THE ROLE OF THE INFORMATICS nurse stretches far beyond the hospital setting. Although most research and industry attention surrounding the adoption and optimization of electronic health records (EHRs) and other health information technologies (HIT) focus primarily on the acute care setting, the role of the informatics nurse is vital to the success of an organization in other healthcare settings, too. This article will review the application of nursing informatics in some of these settings.
Transitions of care
Patients with chronic care needs seek care in many non-acute care settings, such as ambulatory clinics, outpatient clinics, skilled nursing facilities, and home healthcare agencies. Nearly one in two adults lives with at least one chronic illness and more than 75% of healthcare costs are caused by chronic conditions.1 Many adults living with chronic conditions are Medicare beneficiaries who experience significant gaps in the coordination of care from multiple providers and specialists.
Utilization of services in long-term and postacute care (LTPAC) is expected to increase as the population ages. Patients who need services from LTPAC settings usually have more complex conditions and multiple comorbidities. They also make more frequent transitions between these healthcare settings.2 These frequent transitions require timely sharing of relevant data in order to coordinate care and reduce redundant services. If we are to achieve the goals of healthcare reform, providers in all settings must adopt and effectively use systems to support information capture, use, and exchange.
As adoption of EHRs and health information exchange (HIE) capabilities by eligible professionals and hospitals increases, the need to understand and support EHR and HIE adoption in LTPAC settings is amplified. National statistics on EHR use in the LTPAC setting are limited, but data on particular settings indicate that adoption is well behind the acute care settings.2
The informatics nurse in all nonacute settings plays a tremendous role in advancing improvements in the delivery of high-quality healthcare and reducing costs. Many of these settings, however, don't have the same level of maturity in informatics compared with the acute care setting. Smaller organizations may lack resources to place a dedicated staff member in the role of informatics nurse, or the nurse in that role may be performing other duties as well. Even though nursing and medical standards of practice are consistent across all settings, LTPAC settings have unique operational requirements, clinical workflows, and regulations. These challenges are best understood by subject matter experts to guide the selection, design, implementation, and optimization of technology.
The typical functions the informatics nurse performs in nonacute settings are comparable to those of his or her counterparts in acute care and align with the American Nursing Association's Nursing Informatics: Scope and Standards of Practice.3 Informatics nurses in LTPAC settings primarily serve in the following functional areas.
- leadership, administration, and management: strategic direction, policy development, and change management
- compliance and integrity management: data integrity, security, and confidentiality
- analysis: knowledge synthesis, decision support, and outcomes management
- coordination, facilitation, and integration: project management, implementation, and optimization
- development: design, iterative development, and testing.
Scope of practice
Even though LTPAC settings aren't eligible for the Medicare and Medicaid EHR Incentive program, significant grassroots efforts have been in place since 2005 when the LTPAC HIT Collaborative was formed to advance HIT issues through coordinated efforts of its members. The Collaborative hosts an annual LTPAC HIT Summit and publishes the biannual LTPAC HIT Road Map. The 2012 to 2014 LTPAC HIT Road Map guides provider organizations, policy-makers, vendors, payers, and other stakeholders in all areas of HIT relevant to the LTPAC setting. The Collaborative identified five priority areas for action in which the nurse could play a significant role.
1. Care coordination. LTPAC must be a leading participant and enabler of customer-centered longitudinal care planning and coordination across providers and contexts.
The informatics nurse in LTPAC is well-positioned to identify what key data must be shared with outside providers to ensure they have the information they need to make sound clinical decisions about a patient's plan of care. Prompt communication of the right information among members of the care team is essential for successful care coordination and cost reduction.
2. Quality. LTPAC must leverage technology to support transparent accountable delivery, measurement, and improvement of quality care, services, and outcomes experienced by consumers both within and across care settings.
The informatics nurse in LTPAC plays a significant role in quality improvement by ensuring the capture of relevant data for measurement and analysis of trends. The nurse can help identify technologies that support nursing standards of practice and improve data capture and integrity. The nurse must also conduct ongoing evaluation of existing technologies to optimize its use.
3. Business imperative. LTPAC must leverage technology to generate innovative, efficient business and service strategies and models that will ensure that it has a leading role in the future of healthcare delivery.
Informatics nurses in LTPAC understand workflow unique to each setting and can identify when and where information is needed to improve operational efficiency. For instance, the use of telehealth, remote patient monitoring, and other tools to keep patients in the most cost-effective setting of care should be evaluated. Nurses should be included in these strategy discussions as their input can provide valuable insight into the needs of the population.
4. Consumer-centered care. LTPAC's unique opportunity lies in its ability to leverage technology to build on its legacy of longitudinal person-centered care and services through effective integration of care and hospitality paradigms.
Nurses in LTPAC settings are quite accustomed to delivering patient-centered care, so this is a great opportunity to leverage technology to enhance patients' experiences and help keep them engaged in their healthcare. Nurses are well known as patient advocates and can help design services that meet the individual patient's needs and preferences. Informatics nurses play a role in ensuring that key data needed to deliver patient-centered care is captured, displayed effectively in the nurses' workflow, and shared with all care team members for continuity of care.
5. Workforce acceleration. LTPAC must reequip, reempower, and reeducate its workforce to leverage technologies as part of care and hospitality service delivery to create great customer relationships, experiences, and outcomes.
Much can be learned from our counterparts in acute care and informatics nurses in LTPAC should network with the other informatics professionals to stay current with the ever-changing healthcare and technology landscape. They must also mentor others to help them understand the value behind HIT and how it can be used to enhance the delivery of high-quality and efficient care.4
Advancing technology adoption
It's important to call attention to the significant work that has been accomplished by many LTPAC providers and other stakeholders without the benefit of government financial incentives or guidance. As more emphasis is placed on LTPAC providers by the Office of the National Coordinator for HIT and the full effects of healthcare reform and changing payment structures are understood, participation in HIE will be vital to the future success of all providers. Informatics nurses have tremendous opportunities to support LTPAC providers as well as the vendors who support these non-acute care settings; with emphasis on the workforce development, these opportunities are expected to grow. Advancing the adoption of certified EHRs and other technologies for LTPAC providers further strengthens the implementation of the nationwide HIT infrastructure, ensures adherence to national standards for data exchange, and contributes to the provision of high-quality, well-coordinated care for all.