Nursing informatics has been defined as, “a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice” (Shuler, 2011). The systems development life cycle (SDLC) is a conceptual model used in project management that describes the stages involved in the information system development, from a feasibility study to the maintenance of the completed system (Rouse, 2009). With these two definitions in mind, the nursing informaticist plays a vital role in the development of the healthcare information system that incorporates the quality of care and safety outcomes of patients as well as the affect the system plays on effective decision making processes.
The most frustrating elements and challenges has involved poor integration and/or interoperability, regular system failures, limited access to information and applications, and the lack of training (Tietz, 2008). A key concept is the transformation of data to knowledge. Data is the discrete entities described objectively without interpretation. It becomes information after it is interpreted, organized, and structured. Information becomes knowledge after being synthesized so that relationships are identified and formalized. Each level increases in complexity and requires greater intellect.
Some of the roles of the nursing informaticist include consumer advocate, project manager, educator, product developer, decision support/outcomes manager, systems analyst, consultant, programmer, advocate/policy developer, web developer, CIO, CEO, CNO, entrepreneur, researcher, or sales and marketing. Depending on the organizational requirements, the position may encompass any of the roles or any combination of the roles. The primary goal of the position is to improve patient care delivery and the nursing practice experience. The major component standards involve problem identification, alternative (or solution) identification, alternative (or solution) development, solution implementation, and solution evaluation. This requires expert analytical and critical thinking skills, understanding patient care delivery workflow and integration points for automated documentation, experience in utilizing and implementing nursing processes, and excellent project managerial skills (Nursing Informatics 101, 2012).
In SDLC, team members are held accountable for the quality and success of the end project and must work together, understanding strengths and skills of other members, which includes the nurse informaticist (Rouse, Whole-team approach (team-based approach), 2011). This means the nurse informaticist takes apart in the accountability of implementations, usability, change requests, and operability of the system (Staggers, Fall 2013). When the information system development is coupled with delivery of quality of care, patient safety, and the nursing experience, a number of factors play a part that involves the nurse informaticist role.
A good illustration would be with the elderly population as a primary target of a project. The aging process brings thinning skin as well as other illness and conditions. As conditions arise, elders may become less active, increasing risk of pressure ulcers. Standardized pressure ulcer risk assessment and guidelines are usually in paper format, do not describe sufficiency among all patients, and cause difficulty for nurses at the point of care in delivery of care in a timely manner (Choi, Feb 2013). A decision support system can be implemented in the EHR to provide clear defining tasks and recommendations from a clinical practice guideline and perspective. The implementation would require iterative processes of knowledge from the nurse informaticist, modification from the whole team, and validation of the system. The nurse informaticist could implement patient specific recommendations to cover a broader range of skin conditions concerning pressure ulcers. The nurse informaticist plays a role on the team in defining the processes from a nurse perspective for nurses to gain the capability of providing point of care in a timely, accurate manner, with a better outcome experience for the patient. The decision support system becomes particularly useful for facilitating effective decision making and improving the quality of decisions with necessary information without interrupting the point of care workflow.
From a nontechnical view, the nurse informaticist plays a bigger role in increasing the use of the information technology system by the older population and enabling understanding of how the system can improve life and decision making by the ease of getting involved in one’s own care. This becomes a challenge as technological activities decrease as age increases (Tavakoli, Fall 2013). Continued research can determine how technology impacts healthcare decisions and the ability of technology to empower decision making for older adults. In the meantime, the nurse informaticist is equipped to enable better quality of care and patient safety by implementing how information gets processed and delivered.
Another important area of the technology includes alerts in the EHR to providers when things fall outside of the norm (McCool, Summer 2013). This can also include prevention measures for medication errors to nurses and providers. Abnormal lab reports coupled with changing conditions can send alerts to providers to provide different treatment to prevent the onset of big problems. The nurse informaticist would play a major role in how the information is converted to knowledge in the system to provide adequate alert systems.
The nurse informaticist plays a vital role in evaluating current systems on well it meet organizational and patient needs as well as identifying deficiencies. The role goes further in defining requirements and addressing specifics in proposals for improvement. Programming may be a part of the role, especially where communications and security issues are concerned. Training users, testing aspects of performance, and making adjustments also play a part of the roles and well as determining whether it is more appropriate with phase in or all at once in the implementation process. The nurse informaticist also aids in the continued evaluation, maintenance, and in providing users with updates at appropriate times.
When any of the processes are not adequately completed, problems occur that interrupt the workflows. For example, when users are not properly informed and trained of system changes, amidst the frustration, patient care workflow is delayed. Nurses have to spend time to ask questions and develop the proper knowledge of the system change and the operation of the change in order to continue the duties of care. In the meantime, patient outcomes and safety can be compromised.
Nursing informatics is a healthcare tool that emphasizes safety and quality of care outcomes. It allows access to patient information in real time that matches expectations and minimizes errors. The components include data acquisition methods, user interfaces, standards that facilitate data exchange among heterogeneous systems, data repositories and clinical event monitors, data mining techniques, digital resources of evidence or knowledge, communication technologies, and informatics competencies. It provides tools that supports shared decision making and communication, including interactive education to improve risk comprehension, multiple individualized formats for conveying risk, individualized risk calculations, application of decision analysis methods, automated updates of evidence to support shared decision making, and utilization of different preferences. It enables better use of resources to improve accuracy and completeness as well as allowing data to be accessed and evaluated in a timely manner to improve patient outcomes.
Bibliography
Choi, J. & . (Feb 2013). Developing a Computer Interpretable Guildeline with Nursing Knowledge: A Pilot Study of a Pressure Ulcer Risk Assessment and Intervention. Online Journal of Nursing Informatics, 17(1), retrieved from http://ojni.org/issues/?p=2393.
McCool, C. (Summer 2013). A Current Review of the Benefits, Barriers, and Consideration for Implementing Decision Support Systems. Online Journal of Nursing Informatics, 17(2), retrieved from http://onji.org/issues/?p=2673.
Nursing Informatics 101. (2012). Retrieved from HIMSS: http://www.himss.org/files/HIMSSorg/handouts/NI101.pdf
Rouse, M. (2009, May). Systems development life cycle (SDLC). Retrieved from Tech Target: http://searchsoftwarequality.techtarget.com/definition/systems-development-life-cycle
Rouse, M. (2011, Nov 16). Whole-team approach (team-based approach). Retrieved from Tech Target: http://searchsoftwarequality.techtarget.com/definition/Whole-team-approach
Shuler, G. (2011, June 16). Role of Nursing Informatics for Leadership. Retrieved from Advance Healthcare Network: http://nursing.advanceweb.com/Columns/Nursing-Informatics-Leadership.aspx
Staggers, N. (Fall 2013). Critical Conversations About Optimal Design Column. Online Journal of Nursing Informatics, 17(3), retrieved from http://ojni.org/issues/?p=2846.
Tavakoli, A. (Fall 2013). Effects of Technology and Connectedness on Community-Dwelling Older Adults. Online Journal of Nursing Informatics, 17(3), retrieved from http://ojni.org/issues/?p=2864.
Tietz, M. (2008, Aug). Nursing Informatics: What’s It All About? Retrieved from UTA: http://web-ded.uta.edu/wconnect/ace/static/onlinecne/CEAugust08.pdf
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