“WE SAVE LIVES!” This may seem like a different perspective on nursing informatics, but the statement definitely applies to the work of nurse informaticists (NI) across the country. As an RN working as an NI, I stress the clinical focus of informatics and how NIs impact the health and clinical outcomes of patients. One of the key factors impacting nursing informatics is rapidly advancing technology and the use of technology by nurses in a clinical setting. Nurses are adapting to changes in how care is delivered and how information is recorded, processed, and managed.
We're in the midst of a technology revolution in healthcare, and innovation is a constant with new technologies, processes, and tools driving how care is delivered. Currently, a lot of discussion revolves around innovation and how it affects healthcare. Many organizations have chief innovation officers to drive strategy and support innovation.
Technological innovations represent many opportunities in both products and processes within clinical settings. Innovation is driving the way nurses practice and how they manage care delivery.1 This article reviews the importance of technology development in relation to nurses and patients.
Expansion, innovation, and disruption
In the last decade, we've seen an increase in electronic health records (EHRs) implemented throughout hospitals and ambulatory clinical settings. As many as 80% of hospitals and 50% of healthcare providers had implemented EHRs by the end of 2013.2 Most nurses have become adept at using the EHR and have incorporated the management of patient information within the EHR into their practice. However, an abundance of new technologies being deployed to improve patient care is changing the way nurses practice and view the evolution of healthcare. These technologies have (and will continue to have) a significant impact on nursing.
This concept is called disruptive innovation: “an innovation or technology that creates a new market by applying a different set of values, which ultimately and unexpectedly take over the existing market.”3 NIs are involved in the implementation and adoption of these enabling and disruptive technologies in their practice setting, through designing workflows, promoting utilization, and providing education and testing. NIs also provide ongoing support for nurses in their use of these tools.
So, what's new?
Several technologies being assimilated into the healthcare environment impact how nurses interact with patients, families, and their communities. For example, the move to information mobility is more prevalent because patients, families, and clinicians all desire more access to information on their personal devices, such as smartphones and tablets. Patients and families now have access to many healthcare apps, and hospitals are also developing apps or promoting apps for their patients. Patient portals integrate with the EHR, and patients and families can receive up-to-date information, anywhere, anytime, on their personal devices. These portals are becoming much more patient-centric, with increasing ease of access and use, and are rapidly evolving to include expanded capabilities. Thanks to patient portals, patients can now make appointments with their providers, request prescription refills, and even have video visits with their care team. Providers and other clinicians can also electronically send the patient-specific questionnaires or assessments to complete, which are verified by the clinician and added to the patient's health record. This may include health history information, genomics screening questions, or patient test results.
Another new piece of technology is wearable devices that monitor physical activity, vital signs, and other health indicators. These devices can be synced to patient portals so clinicians can monitor patients. This increase in integration between patient portals and the EHR is being used to engage patients, promote health and well-being, and monitor adherence to treatment guidelines. Patient and family interaction with their own health information will continue to expand, both in numbers of patients and in future technology development.
Move to mobility
Nurses also are moving to a more mobile healthcare environment. Tablets and smaller handheld devices can be used for many functions in the clinical setting, such as bar code medication administration (BCMA). BCMA on portable devices isn't exactly new, but BCMA on devices such as a smartphone or tablet is; this expanded technology allows patient information to be stored in one device. The functionality of this technology is expanding and a single device may become a primary tool for nurses to monitor patients, document care, and communicate with patients and other clinicians.
Mobile devices are now being used to provide efficiencies for the nurse through such features as encrypted, secure messaging; managing reminders; or accessing health information for clinical decision making. In addition, these devices have capability for more robust collection of information, such as taking photographs of wounds, I.V. sites, or other clinically significant images. Changes in a patient's clinical status can be captured through images that are uploaded into the EHR. Patient photos can easily be added to the record for patient identification purposes. Nurse informaticists can help develop workflows and functionality with the use of mobile devices that support integration between multiple systems within a single device. In addition, the data are secure because all communication is encrypted and nothing resides on the device. This move to mobile devices provides additional flexibility and functionality for the use of mobile devices by direct caregivers.
Delve into data
Another area of innovation that's becoming more prevalent is the use of analytics and actionable data to help guide patient-care decisions and improve clinical outcomes. Predictive analytics that can identify information in the EHR and present it in a way to show changes in a patient's clinical status can help bring critical information together for decision making by the nurse. Algorithmic tools such as the modified early warning systems, which help identify patients at risk for a significant adverse event, are becoming more widely used EHRs. With ongoing development, these analytic tools may be able to predict targeted outcomes and help with care decisions.5
Tools are also available to help nurses assess mechanical ventilator weaning readiness or manage glycemic control. Other types of analytics are being developed to provide real-time data at the point of care that can be actionable in terms of interventions and treatments.
Finally, the use of social media is expanding to help with communication and networking for people discussing specific health issues. Data from social media sites can be mined to show patterns in tracking certain diseases, such as influenza incidence and prevalence. The opportunities for the use of social media to impact healthcare, not only for consumers and patients but for healthcare providers and nurses as well, are really starting to be explored, and many opportunities for integrating social media into clinical workflows are being developed. This information can be used by organizations to help with staffing decisions or in determining treatment decisions for populations at risk. Tools such as MappyHealth can help mine data from social media sites looking for healthcare trends.6 Educational programs to inform and manage healthcare trends in communities can be developed for the public, based on health issues identified from social media discussions.
Nurses and tech saving lives
These innovations are driving the way consumers, healthcare providers, and clinicians are thinking about their health. Caregivers and patients alike want more mobility and integration of data and systems that can affect healthy behaviors, and the ability to discuss, report, and manage their information.4 As these new technologies are deployed and implemented in the practice setting, nurses need to be diligent in their use of the trends affecting their practice.
Nurses have a role in evaluating technology, while thinking about their own workflows to deliver optimal patient care and the impact of technology on patient outcomes. Using innovations in technology, nurses can help provide a comprehensive view of the patient, with easier access to information and support for clinical decision making. All these innovations help nurses provide the best care possible for their patients.