Nursing Informatics: Where Technology and Caring Meet

515 Pages·2011·0.27 MB·English

by  Marion J. Ball

Health Informatics

Marion J. Ball • Judith V. Douglas
Patricia Hinton Walker • Donna DuLong • Brian Gugerty
Kathryn J. Hannah • Joan M. Kiel • Susan K. Newbold
Joyce Sensmeier • Diane J. Skiba • Michelle R. Troseth
(Editors)
Marion J. Ball • Kathryn J. Hannah
(Series Editors)
Nursing Informatics
Where Technology and Caring Meet
Fourth Edition
Editors
Marion J. Ball Joan M. Kiel
IBM Research Duquesne University
Center for Healthcare Management 600 Forbes Avenue
Baltimore, MD 21239, USA Pittsburgh, PA 15282, USA
Judith V. Douglas Susan K. Newbold
Reisterstown, Maryland 21136, USA Franklin, TN, USA
Patricia Hinton Walker Joyce Sensmeier
Uniformed Services Healthcare Information and
University of the Health Sciences Management Systems Informatics
4301 Jones Bridge Road 230 East Ohio St, Suite 500
Bethesda, MD 20814, USA Chicago, IL 60611, USA
Donna DuLong Diane J. Skiba
The Tiger Initiative University of Colorado Denver
Denver, CO 80045, USA College of Nursing
13120 E. 19th Ave.
Brian Gugerty Aurora, CO 80045, USA
Gugerty Consulting LLC
1038 Bayberry Drive Michelle R. Troseth
Arnold, MD 21012, USA CPM Resource Center
3196 Kraft Ave SE
Kathryn J. Hannah Grand Rapids, MI 49512, USA
HECS Inc.
Calgary, Alb, Canada
ISBN 978-1-84996-277-3 e-ISBN 978-1-84996-278-0
DOI 10.1007/978-1-84996-278-0
Springer London Dordrecht Heidelberg New York
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2010937960
© Springer-Verlag London Limited 2011
Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted
under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or
transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the
case of reprographic reproduction in accordance with the terms of licenses issued by the Copyright Licensing
Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers.
The use of registered names, trademarks, etc., in this publication does not imply, even in the absence of a
specific statement, that such names are exempt from the relevant laws and regulations and therefore free for
general use.
Product liability: The publisher can give no guarantee for information about drug dosage and application
thereof contained in this book. In every individual case the respective user must check its accuracy by con-
sulting other pharmaceutical literature.
Cover design: eStudioCalamar, Figueres/Berlin
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
Foreword I
This is the fourth edition of Nursing Informatics, catchily subtitled Where Technology and
Caring Meet. In the two decades since the first edition debuted, the juxtaposition between
technology and caring has moved from an uncomfortable tension felt by individuals to a
creative force seeking to transform all aspects of the nursing profession, from staff devel-
opment to the design of overarching process improvements. What began as the opposition
of two world views – caring vs. technology – has evolved to become the driving force in
articulating a twenty-first century view of nursing as a field able to change the health care
system by strategically using technology to realize quality care. In this case, point and
counter-point have syllogistically led to a synthesis not unlike the one proposed by the
Institute of Medicine1 urging all health professionals to use informatics to make care more
patient-centered.
This fourth edition is dramatically different from preceding editions because it builds
on the extensive work of the TIGER Initiative, an acronym for Technology Informatics
Guiding Education Reform,2 which began in 2004 when a few nurse/informatics activists
attending the first national health information technology summit decided that something
comprehensive needed to be launched to transform nursing practice, education, scholar-
ship, and leadership through information technology (IT). Believing that IT was not merely
an add-on but the key to a paradigm shift in how future health care would be provided, they
eventually convened their own summit of stakeholders that crossed clinical specialties,
functional areas, and professional organizations (n = ³70).
The 2006 summit gave birth to an action agenda that led to the formation of nine col-
laboratives that collectively addressed workforce advancement (competencies, faculty
development, staff preparation, leadership for change, virtual-demonstration education),
development of an IT infrastructure (standards and interoperability, a National Health IT
Agenda), and improved technologic solutions (standards and interoperability, usability and
clinical-application design, consumer empowerment, and health records) (TIGER 2007).
By the end of 2008, over 1,400 people had been involved in this boundary-spanning effort
that worked to change matters both through existing organizational structures – National
League for Nursing’s Informatics Agenda3; American Association of Colleges of Nursing’s
competencies for Doctor of Nursing Practice4 – and new initiatives – statewide Minnesota
TIGER.5
Because the editors of this edition were also leaders in the TIGER Initiative, they had
access to the wealth of information generated by that multiphase initiative, and that rich-
ness is evident in the selection of the chapter authors and in the range of topics covered.
v
vi Foreword I
For example, the section on future directions provides insights into subjects often not dis-
cussed in any depth, e.g., the interface between comparative effectiveness research and
personalized health care. Because the TIGER Initiative has attracted international atten-
tion, a global perspective prevails.
Though nurse informaticists will find this edition must reading, this is a book that will
be invaluable to any clinician, educator, manager, or executive interested in one-stop shop-
ping for a comprehensive statement on the subject. Chief Nurse Officers will want to share
this book with Chief Informatics Officers at their institutions; faculty will want to adopt the
book for DNP courses. Administrators wishing to understand user interface and clinical
design issues will want to read this edition to frame discussions in their home settings;
researchers will look to this book for insights on how the informatics revolution is accel-
erating the demand for comparative effectiveness research. The fact that this edition was
peer reviewed, therefore subject beforehand to scientific scrutiny, adds to the confidence
one has in using the volume as a major reference.
The increased sophistication of nursing informatics is visible in this fourth edition,
reflecting in part the policy-oriented perspective of the Alliance for Nursing Informatics,
which came into existence after the third edition to provide a coordinated voice for nursing
in various informatics debates. As in the past, mention is made of needed development in
workforce competencies and of enabling technologies, but the day-to-day concerns of the
individual are couched in larger contextual issues too, for example, how practice is being
shaped by reform efforts requiring standardized clinical performance measures and clini-
cal decision support to manage chronic conditions. Hinton Walker’s chapter on culture
change provides a framework for examining the transformations taking place locally,
regionally, nationally, and internationally as nurses play a leadership role in designing and
using information systems that were once thought to be only the province of physicians.
There used to be a time when one book could be the bible for nursing – I’m thinking of
Harmer and Henderson’s The Principles and Practice of Nursing. Given the scope of
twenty-first century nursing, that is increasingly impossible, but this book approaches that
status because the content is relevant to all aspects of nursing. Writing about her specialty
of psychiatric nursing, Haber6 noted that even the legendary Hildegard Peplau would be
embracing information technology and evidence-based practice if she were alive today.
And I suspect this fourth edition would be in her library.
Angela Barron McBride
Distinguished Professor-University Dean Emerita
Indiana University School of Nursing
References
1. Institute of Medicine. Health Professions Education: A Bridge to Quality. Washington, DC:
The National Academies Press; 2003.
2. Technology Informatics Guiding Education Reform. The TIGER Initiative. Collaborating to
integrate evidence and informatics into nursing practice and education: an executive summary.
Foreword I vii
http://www.tigersummit.com/uploads/TIGER_Collaborative_Exec_Summary_040509.pdf
2007 Accessed 20.09.09.
3. National League for Nursing. Preparing the next generation of nurses to practice in a technology-
rich environment: an informatics agenda. http://www.nln.org/aboutnln/PositionStatements/
informatics_052808.pdf; 2008 Accessed 20.09.09.
4. American Association of Colleges of Nursing. The essentials of doctoral education for advanced
nursing practice. http://www.aacn.nche.edu/DNP/pdf/Essentials.pdf; 2006 Accessed 20.09.09.
5. University of Minnesota School of Nursing. Minnesota TIGER Summit: springing into action.
http://www.nursing.umn.edu/MNTiger; 2009 Accessed 20.09.09.
6. Haber J. Hildegard E. Peplau: the psychiatric nursing legacy of a legend. J Am Psych Nurs
Assoc. 2000;6:56-62.

Foreword II
There are several, significant challenges facing healthcare delivery in the United States.
The quality, safety, efficiency, and accessibility of care are not at levels that we would
regard as satisfactory. These challenges will be exacerbated by inexorable movements to
deliver care that is more patient-centric, widen access to care, increase the emphasis on
wellness and preventive care, improve the accountability for care, reduce the costs of care,
and incorporate advances such as personalized medicine.
While the term “transformation” is overused, it is nonetheless the correct description of
what we must do to our system of providing care to those who need it.
Information Technology as a Tool
Improving care through electronic health records (EHRs) requires that we understand the
nature of EHRs as tools.
There is no question that information technology can be a very potent tool in our efforts
to address the challenges that confront our health care system. There is also no question
that information technology is a tool and as a tool does not, in and of itself, have magic
care improvement properties.
For the EHR to achieve any objectives, not only does the organization need the technol-
ogy, but also needs leadership, an ability to effectively change processes, means to provide
training and ongoing support to clinicians, and approaches to measure objectives and
engage in ongoing tuning of the application and care processes.
The EHR is a specific kind of tool. At times, we view EHRs as systems that must be
implemented and our task as done once they are implemented. We view EHRs as interven-
tions. They are not. They are foundations.
A foundation provides the broad ability to perform a “never-ending” series of application-
leveraged small, medium-sized, and occasionally large advances and improvements in
processes.
For example, provider order entry systems can be used as a foundation to improve pro-
vider decision making. Once implemented, the organization can, on an ongoing basis,
introduce a series of decision support rules and guides. These rules can address medication
safety issues, improve the appropriateness of test and procedure orders, and assure that
data relevant to an order are displayed to the clinician.
ix