Nursing Informatics Notes

Nursing Informatics

Background

  • Micki Magoon, MSN, RN-BC, is the Manager of Nursing Clinical & Surgical Informatics at UNMH.
  • Graduated with BSN from Northern Illinois University in 2008.
  • Worked 1.5 years in med-surg and 4 years in Labor and Delivery (L&D).
  • Started in Nursing Informatics in 2013, working in Meditech.
  • Obtained MSN/Informatics from the University of Phoenix in 2014.
  • Became an IT analyst in 2017 for Epic go-live.
  • Moved to management in 2019.
  • Moved to New Mexico in the summer of 2023.

Topics

  • Definition of Nursing Informatics
  • Brief History
  • Practice Guidelines
  • System Design Life Cycle
  • Clinical Informatics Governance
  • Nursing Clinical Informatics at UNMH
  • Clinical Decision Support
  • Interfacing with Other Teams

Definition of Nursing Informatics

  • ANA Definition: The integration of nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice, enhancing the clinical experience for health care providers and patients.
  • Layman's Terms: Translating clinical concepts for IT professionals and IT concepts for clinical staff.
  • The increasing computerization of practice amplifies the need for Nursing Informatics.

A Brief History

  • Late 1950s: Harriet Werley consulted with IBM on potential uses of computers in healthcare, identifying the need for standardized nursing data.
  • 1960s: ANA formed a committee to identify research priorities.
  • 1970s: Initial systems for nursing care were developed. El Camino Hospital in Mountain View, CA, helped develop the first comprehensive hospital information system.
  • 1980s: Rapid expansion of nursing applications due to the proliferation of PCs.
  • 1992: Nursing Informatics was recognized as a specialty by the ANA.

Practice Guidelines

  • Scope of Nursing Informatics Practice:
    • Includes the development, implementation, and evaluation of information and communication systems that support nursing practice, education, administration, and research.
  • Role of the Nurse Informaticist:
    • Collaborate with interdisciplinary teams to design, implement, and evaluate information systems that support safe and effective patient care.
    • Promote the use of technology to enhance communication, decision-making, and patient outcomes.
  • Standards and Regulations:
    • Comply with local, state, and federal laws and regulations related to health information management and privacy.
    • Adhere to professional standards of nursing practice and informatics.
  • Information Management:
    • Develop and implement policies and procedures for managing and protecting patient data.
    • Use data analytics to identify trends, evaluate outcomes, and improve patient care.
  • Technology and Innovation:
    • Stay current with emerging technologies and innovations in nursing informatics.
    • Promote the use of technology to enhance nursing education, research, and practice.
  • Education and Professional Development:
    • Obtain formal education and training in nursing informatics.
    • Participate in ongoing professional development and continuing education to maintain current knowledge and skills.
  • Collaboration and Communication:
    • Collaborate with interdisciplinary teams to identify information needs and develop solutions.
    • Use effective communication skills to promote the use of technology and information systems in nursing practice.
  • Ethical Considerations:
    • Maintain patient privacy and confidentiality.
    • Use technology and information systems in a responsible and ethical manner.
  • Evaluation and Quality Improvement:
    • Evaluate the effectiveness of information systems and technology in supporting nursing practice and patient outcomes.
    • Participate in quality improvement initiatives to enhance the use of technology and information systems in nursing practice.

System Design Life Cycle

  • Ideal steps for every system implementation, ongoing maintenance, and retirement.
  • Transparent to most users.
  • Order of steps dependent on the project.
  • Phases:
    • Planning
    • Analysis
    • Design
    • Implementation
    • Evaluation
    • Maintenance
  • At the Maintenance Phase:
    • Update the system
    • Replace the system
    • Retire the system (and shift its purpose to a different, existing system)
    • All these options require Planning!
  • Planning Phase:
    • Identify the need for a nursing informatics system.
    • Define the goals and objectives of the system.
    • Develop a project plan.
    • Identify and allocate necessary resources.
    • Establish a project team.
  • Analysis Phase:
    • Gather and analyze data to identify user requirements.
    • Determine the scope of the system.
    • Identify potential limitations.
    • Determine the feasibility of the system.
  • Design Phase:
    • Develop a detailed design for the system.
    • Identify hardware and software requirements.
    • Determine the data architecture.
    • Develop a user interface.
  • Implementation Phase:
    • Develop and test the system.
    • Train users.
    • Install the system.
    • Convert data to the new system.
  • Evaluation Phase:
    • Assess the effectiveness of the system.
    • Identify areas for improvement.
    • Determine if the system met the original goals and objectives.
  • Maintenance Phase:
    • Provide ongoing support for the system.
    • Perform routine maintenance.
    • Upgrade the system as needed.
    • Monitor system performance.
  • Disposal Phase:
    • Determine when the system is no longer needed.
    • Dispose of the system and all related data.
    • Perform data backups and archiving.
    • Document the system for future reference.

Clinical Informatics Governance

  • Improving Health Through the Power of People and Technology
  • Advancing Medical Informatics Governance & Oversight (A.M.I.G.O.) Executive Council
  • Includes the following subcommittees:
    • Clinical Informatics Oversight
    • Financial & Business Informatics Oversight
    • Clinical Change Control
    • Interoperability
    • Documentation
    • Clinical Decision Support
    • User Experience
    • Mobility
    • Enterprise Infrastructure
    • Nursing Informatics
    • Forms
    • Alerts
    • Telehealth
    • Radiology Informatics
    • Laboratory Informatics
    • Pharmacy Informatics
    • Surgery Informatics

Nursing Clinical Informatics at UNMH

  • Comprises 5 RNs with one manager.
  • Part of the IT department.
  • Reports to the same Executive Director as the Clinical Applications teams that work on Oracle Health and other clinical systems.
  • Different organizations have different reporting structures (e.g., IT, Nursing, Quality, etc.).
  • Separate from Data teams.
  • Mostly generate usage data or short-term requests.
  • Longer requests (more than 1 week of data) go to the data team.

Current Work

  • iView Optimization, Barcode Med Administration (BCMA) at SRMC, Pharmacy Patient Monitor, Lab labeling Projects – both leading and participating on project teams
  • Data: patients with sedation in PICU so leaders can audit documentation
  • Documentation changes: Changing Braden to Braden QD for Peds
  • Workflows: Helping ED RNs document on inpatient boarder patients
  • Small Requests – Data, documentation changes, workflows
  • Fixing broken phones for med scanning
  • Working with analysts to fix broken scoring for suicide risk
  • Break-fix – Handheld nursing devices, documentation errors

Clinical Decision Support (CDS)

  • CDS is made of tools used to provide clinicians, staff, patients, and others with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care.
  • Examples:
    • Alerts/reminders
    • Integrated clinical guidelines
    • Condition-specific order sets
    • Focused patient data reports/summaries
    • Documentation templates
    • Diagnostic support
    • Contextually relevant reference information

CDS at UNMH

  • Patient Data Integration: Sepsis Discern alert uses discrete patient data to automatically contact Sepsis Response Team
  • Alerts and Notification Systems: Smartzone alert for indwelling catheters in place >7 days, color changes/flags for vital signs outside normal range
  • Order Sets: Many order sets are developed with headers that guide clinicians to evidence-based treatments
  • Dashboards and Reports: Used by leadership to ensure correct steps taken (i.e., BCMA scanning rates, Admission Database Completion rates)

Interfacing with Other Teams

  • Teams:
    • IT
    • Other Health Specialties
    • Leadership
    • Nurses!
  • Roles:
    • Liaison between IT and Clinicians
    • Represent nursing POV in larger system discussions
    • Educate on possibilities and limitations within our HER
    • Collaborate with nurses and nursing assistants to work more efficiently
    • Collect feedback and plan improvements

Nursing Informatics Contacts

  • To learn more, contact mmagoon@salud.unm.edu
  • For UNMH staff needing Nursing Informatics assistance, message the Tiger role during business hours at "Informatics Nurse."