - ers and informat ion s y s t e m s w i th my nu r s ing exper i - ence , I d e c i d e d to c h a n g e m y focus from p rov id ing d i r ec t p a t i e n t care to work ing w i th w a y s to improve hea l th ca re delivery. I enrol led in the Univers i ty of Mary l and a t Balt imore, and c o m p l e t e d a p o s t - m a s - te r ' s cer t i f ica te in nu r s ing informat ics in t he s u m m e r of 1995.

BD: I b e g a n in th is role b y lea rn ing as m u c h as I could a b o u t c o m p u t e r s b y b u y i n g and us ing one extensively. My first role in in format ics w a s as a sup- por t p e r s o n in t he IS d e p a r t m e n t . F rom the re I m o v e d into project m a n a g e m e n t and b e c a m e a sys t em analyst.

VB'- As a d i rec tor of an e m e r g e n c y d e p a r t m e n t , I cons t an t ly l a m e n t e d the lack of suff ic ient d a t a to faci l i ta te s t r a t eg i c p lann ing . I l obb ied for the pur- c h a s e of an ED t r ack ing s y s t e m to faci l i ta te c o m m u - n i c a t i o n w i t h i n t h e d e p a r t m e n t a n d to p rov ide repor t s on d e p a r t m e n t a l ac t iv i t ies . W h e n w e d e c i d e d

to deve lop our o w n program, I j u m p e d at the c h a n c e to m a n a g e th is project . My skills in informat ics have b e e n o b t a i n e d pr imar i ly from self- s t u d y and learn ing b y doing.

6. Why does emergency nursing need nurses in this role? CP: Invo lvement b y nurses will ensu re tha t s y s t e m s e n h a n c e the p a t i e n t care p rocess . Wi thou t comtr ibu- t ions from nu r se s r ega rd ing the des ign , develop- m e n t , s e l ec t ion , a n d i m p l e m e n t a t i o n of c l in ica l informat ion sys t ems , w e are f aced w i th s y s t e m s tha t do not m e e t the n e e d s of nu r s ing in the del ivery of p a t i e n t care. Those nu r ses who c ombine cl inical e x p e r i e n c e and spec ia l i zed s y s t e m s d e s i g n knowl- e d g e (from a v e n d o r p e r s p e c t i v e ) will b e b e s t e q u i p p e d to m a n a g e the se lect ion, implementa t ion , and inheren t work r e d e s i g n process .

BD: Nurs ing informat ics in i ts mos t bas i c form m e a n s c r ea t i ng an env i ronmen t t ha t a ss i s t s in clini- cal dec i s ion m a k i n g and ca re provis ion. The b e s t sys- t e m is one t h a t in te r fe res t h e l eas t w i th w h a t c l in ic ians do bes t . The little t ha t it r equ i res c l in ic ians to do m u s t a d d s o m e value to the i r care provision. E m e r g e n c y nu r se s u n d e r s t a n d t h o s e priori t ies.

VB: I v i ew m y role as p a t i e n t advoca te . My job is to help d e s i g n s y s t e m s tha t allow t h e careg ivers to be more effect ive in thei r role. I also p rov ide informat ion to ca reg ive r s so t hey can ident i fy a n d prior i t ize thei r p rob l ems and eva lua te t he s u c c e s s of their c h a n g e projects . Too often, s y s t e m s are d e s i g n e d or projects a re u n d e r t a k e n t ha t are no t effect ive in p rob lem res- olution. We n e e d spec ia l i s t s w h o can max imize w h a t t e chno logy has to offer to improve our del ivery of e m e r g e n c y ca re to pa t ien t s .

Reference

1. Graves JR, Corcoran S. The study of nursing informatics. Image J Nurs Sch 1989;21:227-31.

Contributions to this column may be sent to Vicky Bradley, RN, MS, 4017 Palomar Blvd., Lexington, KY 40513; phone (606) 25 7-2350 (E-mail address: vmbradle%taonode.mvs.bosp.uky.edu).

608 Volume 22, Number 6