WHEN I WAS IN NURSING school back in the late 1970s, I learned how to properly make a patient's bed. You must place the pillow so that the opening of the pillowcase faces away from the door. Why, you may ask, do I still remember this 35 plus years later? Simply because I could never figure out why it was so important which way the pillowcase faced. Frankly, my nursing instructors didn't inspire a lowly 20-year-old nursing student to ask “why.” So I was careful that the pillowcase opening faced away from the door—at least while I was in school. Today, the need to dig deeper and find out the reason, rather than accepting the knowledge of the past without question, is changing the practice of nursing and healthcare.
Nursing is critical to the evolution of healthcare in the United States, and this evolution will be based on the data and information we can extract from electronic healthcare records (EHRs). Nurses in informatics leadership roles across the country are helping to foster the changes that are needed in our healthcare system. This article will review the role of nurse informatics leaders in changing healthcare.
Getting to know informatics leadership
So, what do nursing informatics leaders look like? In a word: experienced. In the 2014 Health Information Management Systems Society Nursing Informatics Workflow survey, the results showed:
- 60% had master's or doctoral-level education
- 41% had more than 16 years of clinical experience before becoming informatics nurses
- 46% had more than 7 years of informatics experience.
Today's nursing informatics leaders can be found in multiple environments beyond the four walls of a single hospital—for example, in the corporate headquarters of healthcare organizations and in government, academia, and the business world.
In the government sector, informatics nurses help keep the patient the primary focus of policy and law as well as in the development of standards for design and implementation of EHRs, patient engagement, clinical quality, system interoperability, and quality measures.
Informatics nurse leaders in academia are not only helping educate the next generation of informatics leaders, but also helping to transform nursing education as a whole. Basic informatics skills are now a required competency for every RN. Technologies to support nursing education, such as simulation labs, are becoming commonplace.
Research in the usage of informatics to improve care is ongoing; for example, a recent study explored the use of nurse-sensitive indicators and healthcare information technology. The goal was to establish linkages between nursing care and improved patient outcomes in order to better use technology to improve care.1 This study demonstrated the complexities of establishing these linkages and the need to use these data in standardized performance measures.
In business, nursing informatics leaders are working across a spectrum of roles, from CEO of their own companies to chief nursing informatics officer (CNIO) roles in healthcare technology companies. Informatics nurses in industry are helping to design and implement products to improve the workflow of clinicians, use data and information to inform nursing practice, and bring years of clinical experience to provide quality care to patients. Informatics nurses hold executive positions at most of the major EHR vendors, sit on advisory boards, and act as consultants to industry and healthcare organizations.
But not all nurses in business work for corporations—we can't forget those with an entrepreneurial spirit. In 2012, two informatics nurse entrepreneurs, Charles Boicey and Brian Norris, along with an information systems management student, Mark Silverburg, won the U.S. Department of Health and Human Services' Office of the Assistant Secretary for Preparedness and Response Now Trending: #Health in My Community challenge by creating MappyHealth. This software mined Twitter data for disease terms in order to serve as an indicator of potential and trending health.2
Like any executive nursing leader, those in nursing informatics leadership roles need various skills, including some that aren't taught in our basic nursing education programs. Besides earning advanced degrees, many have taken courses in topics such as professional selling; negotiation; public speaking; and working with people, finance, and marketing skills. Although you may not think these courses valuable to nurses, I know from experience that training in these areas has improved my value to my employers over the years.
Nursing informatics leaders need the ability to analyze data and then present complex information to organizations, clients, or students. These presentations need to be done in ways that are understandable not only to clinicians but also to those whose backgrounds are in finance, information technology, or computer science. A major responsibility of any nursing informatics leader is to present data and insights logically and simply, yet in a way that tells a powerful story.
Let's go back to 1999 when the Institute of Medicine's report, To Err is Human: Building A Safer Health System, was released. Suddenly, it seemed that everyone, including me, was quoting the report's statement that “perhaps as many as 98,000 people die in hospitals each year as a result of medical errors that could have been prevented.”3
One day, I decided to do a comparison; 98,000 deaths per year equals to 268 people every day, which is roughly the same number as if a Boeing 737 crashed and killed everyone on board every single day of the year. When I started using that comparison in presentations, many people in my audiences were shocked and a few told me I couldn't say things like that. A few months later, I started to see similar comparisons in articles and other presentations.
The lesson learned from this is that data are fantastic, but, without context, may not be very powerful. Informatics nurse leaders have to see beyond the data to the outcome and what it means to our patients and practice.
Meaningful use is the goal
Over the past 10 years, our major focus as informatics leaders has been the implementation of EHRs across the country. But EHR implementation was never the end-goal, it was a step in the journey. If you've seen or heard the term meaningful use, please understand that meaningful use of the data collected in the EHR to improve healthcare has always been the end-goal.
In a paper-based healthcare system, patient data were available to only one clinician at a time and only as long as that clinician was in physical proximity to the patient's medical record. When I started as a new graduate nurse, I was expected to give the patient's medical record to anyone senior to me, no matter what I needed from it. There was no way to determine who had read the patient information in the medical record, so patient privacy was based on the honor system. Research was difficult and costly. Obtaining large sample sizes was next to impossible without a government grant.
But today, we stand on the threshold of a completely different way of providing healthcare. Consumer engagement is beginning to make its mark. The last vestiges of the paternal “just do whatever the physician orders” system are being swept away. Evidence-based practice will become the norm for nursing, replacing the “we've always done it this way” or “that's what my instructor/preceptor said” mentality. If you're told the pillowcase must open away from the door, there should be available evidence to support the recommendation. And if there isn't, we now have the capability and responsibility to ask “why?”
Imagine having a dashboard for all of your patients that not only shows you their critical indicators but also makes recommendations based on the current evidence. Then picture that dashboard on a smartphone device that you have with you at all times—a device that lets you send secure text messages, document information in the EHR, and make calls; reminds you of patient care tasks; and supports the work you do in many other ways. Now technology truly supports your workflow rather than being just one more thing in a long list of things you must deal with.
Nursing informatics leaders are working to make those visions and many others a reality. As a nurse, I no longer care for individual patients as I did in my years as an ED nurse. Now, as an informatics nurse leader, my goal is to use my clinical experience and informatics knowledge to assist in improving healthcare for all of us and to make your work a bit easier, safer, and more beneficial for your patients.