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Nursing Informatics Transports Documentation into Modern Age

Monday November 1, 2010
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Perhaps there were good reasons Humpty Dumpty could not be put together again. Maybe all the king’s horses didn’t hand Dumpty’s complete medical records over to all the king’s men, or the king’s men couldn’t read the records. It’s possible the men used different terminology than the horses did to describe Dumpty’s condition? And even if Dumpty survived, his caregivers might have inadequately documented the treatment, fallen short of regulatory requirements and failed to get properly reimbursed.

If specialists in the growing field of nursing informatics have their way, such problems that can plague modern-day perioperative care will soon seem like faded folklore. While the work of nursing informaticists — to standardize records, processes and language in healthcare and to computerize patient data — may appear technical and complex, the goal is simple: to apply all the advantages of the digital age to the process of learning about, caring for and making decisions regarding patients.

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An informatics approach can support perioperative nursing practice by expediting the recording of patient information throughout the perioperative environment and making it easier to share patient outcomes across disciplines, says perioperative informatics expert Judith L. Clayton, RN, BSN, CNOR. Automated systems also can help RNs document nursing activities and their contribution to patient outcomes.

“Data that are captured in a standardized, automated fashion can help in identifying trends and benchmarking, which are powerful tools in identifying areas for process improvement and making the case for increased resource allocations,” Clayton says.

In the past, computers in healthcare facilities have been used largely to capture nonclinical data such as room turnover times or total orthopedic cases, says Denise Downing, RN, MS, a clinical informatics specialist for the Association of periOperative Registered Nurses. But with new systems focused on patient care, “now you can drill down and see what kind of orthopedic cases were done; the patient population in which a particular procedure is done; the positioning aids that were used, which ties into pressure ulcer outcomes; and comorbidities such as diabetes,” she says. “This will all provide data for development of best practices.”

In part because electronic health records can require that each section of a document be filled out, patient safety also can be improved, says Patricia Hinton Walker, RN, PhD, FAAN, PCC, vice president for nursing policy at the Uniformed Services University of the Health Sciences in Bethesda, Md. “If I have to check off every box before I sign off, I will not miss an allergy,” she says. “In the paper record it could be unreadable or forgotten or put somewhere people don’t look.”

Electronic records also can include tools to support clinical decision-making. “All of us can’t be as up on every single diagnosis or the interaction of every drug,” Hinton Walker says, but technology can keep that information handy. “It’s not going to be right there at the front of my brain, but it is there at my fingertips.”

Although the benefits of digitizing healthcare records and processes had long been recognized, President George W. Bush gave the national effort a boost in 2004 by establishing the Office of the National Coordinator for Health Information Technology and setting 2014 as a target date for the widespread adoption of electronic health records. Since then, the Obama administration has endorsed the 2014 timeline and added funding, as well as specific interim steps to get there, Hinton Walker says.

Same Key, Many Doors
As the target date approaches, opportunities for nurse informaticists have become as varied as those for staff nurses, says Teresa McCasky, RN-BC, MBA, business leader for AORN SYNTEGRITY, a multifaceted technology framework that standardizes perioperative documentation.

An informatics specialist can work in acute or ambulatory care, McCasky notes. There, nurses can participate in design and development, or in implementation, of technological solutions. And implementation can include simultaneously redesigning processes as needed. “People … don’t want to implement their bad processes,” McCasky says. “It’s good to have nursing informatics people involved because they really understand the workflow as well as the technology.”

Other new roles also are emerging, such as that of chief nursing informatics officer. And nurse informaticists can work for nonprofit groups such as AORN, data exchange organizations, or special projects such as a Veterans Affairs-Kaiser Permanente national data exchange initiative, says Sharon Giarrizzo-Wilson, RN, BSN/MS, CNOR, who is an AORN clinical informatics specialist and, along with Downing, a team member for AORN SYNTEGRITY. “It’s really exciting because this is the biggest initiative being done,” she says of the VA-Kaiser project.

Clayton notes the electronic revolution requires a massive effort. “We will see the need to prepare a workforce with the necessary knowledge and skills to ensure meaningful use of health information technologies,” she says. “We will need informatics nurses who can speak the lingo, help us transition from paper to electronics, and assist the nurses in the field to become literate in the perioperative electronic health record.”

Supporting that mission is AORN’s Perioperative Nursing Informatics Specialty Assembly. AORN established the assembly, for which Clayton is communication chair, in 1998 to aid nurses who specialize in technology or are interested in the field. Membership has increased 25% in the past five years, AORN says, with more than 2,300 members in total.

To pursue an interest in informatics, perioperative nurses can take various paths. McCasky advises that nurses become technology super-users at their own facilities, and immerse themselves in technology design as well as its selection. A host of educational opportunities, at the undergraduate and graduate levels as well as certificate programs, also are available.

Another avenue for exploring informatics will be phase 3 of a national initiative called TIGER (Technology Informatics Guiding Education Reform). This phase, chaired by Hinton Walker, will provide a virtual learning environment, where nurses involved with organizations or institutions that contribute to the project can participate. An “open door” website also is planned to make informatics resources more widely available. A pilot site is scheduled to launch by early 2011.

Whatever path they take, nurses should note that an informatics career has the power to impact patients exponentially, McCasky says. “You go from providing care to a single patient to being in informatics, [where] the solutions you develop and deploy are impacting and touching hundreds of patients.”

Karen Patterson is a freelance writer.