Nursing Informatics and Healthcare Policy

Unit 3 Chapter 11

Healthcare Policy and Nursing Informatics as a Specialty

• Demonstrate differentiated practice base• Identify the existence of educational programs

in in the field• Show support from nationally recognized

organizations• Develop a research agenda

Nursing Informatics“…a specialty that integrates nursing science,

computer science, and information science to manage and communicate data, information, and knowledge in the nursing practice…”

“ NI facilitates the integration of data, knowledge and information to support nurses, patients, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes and IT.”

• The Domain of NI is focused on:– Data and its structures– Information management• Technology needed to manage information effectively

Differentiated and Interdisciplinary Practice

• NI brings an added dimension to nursing practice that focuses on knowledge and skill in information and information management techniques

• Informatics Nurses should assist with the development and implementation of technology tools

• NI has been described as one example of a specific domain of informatics that falls under a broader umbrella of health informatics (National Advisory Council on Nurse Education and Practice,1997)

• All healthcare professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphazising evidence-based practice, quality improvement, approaches and informatics.”(IOM, 2002)

Preparation for Specialty Practice

• Division of Nursing (DN) and Health and Human Services Administration (HRSA) funded 2 Master’s programs– University of Maryland (Heller et. Al., 1989)– University of Utah (Graves et. Al., 1995)

• 1 doctoral program in the University of Maryland

• 1997 : NI specialty program opened in New York University

• 1998 : specialty program implemented at Duquesne University in Pittsburgh

• New Title VII authorizing legislation was passed enabling DN to fund NI programs

• June 17, 2004 : American Medical Informatics Association (AMIA) president, Charles Safran testified to the House of Ways and Means that a new generation of healthcare professionals need to be prepared to lead the development, selection, and implementation of patient-centered health IS

• Certification examination currently available through the American Nurses Credentialing Center is for the generalist in NI

• November 1995 – December 2003 : 551 nurses have been certified as generalist in NI (ANCC, 2003)

• Identifying a research focus as one of the criteria for a specialty (Styles, 1989)

• NI researchers described seven areas needing scientific study (National Center for Nursing Research,1993)

• NI has the support of both nursing and multidisciplinary organizations

• Within nursing, the is organizational support in American Organization of Nurse Executives

• Multidisciplinary organizations include AMIA and Health Information Management Systems Society

Healthcare Policy Impact on Nursing Informatics Practice

Nursing Shortages and Nursing Informatics

• An older nursing workforce, a higher ratio of older associate degree graduates rather than their younger counterparts (Buerhaus et. Al., 2000; Staiger et. Al., 2000; HRSA, 2001; Berliner and Ginzberg, 2002)

• HRSA’s National Center for Health Workforce Analysis : shortage for 2007 occurred by 2000

• Shortage will rise from 6% in 2000 to 29% in 2020 or 800,000 nurses short (HRSA, 2002)

• Registered nurses positions will increase >600,000 between 2002 and 2012

• 1.1 M nurses will be needed by 2012 (BLS, 2004)

• increase nursing workforce : schools and colleges of nursing have shortened program lengths and instituted accelerated programs for baccalaureate degree holders

• In 2003 nearly 16,000 qualified applicants were turned away from entry-level baccalaureate programs primarily due to lack of faculty to supervise students (AACN, 2004)

• American Academy of Nursing (AAN) have focused on decreasing the demand side of nursing practice (McClure and Bolton, 2003).

• The academy believes that more efficient systems, including IT systems, must be created that will support care and lighten the workload of nurses

• In 2002 the AAN Commission on Workforce launched a multiphase project to develop IT that will– Help nurses in their day-to-day work– Reducing the demands on their jobs

Phase I• Interdisciplinary thinkers were assembled to

determine how technology could be used to facilitate nurses’ work

Kennedy (2003)• Healthcare and nursing would benefit from

decision support technology, streamlined and integrated documentation support, measurement capability built into systems for determining intensity of care and outcomes, and outflow management tools

Bradley (2003)• Technology solutions should improve existing

care processes and outcomes, increase access through the use of portable and hand-held devices, incorporate Internet capability to overcome distance barriers of care and improve access to knowledge acquisition

• Given the average age of nurses is 45.2 (Spratley, et. Al., 2000), technology devices would enable some nurses to stay in their careers longer

• Wireless technology and PDAs could support nurses’ workflow by providing information at the point of care (Sensmeier and colleagues, 2003)

Phase II• AAN technology project began• Systems will be designed, implemented, and

tested to determine their effect on nurses’ work

Patient Safety and Nursing Informatics

• To Err is Human Building a Safer Health System (Corrigan et. Al., 1999)– Used data from 2 studies with a large number of

hospital admissions as a basis for analysis– Determined adverse events occurred in 2.9 and

3.7%– Recommended implementation of computerized

physician order entry (CPOE) systems

• Concern for patient safety is the biggest factor driving IT (Anderson, 2004)

• prevention of errors as the main reason for increasing IT budgets

California law 1875

• Passed in 2003• Applies pressure to hospitals to install IT to

help healthcare professionals reduce errors

National Alliance for Health Information Technology• A partnership of diverse healthcare leaders

who are working to influence the use of technology to improve patient safety, quality and efficiency

Connecting for Health (CFH)

• Established by the Markle Foundation with support from Robert Wood Johnson Foundation– Markle Foundation is a private philanthropy that

works to improve technology to improve people’s lives

National Informatics Initiatives and Nursing Informatics

Executive Order for the National Interoperable Information System

• Clinical Information systems– Introduced in the 1970s– Need for system improvement, integration and

wider dissemination

• President’s Information Technology Adviser Committee– Highlighted key issues in IT– US lacks broadly disseminated and accepted

national vision for IT healthcare– Recommended appointment of senior IT person to

be a member of the Department of Health and Human Resources (DHHR)

Executive Order

• “Incentives for the use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator”

• April 27, 2004• 6 components• 6 guidelines for infrastructure

• in June 2004, the bipartisan House members formed a congressional caucus to influence issues surrounding IT

• Secretary of Health and Human services had stated that the federal government would not wait long for the private sector to create a technology infrastructure in healthcare

• National Health Information Infrastructure (NHII)– Intended to improve effectiveness, efficiency and

overall quality of health and healthcare

• Health Insurance Portability and Accountability Act (HIPAA)– Intended to improve public and private health

programs by establishing standards to facilitate the efficient transmission of electronic health information (Public Law, 104-191, 1996)

• National Agenda for Nursing Informatics– DN, HRSA are responsible for setting national

policy to guide the preparation of the nursing workforce, including preparation in the area of NI

– 1997 the National Nursing Informatics Work Group (NNIWG) was convened to make recommendations to the National Advisory Council for Nursing Education and Practice (NACNEP)

• A National Informatics Agenda for Nursing Education and Practice– 5 assumptions still considered pertinent– 5 key directions for informatics in nursing

education and practice were recommended

Telehealth and Nursing Informatics

• Telehealth– The use of electronic information and

telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

• three major issues : reimbursement, licensure, and security

• States issue special purpose licenses for telehealth practice.

• Center for Telehealth Law and Office for the Advancement of Telehealth in HRSA assembled for telehealth experts and state licensing board to discuss options for eliminating interstate licenses.

• Lack of reimbursement has been identified as the key barrier to expanding telehealth practice

• Balanced Budget Act passed in 1997 mandated the 1st national reimbursement policy of telehealth services for medicare recipients.

• Benefits Improvement and Protection Act of 2000 (BIPA)– Changed reimbursement policies