This presentation will discuss the Infrastructure of an Informatics department as it applies to nursing and healthcare in today’s rapidly changing technological world.
To many, the use of EMR’s and computers in healthcare may seem to be a recent development in the ever changing and evolving world of technology and healthcare. However it has actually been in use for almost 4 decades. Early use of computer systems to support patient care occurred in the 1960’s. Experiments were underway in the use of electronic medical records systems that collected data directly from clinicians in inpatient and outpatient settings by the end of that decade. Still, adapting computing technology and electronic communications into healthcare has progressed at a snails pace when compared to other venues and industries. The slow rate of adoption of information technology into healthcare has even been surpassed by the use of modern smart phones and their capabilities.For the first time since this initial use in the 1960’s, a U.S. President has called for the sole use of EMR’s within a decades time frame, and this administration has created the Office of the National Coordinator for Health Information Technology in the Office of the Secretary of Health and Human Services as just one part of the implementation of the Affordable Care Act.
Nurses, we’ve all been there. This is a typical start of shift in a typical day, no matter what inpatient unit you work, and it continues throughout the shift, even when you haven’t had a lunch break or snuck to the bathroom. Unlike the average everyday 9-5 jobs, we have the daunting task of caring for people, often at their worst. We are entrusted with the most precious thing available to an individual, their very life. We must be organized and flexible, complete tasks with constant interruptions, adapt to any situation imaginable and unimaginable at a moments notice, we must do our jobs with not just our minds, but our bodies and souls. Who brought up this brilliant idea of throwing computers into the mix in healthcare? Who would do that to us? AS if we have time for that!!!!
Nurses are intelligent professionals with a very unique specialty who are constantly learning and adapting. Sometimes, however, this causes us to put on blinders, and we are resistant to integrating knowledge from other fields outside of health and medicine. We utilize information continuously to do our jobs. We learn about the body and the care of patients in nursing school….thereby taking in information. We apply what we have learned in practice. We gather information from patients to render care. We record this information through charting, and relay this information in communication with other nurses, physician, pharmacies, families, etc. This processing of information is the basis of Informatics. What we must realize is that technology is being incorporated into every aspect of our lives, and without it, we will be left behind. Those who continue to resist the change will have no choice but to be phased out of healthcare, because it is here to stay……
Various sources provide various definitions of the term INFORMATICS. It can change based on the field it in which it is being applied. Merriam Webster online and Business Dictionary online are obviously reference sources with a more generic definition. The Indiana University Purdue University definition comes from their school website section describing their Masters of Science in Informatics programs. Probably the most appropriate definition is that as described by William Hersh….” The discipline…..”
Over the years, the definition of Nursing Informatics has undergone many changes, to adapt to the ever changing role of technology and advancements in the scope of nursing practices has evolved. The ANA breaks down the various types of definitions into 3 categories, 1.) definitions with an IT focus, 2.) conceptually oriented definitions, and 3.) definitions that focus on roles. As nursing informatics gained respect and acceptance as a specialty, the role oriented definitions developed. The ANA’s definition of the field and its scope of practice has evolved as well, with this being it’s official definition as of 2008. As the specialty grows and advancements are made, the definition will continue to be modified and adapted to encompass the scope and depth of the field.
There’s that word….INFRASTRUCTURE….again. But again, it’s not alone. As we are seeing, the common theme is an infrastructure is made up of many parts, from computers, to processes, to people.
There are so many terms in utilized in Informatics. Some of them are interchangeable. It makes it very difficult to give one definition and description of the Infrastructure of an Informatics department. That is why they ALL come together to define and describe what it means.
Additional Information for application of evidence to practice:Building Block 1: UTILIZING standardized terminologies and structures…. AEP: Standards fro representation of knowledge facilitate the application of decision support rules.Building Block 2: The use of digital sources of evidence.Building Block 3: The use of established data exchange standards…..AEP: Facilitate the delivery of tailored health-related messages based on patient-specific dataBuilding Block 4: AEP: Use decision analytic techniques to tailor evidence to specific patients.Building block 5: Establishing Informatics Competencies…..AEP: Perform critical analysis of evidence for its applicability to practice.
We have learned that infrastructure supports the framework of a much larger superstructure. In this presentation, the superstructure can be considered a hospital or other healthcare organization. The infrastructure can be the employees and departments within the hospital or healthcare organization that through their work, contribute to the day to day function of their employer. A subcategory of the larger infrastructure would be the Informatics Infrastructure. The Informatics Infrastructure is comprised of and not limited to the components listed here. There is no one definition that encompasses the makeup and function of the informatics departments infrastructure.
Infrastructure of an informatics department
Infrastructure of InformaticsAs applied to nursing and healthcare in todays rapidly changing technological world…… Kimberly Aniskevich, RN Jacksonville University Online RN to BSN Information Management In Healthcare NUR 353 Spring 2013 S
President Barack Obama, February 9, 2009…. “We have the most inefficient health care system imaginable…We’re still using paper. Nurses can’t read the prescriptions that doctorshave written out. Why wouldn’t we want to put that on anelectronic medical record thatwill reduce error rates, reduce our long-term costs of healthcare, and create jobs right now?”
No Time for Computers!!! 06:45 Shift Report, Call light, Assessment, Vital Signs, Call light, Medication, Response, Evaluation, Call light, Stat, Diet, NPO, Procedure, Call light, Fall Risk, Braden Scale, Mini Cog, Call light, IV, ECG, Lab draw, Call light, CODE, Discharge, Admission, Call light, Transfer, Surgery, Respiratory Distress, Call light, Chest pain, Vomiting, Dr. on the Phone, Call light, Family on the phone…. If this then that… 07:45 You want me to what with that computer????....Call light…… Oh NO….DOWNTIME…...
What is INFORMATICSand really…why do Icare as a nurse? I takecare of people, notinformation…I don’thave time for all thatother stuff... Defining the “foreign” world of Informatics…… S
INFORMATICS The collection, classification, The study and application of storage, retrieval, and information technology to the arts, science, and professions, and to its dissemination of recorded use in organizations and society at knowledge…. large….Merriam Webster online IUPUI School of Informatics “The discipline focused on the acquisition, Application of information science storage, and use of information in a specific and statistical techniques to the setting or domain….(It) is more about information than technology, with the latter management of information…. being a tool…to make the best use of information….”.Business Dictionary Online William Hersh
“Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom into nursing practice. Nursing informatics facilitates the integration of data, information, knowledge and wisdom to support patients, nurses, and other providers in their decision making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology”……American Nursing Association, 2008
INFRASTRUCTURE Basic and usually SUPERSTRUCTURE: permanent framework which supports a Construction above the basement or foundation, supported by an superstructure and is infrastructure which is in turn supported by a supported by the substructure… substructure…. SUBSTRUCTURE: Basic framework or foundation that supports a superstructure, and isBusiness Dictionary Online supported by an infrastructure….
INFORMATION SYSTEMA combination of hardware, software, infrastructure, andtrained personnel organizedto facilitate planning, control, coordination, and decisionmaking in an organization…Business Dictionary Online
Infrastructure=Substructure= Superstructure=IT=Informatics=Information=System=Hardware=Softwa re=Equipment=Systems=Services=Fra mework=Support=Storage=Data=Appli cation=Information System= Networks=Knowledge=Nursing Informatics=Evidenced Based Practice (Hey! I know that one!)=Collaboration=Interface= OUCH….My head hurts…
Building Blocks of anInformaticsInfrastructure forEvidenced-basedPractice……… Taken from : Bakken, Informatics and Evidence- based Practice, JAMIA, 2001 S
Building Blocks of Informatics Infrastructure BUILDING BLOCK APPLYING EVIDENCE TO PRACTICE Provide basis for indexing digital1.) Standardized terminologies and sources of evidence and matchingstructures sources to clinician specific needs.2.) Digital Sources of Evidence Provide access to evidence. Support the communication among computer based systems to bring3.) Data Exchange Standards together patient data and decision logic. Integrate and link heterogeneous4.) Informatics Processes sources of evidence. Present clinician alerts related to potential adverse events. Retrieve clinically relevant sources of5.) Informatics Competencies evidence through the use of search tools
SO….What do we know? PEOPLE, EQUIPMENT COMPUTERS, TECHNOLOGY HARDWARE and SOFTWARE KNOWLEDGE, DATA, INFORMATION, EVIDENCED BASED PRACTICE, SERVICE DELIVERY, RESEARCH and DEVELOPMENT, DATA MANAGEMENT, PLANNING AND IMPLEMENTATION, EMR and HEALTH INFORMATION SYSTEMS………..
ReferencesBakken, S. (2001). An informatics infrastructure is essential for evidenced- based practice. Journal of The American Medical Informatics Association, 8(199-201). http://doi: 10.1136/jamia. 2001.0080199Hebda, T., & Czar, P. (2013). Handbook of informatics for nurses & healthcare professionals (5th ed.). Upper Saddle River, NJ: Pearson Education.Hersch, W. (2009). A stimulus to define informatics and health information technology. BMC Medical Informatics and Decision Making 2009, 9(24). http://doi10.1186/1472-6947-9-24www.businessdictionary.comwww.merriam-webster.com