INTRODUCTION

The sentinel 2001 publication by the Institute of Medicine (IOM), Crossing the Quality Chasm: A New Health System for the 21st Century, addressed issues in healthcare quality, cost, and burden. The report discussed concerns related to overuse and duplication of unnecessary procedures, underuse of procedures deemed to be beneficial, and medical errors resulting in unsafe practices. The report cited six specific aims to improve healthcare, targeting safe, effective, patient-centered approaches to timely, efficient, and equitable care. The IOM published a series of reports addressing healthcare needs, providing a road map to improved patient outcomes. Fundamental points for healthcare improvement were the need to radically change the healthcare system, including increasing patient safety by reducing error, increasing communication efficiency through the quality of a learning health system, transforming the nursing environment to create a better workflow, containing healthcare costs, and facilitating these improvements through information technology. Making this happen would require an educational reset, creating competencies (Chapter 2, Informatics Frameworks and Competencies: What a Nurse Needs to Know) related to training necessary to move into the digital age and incorporate information technology into bettering patient outcomes.

So what is information technology? Information technology is a systems approach to storing, retrieving, and distributing information using computers. Health information technology (HIT) uses a computerized or EHR, electronic medical record, and public health record (Chapter 6, The Electronic Health Record, Electronic Medical Record, and Personal Health Record). We suggest that informatics is the science and study of information technology and processes, but health informatics is the science and study of HIT and processes to improve patient care.

INFORMATICS AND THE EHR

Electronic communication is a widely accepted form of person-to-person or person-to-group interaction. The world has become a smaller planet due to the usability and speed of global communication devices, including computers and smartphones, wearables, email, and social media platforms. According to the American Health Information Management Association (AHIMA Work Group, 2014), health informatics is the “scientific discipline that is concerned with the cognitive, information-processing, and communication tasks of healthcare practice, education, and research, including the information science and technology to support these tasks” (p. 60). Health informatics can move the American healthcare system toward quality care by enhancing communication between practitioners and patients—increasing the patient–provider dyad by increasing the human–computer interaction. The merging or melding interdisciplinary communications will decrease the healthcare silos and increase a team approach to collaboration to increase patient outcomes. Go team!

From a healthcare practice perspective, the initiation of EHRs, electronic medication administration records (EMARs), and computerized provider order entry (CPOE) changed the way many nurses and other healthcare providers practice. Laws, such as the Health Information Technology for Economic and Clinical Health (HITECH) Act (a part of the American Recovery and Reinvestment Act of 2009), were put into place to encourage EHR implementation and use of these systems in meaningful ways (U.S. Department of Health & Human Services [HHS], n.d.-a). Electronic access to patient information, provider orders, and clinical decision-making tools via EHRs and EMARs allows bedside and primary care nurses to provide care, administer medications, and connect patients to resources in a safer, more efficient manner (Office of the National Coordinator for Health Information Technology, 2013). The ability for interdisciplinary communication explodes with the use of HIT, making it easier to comprehensively reconcile medications and e-prescribe medications quickly, saving time and money while increasing productivity—not to mention decreasing burden and healthcare costs! The CPOE has made the difficult and dangerous task of interpreting physicians’ orders a thing of the past.

INFORMATICS AND EDUCATION

Nursing education took steps to incorporate the use of data and information into their curriculums and tying the EHR to patient care. Educators, in the era of the Internet, are moving education to a digital environment not only to assist in spreading the concept of digital learning but also to reach many healthcare providers at all levels of learning. The emphasis on the need to maximize the use of data and information for better patient outcomes is creating greater interest in interdisciplinary conversations surrounding patient care (Figure 1.1). Consider the Consider this! case of Mike and how greater access to medical information may have facilitated his care. Nursing access to his previous health records would have expedited his care, allowing for better understanding of what the scar on his chest meant. We are all teachers and learners when it relates to information technology. Pay attention, grasshopper!

Figure 1.1

Interdisciplinary approach to health informatics.

Source: Lynda R. Hardy. Used with permission.

A tsunami of technology-based electronics has come our way. The use of smartphone and tablet applications possesses a multitude of bedside educational resources for healthcare provider and patient use, aiding in administering medications, performing procedures, translating languages, and allowing patients real-time access to their health information. Similarly, online patient education portals, which provide education and house personal health information, allow patients to more actively participate in self-care. These portals can be accessed via website, and many have mobile apps. There is an app for that! Chapter 9, Digital Health: mHealth, Telehealth, and Wearables, will explain more.

As nursing continues to elevate the profession by increasing educational requirements and encouraging professional development, the need for nursing faculty continues to rise. Online teaching gives flexibility to instructors, increasing the number of faculty available to teach nursing. Online learning management systems foster creative thinking and engage diverse student populations. The tsunami discussed earlier has a greater reach in educating the next generation of informatics educators with the depth and breadth of knowledge to provide sound education at all levels of nursing education.

Melnyk and Fineout-Overholt (2019) posit patients are multifaceted, requiring nurses of all preparations to be knowledgeable and efficient at generating new research, as well as finding evidence to support practice. PhD nurse scientist researchers and DNP integrators of evidence into practice now have largely unlimited access to the literature at their fingertips. The process of research and evidence exploration has changed significantly, with the publication of nursing research increasing considerably since the advent of electronic databases, online document sharing, professional listservs, and social media communication applications.

Technology operationalizes the research process by heightening the topic specificity and speed when locating literature via electronic categorical searches. Databases with a myriad of research tools, such as the Cumulative Index to Nursing and Allied Health Literature (CINAHL), are huge time-savers when finding appropriate evidence, as well as collecting and analyzing data. Online document-sharing applications, such as Google Docs and Dropbox, have enabled multiple contributors to collaborate more efficiently without constant email lag. Nursing organization-specific listservs allow intradisciplinary nursing and interprofessional healthcare team members to easily discuss issues of all kinds, adding to the robustness of subject matter and therefore study design and implementation. Social media communities of practice (CoPs) have empowered nurses to securely exchange practice information, education, and support, leading to clinical expertise in application of evidence-based practice (EBP) and research (Isaacson & Looman, 2017). Technology is constantly evolving, requiring nurse informaticists and nurse educators to continually update nurses about the most current applications available to find evidence, implement change, and improve patient care.

INFORMATICS AND EVIDENCE

Practice change must be evidence based to be successful and sustainable. According to Melnyk and Fineout-Overholt (2019), patient acuity is increasing, requiring a greater evidence base to provide appropriate care. True EBP requires the inclusion of critical appraisal of systematic approaches, clinical expertise application, and consideration of patient preferences and values. Utilizing informatics within this EBP framework enables exhaustive literature searches, facilitates practitioner collaboration, and collects patient preferences both individually and aggregately.

Performing comprehensive yet rapid and efficient peer-reviewed literature searches is no longer the exception but is now the rule for both researchers and those applying evidence to practice. Informatics provides many tools to aid in these searches. Online access to the literature via filtered scholarly databases and Boolean search terms allows nurses to drill down to the specific topics they wish to explore, decreasing frustration and encouraging less-experienced researchers and writers to continue their journey toward EBP. Additionally, reference management services such as RefWorks, Write n Cite, and Endnote enable online storage and organization of articles, contributing to an author’s ease of access to find information. Informatics also provides numerous ways to compile, format, and present evidence-based ideas, as well as receive the needed feedback to evaluate those ideas and make appropriate changes. Nurse informaticists and nurse educators have an important role in keeping nurses current and competent with available electronic resources that assist with examining large databases of evidence (data mining), to promote application of evidence to practice and thereby improve patient outcomes.

DIGITAL IMPLICATIONS

The digital revolution has begun—and we are all in it. McKinsey’s sentinel article (Manyika et al., 2011) warning of the impact of big data and information technology on healthcare was a shot across the bow, explaining that the tsunami was on its way—but did we listen? “Today’s medical professionals are more likely to greet you with an iPad and stylus in hand, rather than a paper folder and pen” (NursesJournal.org, n.d., para. 1). Nurses use desktop and mobile applications to administrate hospitals, manage units, educate staff, and care for patients. A vast number of online clinical healthcare resources, including those associated with evidence-based guidelines developed by professional organizations, government entities, and hospital systems, have been developed to be used by the healthcare team at both the point-of-care and within the C-suite.

Top applications for bedside nurses include those dealing with medication administration, language translation, decision-making tools, procedural guidelines, and assessment. Nurse educators present information to clinical staff via a variety of methods, such as online learning modules, social media–moderated specialty or organizational specific CoPs, and computer-based annual education. Administrative nurses use many electronic resources to hire and evaluate staff, prepare budgets, determine staff productivity, assess risk, and analyze medical errors. For most nurses, mobile devices and desktop computers are two of their most important clinical tools, creating a direct link from clinical expertise to practice. Today’s students, nurses, and educators are understanding the need to increase their toolkit, including methods to visualize health-related data to better manage nursing workflow and productivity.

Assessing and incorporating patient preferences into practice is perhaps the most important prong in the EBP process. Regardless of what the evidence shows, or the practitioner knows, if the patient’s values do not align with the proposed implementation of research, it will not be successful or sustainable. Educating patients is the first step in practitioner–patient value alignment. Academic databases and professional websites, however, are not the only place to find health information. The endless amount of available online health information can be overwhelming to many and learning to navigate the Internet and appraise the validity of resources is critical for patients (Silver, 2015) as well as nurses. Teaching patients to appropriately search, correctly interpret, and apply online health information as an addition to regular professional medical care is key, creating trust within the nurse–patient relationship, moving it toward value alignment.

Although the rate of application of evidence to practice is slow, researchers and clinicians continue to seek ways to bridge this gap. Informatics removes communication barriers from researcher to clinician to patient, allowing evidence to be integrated into practice. The nurse informaticist is in a prime position to lead the movement of evidence into practice, possessing the knowledge and technical skill set to enhance collaboration among the patient-centered healthcare team.

ADDRESSING THE QUADRUPLE AIM

The IOM publications To Err Is Human (Kohn, Corrigan & Donaldson, 2000) and Crossing the Quality Chasm (Committee on Quality Health Care in America, IOM, 2001) contain information regarding the alarming rate of medical errors within American healthcare. These sentinel publications warned of the need to modify practice for better patient outcomes, but even now, that rate has continued to climb. Discussions related to the critical need for EBP in healthcare, establishing the STEEEP (safe, timely, effective, efficient, equitable, and patient-centered) guidelines for healthcare redesign, including the need for patient care, encourage a response from healthcare organizations and academic to move traditional nursing approaches to care toward the integration of evidence into nursing education and practice.

Furthering the EBP-to-healthcare approach, the Triple Aim includes “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations” (Berwick, Nolan, & Whittington, 2008, p. 760). It became clear that these added initiative stressors placed on clinicians have taken a toll, making the Triple Aim difficult to attain as well as sustain. The remedy proposed by Bodenheimer and Sinsky (2014) suggested adding a fourth aim: supporting the need to decrease healthcare providers' burdens and make their work lives better. Combining STEEEP principles and Quadruple Aim components with informatics provides a practical framework that nurse informaticists can build on.

WHY DOES HEALTH INFORMATICS MATTER?

It matters because it provides the evidence to better patient care through increasing patient safety and quality and decreasing patient care costs and provider burden. Health informatics gives us the data and information we need to increase our knowledge and wisdom as we approach the four critical goals of the Quadruple Aim. The digital ecosystem that incorporates informatics gives healthcare providers rapid ability to determine individual, institutional, and population-based trends with the ability to act faster and with greater precision to ensure adequate responses to healthcare emergencies. Health informatics ensures that we get the right information to the right person and the right time to make the best health-related decisions on current, accurate data.

It matters because without access to real-time data and information, there is no knowledge and wisdom, and our healthcare system depends on providing the right information to the right person at the right time.

SUMMARY

This chapter introduced the rationale and importance of educating all levels of nursing about the use of data in decision-making. Using data as a road map for patient care provides the right information to the right person at the right time. Data are powerful, and they inform practice! As you continue through this book, keep in mind the lessons taught and the insights provided—Consider this!—and if the ED healthcare providers had access to Mike’s previous medical record, they would have known the following:

REFERENCES