Introduction
Because of recent legislation by the United States Government, it is likely that just about all nurses are now involved with informatics. This is because of Center for Medicare and Medicaid Services (CMS), HIPPA and EMR related legal requirements. National standards for electronic health care transactions and national identifiers for providers, health plans, and employers have now been enacted (United States Federal Government). Information about each visit is now longitudinal over time rather than episodic and follows the strict format of international standard ICD-10 guidelines. Nurses educated in informatics are best qualified to evaluate software that implements this legislation. Training in informatics that supports medical practice functions is now common in BSN programs.
Observation with Electronic Health Record in Clinical Environment
An interview was conducted at a large federally funded medical facility in a family practice with a nurse practitioner named Kay. The discussion centered around the patient record. Kay logged into the practice software developed by a very large software corporation and sold to the medical facility at a cost of millions of dollars.
Kay asked questions about a patient’s medical history and entered the answers into her computer. The interview went smoothly as she filled out the information. At times, she paused to refer to information in other windows. Sometimes it took quite a bit of navigation to find what she was looking for. I asked her if she liked the software that she was using. She said that it was OK in general, but sometimes navigation was difficult and slowed down the entire process considerably. She confided that the user interface could be vastly improved if nurses, doctors and other practice members were consulted during the design, and that frequently it was very difficult to find essential information.
The software was developed in 2014 by EPIC. This company stores over half the patient information data in the United States. The electronic health record system allows viewing by multiple providers on a single screen. It enables both nurses and doctors to share patient test results, medication and notes, as well as transitions from one care setting to another.
An important feature of the software is its ability to support patient interaction. This can help patients be proactive in their own care and there is evidence that this plays a role in maintaining better heath, especially for chronic conditions. Patients can access their medical record, view a list of current medications, see current and previous test results as well as immunizations and allergy records. They can also view their appointment history. All this can be done via the internet or by using a smartphone.
Electronic Health Record Software Selection
Selecting an EHR system is a critical decision that requires planning. Key goals are identified by most practices during an initial planning phase. Documenting workflow is a task that should be completed up front by those who participate in the actual work. Not everyone needs to be involved, but those who are will be the first to become familiar with all the variables involved in the software system (HealtIT).
The next thing that must be understood is how the vendor’s software works and whether or not it meets the needs of the practice’s workflow. Test driving the software before purchase is crucial.
Costs must be investigated too. These include hardware, software, maintenance, support and upgrade costs as well as the cost of connecting to a health information exchange (HIE).
In almost all cases a data migration strategy plan must be defined. Roles and responsibilities of practice members and vendor participants must be determined.
Increasing Awareness of Nursing Informatics
With the integration of the electronic health record (EHR) and health information technology (HIT) into the health care workflow arena, there are expectations of costs decreasing and improved, patient-centered care. Despite this, 80% of health care software implementation projects are not successful, about one third are never completed and many are over budget and miss the original deadline (Houston, Bove, 2007, p. 51).
When nursing projects fail there can be a direct negative financial impact that includes late fees and penalties. Strong project management is essential to complete the assigned task successfully. Project management training is needed to introduce terminology, tools, and responsibilities to clinical professionals who are members of a practice team (Fleisher, 2015).
Those nurses who have obtained a BSN can specialize in nursing informatics by obtaining a Master of Science in Health Care Informatics. Those employed in the field of information technology know that they must engage in a process of continuous learning. For most medical professionals, that means keeping abreast of advances in health care informatics as part of their ongoing responsibility.
Health informatics is a relatively new interdisciplinary field that encompasses both information science, medical and biological data and knowledge base. As a result of rapid growth in this field, making a habit of reading contemporary journals can be of immense help (Dalrymple, 2011).
In the past the model for medical practice has been episodic. But today more than patient treatment is the goal. Disease control is also important. With informatics systems and standardized international patient record formats, the epidemiology of disease can more rapidly be comprehended.
While much of the current focus has been on decision support and clinical
issues, the field of medical informatics includes medical ontology construction, information organization, storage and retrieval, artificial intelligence, text mining, data exchange, data standards and natural language processing (Dalrymple, 2011).
- Houston, S., Bove, L. (2007). Project Management for Healthcare Informatics. Retrieved from https://play.google.com/store/books/details?id=7IZZW3vBZb8C&rdid=book-7IZZW3vBZb8C&rdot=1&source=gbs_vpt_read
- Dalrymple, P. (2011). The Emerging Field of Health Informatics. Retrieved from https://www.asis.org/Bulletin/Jun-11/JunJul11_Dalrymple.pdf
- Fleisher, Elizabeth (2015).
