NURSING INFORMATICS Nikole L. Farmer, MSN, RN, PMP

September 6, 2014

WHAT IS NI?

• Nursing Informatics (NI): • “Specialty that integrates nursing science, computer science, and information

science to manage and communicate data, information, knowledge, and wisdom in nursing practice. NI supports consumers, patients, nurses, 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 information technology.”

ANA, Nursing Informatics: Scopes and Standards of Practice, 2008

• “The science and practice that integrates nursing, its information and knowledge, with management of information and communication technologies to promote the health of people, families, and communities worldwide.”

AMIA, Special Interest Group on Nursing Informatics, 2009

NURSE INFORMATICIST: A.K.A. “THE TECHIE NURSE”

Computer Geek! Nerd! Just a Nurse... Computer Help Desk

Subject Matter Expert (SME) Technical Liaison

Functional Tester Analyst Developer Project Manager

NURSE INFORMATICISTS

• Analyze Current Clinical & Business Processes

• Design Systems (Create Requirements)

• Develop/Configure Systems

• Act as Liaison between Providers & IT Personnel

• Test System Changes

• Deploy New Systems

• Train & Educate End Users

• Manage IT Programs

• Create Policy

• Perform Research

EDUCATION

• On the Job Training

• Degree Programs • Bachelors Degree Courses • Masters Degree: MS Nursing

Informatics • Doctorate Degree: DNP Informatics

• Certifications • HIMSS: CPHIMS • ANCC: RN-BC

• Organizations • HIMSS • AMIA • ANIA

0

5

10

15

20

25

30

35

40

45

Masters

Degree/ PhD

Bachelors

Degree

Certificate On the Job

Training

HIMSS 2011 NI Training Survey

2011 2007 Highest Degre

ON THE JOB TRAINING

• Subject Matter Experts (SME)

• Nurses Know the Clinical Use Case Best!

• Technical development follows a process similar to the nursing process:

• SDLC: Software Development Lifecycle

• Nursing Process

Analyze/Write Requirements

Develop Solution

Test Solution

Implement Solution

Analyze the Solution for Improvements

HEALTH IT IMPACTS

Clinical

Electronic Health Records (EHRs)

Admission (ADT) Systems

Med System

Barcode Scanning

Medication Pumps

FHR Monitoring

Ventilation Systems

Documentation Scanning

X-rays and Imaging

Dictation

Safety and Risk Monitoring Systems

Finance/Mgmt

Registration

Claims Systems/ Direct Billing to Insurance Companies

Billing to Patients

Charge Captures

Payroll Systems

HR Systems

Staff Scheduling

Procedure Scheduling

Networks

Wi-Fi

Internet (Network Bandwidth)

Intranet

Back-up Power Source Location/ Planning

Intercom Systems

Mobile/Telecom Networks

Smart Phones

Tablets

INTEROPERABILITY

XML

</SOAP-ENV:Header>

<SOAP-ENV:Body>

<AppBody>

<OHIQuery>

<PTNT_ID>9999999999</PTNT_ID>

<OHI_INQ_PERD_BGN_DT>20140901</OHI_INQ_PERD_BGN_DT>

<OHI_INQ_PERD_END_DT></OHI_INQ_PERD_END_DT>

<HIC_ID>ABCDE012345</HIC_ID>

<OHI_PLCY_ID></OHI_PLCY_ID>

<OHI_CVG_TYP_CD></OHI_CVG_TYP_CD>

<OHI_CVG_PYR_TYP_CD></OHI_CVG_PYR_TYP_CD>

</OHIQuery>

</AppBody>

</SOAP-ENV:Body>

</SOAP-ENV:Envelope>

X12

• Claims/Benefits/Financial Data

• Sample Message:

ISA*00*0000000000*00*0000000000*ZZ*MHSEWRAS-CENTRAL*ZZ*DMDCDEERS1600NB*030409*1051*U*00401*000000001*0*T*+!GS*HS*AGA000000000000*DMDCDEERS1600NB*20011014*184800*1*X*004010X092!ST*270*0002!BHT*0022*13*0005*20030409*1051!HL*1**20*1!NM1*P5*2*DMDCDEERS*****46*DMDCDEERS1600NB!HL*2*1*21*1!NM1*1P*2*EWRAS*****SV*385!HL*3*2*22*1!NM1*IL*1******MI*123456789!HL*4*3*23*0!NM1*03*1*Smith*John!DMG*D8*19850217!EQ*30**IND*C1!SE*13*0002!GE*1*1!IEA*1*000000001!

HL7

• Healthcare Data

• Sample Message:

MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A01^ADT_A01|MSG00001-|P|2.5|<cr>

EVN|A01|198808181123||<cr>

PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONES^WILLIAM^A^III||19610615|M||C|1200 N ELM STREET^^GREENSBORO^NC ^27401-1020|GL|(91-9)379-1212|(919) 271-3434||S||PATID1234500 1^2^M10^ADT1^AN^A|123456789|987654^NC|<cr>

NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>

PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||||ADM|A0|<cr>

HL7 ADMIT MESSAGE

MSH|^~\&|ADT1|MCM|LABADT|MCM|198808181126|SECURITY|ADT^A01^ADT_A01|MS

G00001-|P|2.5|<cr>

EVN|A01|198808181123||<cr>

PID|1||PATID1234^5^M11^ADT1^MR^MCM~123456789^^^USSSA^SS||JONES^WILLIAM^

A^III||19610615|M||C|1200 N ELM STREET^^GREENSBORO^NC^27401-1020|GL|(91-

9)379-1212|(919)271-3434||S||PATID12345001^2^M10^ADT1^AN^A|123456789

|987654^NC|<cr>

NK1|1|JONES^BARBARA^K|WI^WIFE||||NK^NEXT OF KIN<cr>

PV1|1|I|2000^2012^01||||004777^LEBAUER^SIDNEY^J.|||SUR||||ADM|A0|<cr>

*Sample message from HL7 v2.x Certification Practice Guide

HL7 RADIOLOGY MESSAGE

MSH|^~\&|XRAY||CDB||200006021411||ORU^R01|K172|P|...<cr>

PID|...<cr>

OBR|1|X89-1501^OE|78912^RD|71020^CHEST XRAY AP \T\LATERAL|||19873290800||| 9218^MASTERS^JOHN^B|...<cr>

OBX|1|CE|71020&IMP^RADIOLOGIST'S IMPRESSION|4|^MASS LEFT LOWER LOBE|||A|||F|...<cr>

OBX|2|CE|71020&IMP|2|^INFILTRATE RIGHT LOWER LOBE|||A|||F|...<cr>

OBX|3|CE|71020&IMP|3|^HEART SIZE NORMAL|||N|||F|...<cr>

OBX|4|FT|71020&GDT|1|circular density (2 x 2 cm) is seen in the posterior segment of the LLL. A second, less well-defined infiltrated circulation density is seen in the R mid lung field and appears to cross the minor fissure#||||||F|...<cr>

OBX|5|CE|71020&REC|5|71020^Follow up CXR 1 month||30-45||||F|...<cr>

*Sample message from HL7 v2.x Certification Practice Guide

MEANINGFUL USE

• The Health Information Technology for Economic and Clinical Health (HITECH) Act was part of the American Recovery & Reinvestment Act (ARRA) of 2009

• Stimulus to promote adoption and meaningful use of health IT

• Improve quality, safety, efficiency, and reduce health disparities

• Interoperability

• $550 Million in Grants for State Health IT Exchanges in 2011

• NHIN: Nationwide Health Information Network

• Adoption of Certified EHR’s by 70% of Primary Care Providers by 2014

• $27 Billion in Phased Incentives

• As much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible health care professional

• Eligible Hospitals can receive up to $2 Million

www.HealthIT.gov (July 2014)

WHAT DOES THIS MEAN TO ME?!

• Increased presence and use of multiple Health IT systems

• Connected commercial and personal Health systems

• Improved ability to care for patients

• More comprehensive health data available from various providers

• Increased patient safety

• Better patient monitoring and reporting tools available

• More comprehensive health data for diagnosis

• Time savings

• Data shared across systems and providers

• Patient involvement

• Apps available for patient’s home use increase compliance and engagement

WHAT CAN I DO?

• Support Health IT initiatives in the workplace

Participate in surveys and studies for improving your systems

Engage in NI working groups at your organization

Provide feedback on enhancements or changes to make your systems better

Volunteer to be a tester

Help train new users

• Support Health IT initiatives in your personal life

Utilize personal health apps

Utilize health apps and tools from your provider or insurance company

Be patient with system upgrades and conversions (especially at small providers)

QUESTIONS?