NURSING INFORMATICS and HEALTHCARE POLICY

To practice effectively in today’s continually changing healthcare environment, informatics professionals need to be aware of existing and proposed healthcare policy.

Policy - a course of action that guides present and future decisions.

Healthcare policy is established on local, state, and national levels to guide the implementation of solutions for the populations health needs.

The number of informatics programs for nurses has significantly increased, preparing more informatics nurse specialists to practice in the field, and a number of trends and events have placed information technology (IT), information systems (IS), and informatics at a center of attention in healthcare.

Healthcare Policy and Nursing Informatics as a Specialty

Ø  Nurses have contributed to the purchased, design, and implementation of IS since the 1970s and in 1992, the American Nurses Association (ANA) recognized NI as a specialty.

Ø  To be acknowledged as a specialty within nursing, informatics had to:

§  Demonstrate a differentiated practice base

§  Identify the existence of educational programs in the field.

§  Develop a research agenda.

The definition of NI:

q  Before: NI was defined as the combination of nursing information, and computer sciences to manage and process nursing data into information and knowledge for use in nursing practice.

q  Now: NI is described more broadly as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.

NI facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in roles and settings thru the use of information structures, information processes and IT.

Differentiated and Interdisciplinary Practice

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

Ø  NI practice differentiates itself from other areas of nursing practice but emphasizes its interaction with informatics disciplines such as mathematics, statistics, linguistics, engineering, computer science, and health informatics.

Other example of domain specific informatics practices:

§  Medical informatics

§  Dental informatics

§  Consumer informatics.

NI community believes it is essential to practice within an interdisciplinary team and a one good example of interdisciplinary work is the “Vocabulary Summit”  held annually at Vanderbilt University since 1999 spearheaded by Judy Ozbolt.

Preparation for Specialty Practice

Ø  To become a specialty, it was necessary for NI to show that educational programs are available to prepare nurses to practice in the field.

Ø  The Division of Nursing (DN), Health and Humans Services Administration

Ø  (HRSA) founded two Master’s NI programs and one Doctoral program  in NI at the University of Maryland.

Ø  In 1997 an NI specialty program open at New York University and in 1998 a specialty program was implemented at Duquesne University at Pittsburgh.

Ø  In her discussion of specialization, Styles included for identifying a research focus as one criterion for a specialty.

Ø  A final requirement for a specialty is representation by at least one organization.

Ø  Within nursing, there is organizational support in the American Organization of Nurse Executives.

Healthcare Policy Impact on Nursing Informatics Practice

Nursing Shortage and Nursing Informatics

Ø  Nursing has experienced a number of shortages in recent history.

•       An older  nursing workforce

•       A higher ratio of older associate degree graduates

•       The availability of more attractive career opportunities for women

•       Decreased interest in nursing as a career difficult work environments.

Ø  Unless something is done the shortage will rise from 6% in 2000 to 29% in 2020 or more than 800,000 nurses short of the number needed.

Ø  The Bureau of Labor Statistics As Phase 2 of the AAN technology project began, staff nurses from three hospitals in Virginia and California were asked to identify or verify the most difficult aspects of their practice and how technology would improve those tasks.

Ø  As the project continues, systems will be designed, implemented, and tested to determine their effect on nurses’ work.

Ø  It is up to NI specialists to help design and implement IT systems that will finally assists nurses in their practice and to validate the results thru research.

Ø   (BLS) is predicting registered nurse positions will increase more than 600,000 between 2002 and 2012. To cover these new positions and replace retiring nurses 1.1 million more nurses are needed by 2012.

Ø  Although these numbers differ it is clear that without intervention the healthcare industry is headed for a major crisis in the nursing workplace.

Ø  Schools and colleges of nursing have shortened program lengths and instituted accelerated program for those who already hold a baccalaureate degree in an attempt to increase nursing workforce numbers.

Ø  Nursing organizations have been actively advocating for increased federal funding to expand programs and increase loans, scholarships, and incentives.

Ø  In 2002 the AAN Commission on Workforce launched a multiphase project to develop IT that will help support nurses in their day to day work.

Ø  In Phase 1, interdisciplinary, creative thinkers were assembled to determine how technology could be use to facilitate nurses’ work.

Ø  Bradley (2003) indicated that technology solutions should improve existing care processes and outcomes, increase access thru the use of portable handheld devices, incorporate Internet capability to overcome distance barriers of care and improve access to knowledge acquisition.

Ø  These authors also advocate for using bar-coding of medications, use of speech recognition, and fine tuning the user interface of systems to support nurses.

National Informatics Initiatives and Nursing Informatics

   Executive Order for National Interoperable Information System

Ø  As indicated earlier, patient safety is one of the driving forces in increased clinical automation.

Ø  National events have placed IS at the forefront of health policy. The impact of the first two IOM reports on patient safety has been discussed.

Ø  An additional IOM report Patient Safety states even more emphatically those electronic medical records, using standard data elements, are a critical tool to improve patient safety.

Ø  A 2001 report from the President’s Information Technology Advisory Committee (PITAC) highlighted key issues in IT.

Ø  PITAC indicated that the United States lacks broadly disseminated and accepted national vision for IT in healthcare and recommended the appointment of a senior IT person to provide strategic leadership.

Ø  On April 27, 2004, President George W. Bush issued an executive order  “Incentive s for the Use of Health Information Technology Coordinator” that has the potential to impact every healthcare entity, provider, and NI professional in the United States( Executive Order 2004).

—  Components of the order are:

1.) Establish a national health information technology coordinator position.

2.) Work to develop a nationwide interoperable health infrastructure

3.) Develop, maintain, and direct implementation of a strategic plan to guide implementation of interoperable health IT in both public and private sectors.

v  The interoperable health IT should reduce medication errors, improve quality, and produce greater value for healthcare expenditures.

National Health Information Infrastructure

—  Another national initiative that will impact NI is the National Health Information Infrastructure (NHII).

—  This voluntary initiative, involving a three stage process over 10 years, is intended to improve the effectiveness, efficiency, and overall quality of health and healthcare in the United States.

—  NHII calls for comprehensive knowledge-based networks that integrate clinical, public health and personal health information to improve decision making by having information available to providers.

Health Insurance Portability and Accountability Act (HIPAA)

—  HIPAA was passed in 1996 and is intended to improve public and private health programs by establishing standards to facilitate the efficient transmission of electronic health information.

—  HIPAA preempts state law and payer specific variations of data standards; mandates input from private, standard setting organizations.

—  HIPAA has a significant impact on informatics: IT must be designed to comply with Title II of the act.

—  All of the requirements of HIPAA are expected to be in placed  by May 23, 2008

—  Timetable :

—  October 16, 2002-Electronic Healthcare Transactions  and Code Sets

—  April 14, 2003-Privacy

—  October 16, 2003-Electronic Healthcare Transactions

—  April 14, 2003- Privacy-small health plans

—  July 30, 2004- Employer Identifier Standard

—  April 21, 2005-Security Standard

—  August 1. 2005- Employer Identifier Standard

—  April 21, 2006- Security Standards-small health plans

—  May 23, 2007- National Provider Identifier

—  May 23, 2008- National Provider Identifier.

§  In November 2004, under HIPAA administrative simplification, CMS expects to publish the proposed rules for a national health payer identifier and a format for standardized claims attachments.

§  The privacy rule of HIPAA was published in December 2000 and became effective in April 14, 2001

§  The privacy rule and other HIPAA regulations are having tremendous impact on health informatics, including NI. For example, under HIPAA patients must be permitted to review and amend their medical records

§  Informatics nurses are responsible for understanding and helping to implement HIPAA regulations.