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The American Nurses Associa-tion (ANA) defines informaticsnursing as the integration of

“nursing science with multiple in-formation and analytical sciencesto identify, define, manage, andcommunicate data, information,knowledge, and wisdom in nursingpractice.” That definition is accu-rate, but it doesn’t fully explain thebreadth of opportunity that existsfor nurses considering an informat-

ics career. This real-world story of-fers a concrete example:

In 2018, the CHRISTUS TrinityMother Frances Health System inTyler, Texas, received the SouthwestTransplant Alliance (STA) with theLife Champion Partner Gold Awardfor its organ transplant conversion(88%) and effectiveness (81%) rates.The increased rates were the result oftools the informatics team developedand implemented within the hospi-

tal’s electronic health record (EHR).The tools saved nurses about 30 min-utes when inputting informationand making referrals to STA, whichprovided them with time to providebetter patient care and support.

Nursing informatics is broad, ac-commodates a diverse array ofnursing strengths and interests, andimpacts virtually every aspect ofhealthcare where technology inte-grates with clinical practice, no

Nursing informatics: The EHR and beyond

Informatics nurses increase efficiency, reduce costs, and enhance patients’ lives.

By Tanna L. Nelson, MSN, RN-BC, CPHIMS, and Cheryl D. Parker, PhD, RN-BC, CNE, FHIMSS

AmericanNurseToday.com March 2019 American Nurse Today 37

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matter the setting. Nurses whochoose informatics as a career ex-pand their reach beyond direct pa-tient care, but they still experiencethe rewards of helping people andadvocating for their profession.

BackgroundThe adoption of EHRs in 2004, un-der President George W. Bush’sstrategy and funding to improve patient safety, spurred significantgrowth in informatics nursing. In2009, President Barack Obamafurther advanced the use of EHRsthrough Medicare and Medicaid in-centive programs that reward hospi-tals and providers who demonstratemeaningful use of EHRs. As a result,implementations escalated across thenation, and informatics nurses havesince been on the frontlines of EHRapplication and optimization to im-prove patient care and enhance cli-nician experience.

Since the adoption of EHRs,healthcare technology continues toadvance, and informatics nurses’roles are evolving quickly. Organi-zations are moving past implemen-tation-related strategies to focus ontrimming documentation burdens,streamlining processes for high re-liability, and identifying the EHRs’true value by generating new knowl-edge and improving care throughevidence-based practice.

Healthcare impactInformatics nurses embrace the useof data generated from EHRs to sup-

port knowledge and wisdom devel-opment. Before digitization, datawere extracted manually, an expen-sive and time-consuming process.Using EHRs and other clinical sys-tems, informatics nurses can gatherdata rapidly, creating opportunitiesfor innovation.

Because they are well positionedto recognize healthcare gaps andfind transformative ways to guidepractice, informatics nurses lead ini-tiatives that improve patient well-be-ing. At John Peter Smith Hospital inFort Worth, Texas, informatics nurs-es developed and operationalized analgorithm for recognizing intimatepartner violence and red flags forhuman trafficking. The algorithm fitsseamlessly into the emergency de-partment (ED) nurse workflow, pro-vides step-by-step instructions to thenurse, and includes a narrative touse if the patient screens as positive.Patients are offered assistance imme-diately.

At the same organization, infor-matics nurses maximize the use ofmobile technology to bring health-care to the homeless. Cliniciansbring the benefits of EHR technolo-gy into the field, where they createwalk-in visits, provide treatments,prescribe and arrange for delivery ofmedications, offer education and fol-low-up care, and monitor healthconditions. The program has re-duced unnecessary ED visits andpreventable complications.

Informatics nurses use advancedanalytics skills to quantify the true

value of the work clinicians do eachday. At Texas Health Resources inDallas-Fort Worth, informatics nurs-es show how sending vital signsfrom the machine directly into the EHR on medical/surgical andtelemetry units saves hours of man-ual documentation each day. Thesesame nurses are combining clinicalexpertise with advanced analyticsstrategies to develop predictivemodels. Their work with predictivemodeling enhances and saves lives,identifying sepsis risk to readmis-sion risk, and even helps recognizepeople who may benefit from pal-liative care.

Specialty insightEvery 3 years, the Healthcare Infor-mation and Management SystemsSociety (HIMSS) conducts a nursinginformatics workforce survey to gaininsight into the specialty. We’ve sum-marized the data gathered from the2011, 2014, and 2017 surveys thatwill help with considering an infor-matics career.

Clinical experienceClinical experience is integral forsuccess in informatics nursing; 82%of respondents reported working ina clinical setting for more than 5years before switching to informat-ics. The most commonly reportedcare settings were medical-surgical,critical care, emergency, pediatrics,and administration. Of the informat-ics nurses who responded, 80% arehighly satisfied with their careerchoice.

Training and educationOn-the-job training was commonjust a few years ago, but the currenttrend is toward master’s and doctor-al degrees and postgraduate certifi-cates. The ANA classifies two formalroles for the specialty: informaticsregistered nurse (with experienceworking in health information tech-nology [IT]) and informatics nursespecialist (with health IT experienceand a master’s or doctorate degree).Board certification through theAmerican Nurses Credentialing Cen-ter, professional certification through

The most common jobs for informatics nurses are within hospitals and health-care delivery systems, but don’t ignore the growing opportunities that span theentire healthcare industry, including:

• transitional and subacute care settings

• clinics and community health programs

• healthcare vendors

• consulting and staffing firms

• analytics and cognitive computing services

• state and national government agencies.

The Office of the National Coordinator for Health Information Technology(HealthIT.gov) is a good starting point for finding career opportunities.

Where can you work?

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HIMSS, and project managementcertifications are common. Informat-ics nurses perceive that these certifi-cations benefit their careers.

Roles and responsibilitiesInformatics provides a tremendousopportunity to advance nursing sci-ence. The initial boom in EHR im-plementation is winding down inacute care, but design and imple-mentation responsibilities continueto grow, as does healthcare technol-ogy innovation. (See Where can youwork?) In some cases, healthcare or-ganizations are replacing their origi-nal EHRs with systems better suit-ed to their needs. In other cases,healthcare organizations are search-ing for value, efficiency, a seamlessexperience for clinicians, and cre-ative solutions to healthcare chal-lenges within their existing EHRs.Informatics nurses will continue tospend significant time creating andimplementing systems that maintainthe clinician’s voice within their de-sign. Roles requiring data analysis,visualization, and presentation skillsare in demand. In addition, infor-matics nurses will continue to playsupportive and educator roles asprocesses change and improve.

CompensationBase salaries for informatics nurs-es are on the rise. Nearly half of

2017 survey respondents reportedearning a base annual salary over$100,000, an increase from the one-third who reported six-figure salariesin 2014. Informatics nurses whoobtain certification or postgraduateeducation earn the highest salaries.Those who earn the most are con-sultants or work for healthcarevendors, positions that require sig-nificant travel and are consideredhigh-stress.

Networking and membershipThe best way to get involved inthe nursing informatics communityis through professional organiza-tions. Employers want to see po-tential employees who are activelyinvolved in local informatics proj-ects within their current practicesettings and who participate in lo-cal or regional informatics chapters.Most professional organizations arepolitically active and need infor-matics nurses to advocate for legis-lation that improves healthcaretechnology interoperability. (SeeBuild a network.)

The future of informaticsnursing Informatics nursing provides chal-lenges and opportunities to trans-form healthcare in meaningful ways.The work of informatics nurses sup-ports those who provide direct care

by advocating for effective practicethrough appropriate technology.Opportunities are available to im-pact healthcare at local, state, na-tional, and global levels. How willyou choose to expand your prac-tice? Is an informatics career in yourfuture?

Tanna L. Nelson is a nursing informatics specialist atTexas Health Resources Dallas-Fort Worth and 2018American Nursing Informatics Association (ANIA)Chapter President. Cheryl D. Parker is a clinical assis-tant professor and educational technology specialistat the University of Texas at Tyler School of Nursingand 2019 president-elect of the ANIA National Boardof Directors.

Selected referencesAmerican Nurses Association (ANA). NursingInformatics: Scope and Standards of Prac -tice. 2nd ed. Silver Spring, MD: ANA; 2014.

American Nursing Informatics Association.ania.org/about-us

Beaudoin J. The decade of health IT. HealthcareIT News. December 20, 2013. bit.ly/2RH6TFq

Certified health IT product list. chpl.health-it.gov/#/search

CHRISTUS Mother Frances Hospital-Tylerearns GOLD recognition organ for transplantconversion rates. October 19, 2018.tmfhc.org/about-us/news-media/2018/chris-tus-mother-frances-hospital---tyler-earns-gold-recognition-/

Dunbar D. Street medicine: North Texas hos-pital helping the homeless. CBS DFW. Janu-ary 19, 2018. dfw.cbslocal.com/2018/01/19/street-medicine-jps-helps-homeless/

Healthcare Information and ManagementSystems Society. himss.org/about-himss

HIMSS 2017 Nursing Informatics WorkforceSurvey. himss.org/sites/himssorg/files/2017-nursing-informatics-workforce-full-report.pdf

JPS program hopes to identify, assist victimsof violence. JPS Health Network. July 12,2018. jpshealthnet.org/news/jps-program-hopes-identify-assist-victims-violence

Promoting innovation and competitiveness:President Bush's technology agenda. TheWhite House. January 20, 2004. georgew-bush-whitehouse.archives.gov/infocus/tech-nology/economic_policy200404/chap3.html

Rust L, Nelson T. Vital Sign Integration onMed/Surg Units: Challenges, Successes and Un-intended Consequences. community.ania.org/HigherLogic/System/DownloadDocument-File.ashx?DocumentFileKey=591d3f31-e206-c98e-da43-660fde841397&forceDialog=0

Staggers N, Thompson CB. The evolution ofdefinitions for nursing informatics: A criticalanalysis and revised definition. J Am Med In-form Assoc. 2002;9(3):255-61.

Building a strong professional network is your best bet to launching your infor-matics career.

• American Nursing Informatics Association (ANIA). This national organizationhas regional chapters throughout the United States. Membership expands be-yond nursing and serves to advance informatics “through education, research,and practice in all roles and settings.” www.ania.org

• Healthcare Information and Management Systems Society (HIMSS). HIMSS, a global organization with regional chapters, “supports the transformation ofhealth through the application of information and technology.” himss.org

• American Medical Informatics Association (AMIA). Some members of thismultidisciplinary organization collaborate with ANIA on a nursing informaticssubgroup, which serves as U.S. representative to the International Medical In-formatics Association. amia.org

• Alliance for Nursing Informatics (ANI). ANI is a joint venture between HIMSSand AMIA. Its goal is to “represent a unified voice for nursing informatics andprovide the synergy and structure needed to advance the efforts of nursing in-formatics professionals in improving the delivery of patient care.” allianceni.org

Build a network