A landmark report was recently published titled: The Future of Nursing: Leading Change, Advancing Health, as the result of a partnership launched in 2008 between the Robert Wood Johnson Foundation and the Institute of Medicine. The purpose of the report was to determine criteria to transform the nursing profession, leading to new roles and leadership positions for nurses in the redesign of the health care system.
As co-chair of the Alliance for Nursing Informatics (ANI), co-sponsored by HIMSS and AMIA, I provided testimony to the Committee. This testimony emphasized that nurses are key leaders in the effective use of information technology to impact the quality and efficiency of healthcare services. The ANI contributions were used in the development of the report which has been described as a “tipping point in nursing care,” calling for the nursing profession to be re-engineered.
The report outlines several opportunities to transform nursing practice through informatics and technology:
Implications of Technology’s Impact on the Design of Health Care Delivery
Given the nature of patient data collection, nurses will be integral to proper collection of meaningful use data. As EHRs become more refined and integrated, nurses will have the opportunity to help define additional meaningful use objectives.
Implications for Time and Place of Care
Care supported by interoperable digital networks will shift in the importance of time and place. It is likely that a significant subset of care might be independent of physical location when health IT (HIT) is fully implemented. Nurses provide care in every setting, particularly the community and need to be involved in shaping the effective use of information technology across settings.
Implications for Nursing Practice
While HIT will have its greatest influence on how RNs plan and document their care, all facets of care will be mediated increasingly by digital workflow, computerized knowledge management, and decision support.
Implications of Technology’s Impact on Quality, Efficiency, and Outcomes
Adoption of HIT is expected to increase the efficiency and effectiveness of clinician interactions with each patient and the target population.
Technology’s Role in Transforming the Practice of Nursing
Interoperable EHRs linked with personal health records and shared support systems will influence how collaborative care teams work and share clinical activities.
Involving Nurses in Technology Design and Implementation
The TIGER Initiative’s goal of engaging more nurses in leading both the development of national healthcare information technology infrastructure and health care reform is referenced; as well as the TIGER goal to “accelerate adoption of smart, standards based, interoperable technology that will make health care delivery safer, more efficient, timely, accessible, and patient-centered, while also reducing the burden of nurses.”
This IOM report further emphasizes that the United States has the opportunity to transform its health care system, and nurses can and should play a fundamental role in this transformation.
- What do you think about nursing’s role in this transformation?
- Is the nursing voice active and being heard?
- What are the specific actions that informatics nurses can take based on these recommendations?
- How can we use this report to advance nursing’s role in leading change and advancing health?
I am interested in your thoughts and hope you will join me in the dialogue, here on the HIMSS Blog and by listening to my video commentary on the HIMSS YouTube channel.
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No where does it mention libraries. As a qualified librarian/information professional our expertise in using IT is often overlooked. Librarians already use IT to support nurses education and those undertaking research and I feel that our skills and knowledge in this area could be utilised more effectively.
Helen – thank you for your comment. I could not agree more! Any nurse that I know that is doing research or is in an educational program well understands the importance of the information professionals/librarians!! We have much to learn from you in terms of how to turn find evidence as well as how to turn data into information, knowledge and hopefully wisdom. Have you had an opportunity to read the full report in its context? At the recent American Academy of Nursing conference that I attended, the Committee co-chair Linda Burnes-Bolton noted that it is important to read the report in its entirety to fully understand the recommendations. I welcome your thoughts on how informatics nurses and information professionals/librarians can work together to lead change and advance health.
The TIGER report mentions that “by 2014, it is imperative that nursing graduates are fluent in the use of these tools in order to practice safe and effective patient care”.
As a nursing student myself, I was wondering if you could comment further on this. Will there be mandatory courses on the electronic health record for nursing students? How rapidly are EHR’s evolving, and what is the most beneficial way for nurses to get involved in targeting the enhancement of patient care as the top priority for this technology?
Thanks!
Hi Christine,
You are definitely going to the head of the class by analyzing this topic in your role as a nursing student! As a result of the efforts of TIGER and other organizations, in 2008 the National League for Nursing (NLN) published a position statement for nursing faculty on this topic: http://www.nln.org/aboutnln/PositionStatements/informatics_052808.pdf
The NLN position statement states that, “Federal initiatives are pushing the adoption of electronic health records (EHRs) throughout
all health care institutions by the year 2014, an initiative that will dramatically change how nursing is practiced. It is imperative that graduates of today’s nursing programs know how to interact with these important informatics tools to ensure safe and quality care. In addition,
there is a growing consumer movement wanting to interact with health care professionals through personal health records and various electronic communication devices. It is important that nurses acquire the necessary “21st century knowledge and skills for practice
in a complex, emerging technologically sophisticated, consumer-centric, global environment”
The NLN goes on to recommend the following for faculty, administrators, and its own leaders and members:
For Nurse Faculty
< Participate in faculty development programs to achieve competency in informatics.
< Designate an informatics champion in every school of nursing to: (a) help faculty distinguish
between using instructional technologies to teach vs. using informatics to guide, document,
analyze, and inform nursing practice, and (b) translate state-of-the-art practices in technology
and informatics that need to be integrated into the curriculum.
< Incorporate informatics into the curriculum.
< Incorporate ANA-recognized standard nursing language and terminology into content.
So it is likely that you will begin to see these changes in nursing programs moving forward.
Regarding the status of EHR implementation, I will point you to a model from the HIMSS Analytics database which represents data from more than 5,000 U.S. hospitals. http://www.himssanalytics.org/hc_providers/emr_adoption.asp
You will be able to see the most recent scores via that link. While we are making good progress, we aren't completely there yet!
To your question about how to get involved, I would encourage you to join HIMSS Nursing Informatics Community. HIMSS has student membership rates, and when you join HIMSS you will be given information on how to get involved with this community. Meanwhile you will find some great resources via this link. http://www.himss.org/ASP/nursingInformaticsCommunity.asp
Best of luck in your nursing program!
Nursing in leadership is so important in the health care system. Nurses are the heart of the health care system and affect the outcome of the patient. Nurses are the first person usually to see the patient. They do collect the pertinent data that is sometimes overlooked and can change a patient’s outcome in a vital disease. The nurse views the patient holistically and integrates every part of the patient as a person in the diagnosis which could easily be overlooked when focusing on the disease. Her access to the EMR can enter specific data she feels will help the patient have a better outcome with their care and disease process. Technology in the community is very pertinent to the Public Health Nurse. This is also a place where the nurse can be overlooked however PHN’s are very important. With some of the newer technology nurses can monitor patients in homes if the patient can not leave the home or if the nurse does not feel comfortable going to an area alone however still would like to provide care. This is opening the window to improve care and provide outreach into the community. Being a nursing student this is very applicable to my generation because we were the “technology generation” growing up. This will support safer nursing practices!
Technology in Health Care Systems
Transformation in nursing can only be achieved through involvement of the nurses. I agree with the blog that nursing practice can only be transformed through informatics and technology if nurses are trained and encouraged to commit to the changes. Reading the article on The Benefits of Mobile Health during Epidemics made me realize the importance of a nurse in the healthcare system. I agree with the blogger on the fact that nurses are the first people to attend to the patient and record the initial health condition. Providing access to Electronic Medical Record will help the nurse to have necessary information on the condition of the patient. Access to technology will also promote the efficiency of public health nurses as they can monitor patients at home. It is true that application of technology in nursing will open the window to improve health services providence to the community. I think that the application of technology in nursing will eliminate the access barrier that has faced nursing for a long time. The information provided in the article The Benefits of Mobile Health during Epidemics is enough to encourage the governance and leadership structures indulge in serious training of the nurses. Additionally, the information is necessary in the provision of the technological paraphernalia required in the application of technology for the nursing profession. However, application of information technology in nursing should not wholly substitute manual storage and handling of nursing information. Instead, the technological advancement should be applied in promoting the efficiency of information sources such as libraries.