Informatics: The Big Picture

Are you asking yourself what could Florence Nightingale possibly have to do with informatics?

 

Here we will connect how the past, present, and future of informatics impacts nursing care and nursing leadership. This post is full of media aids as well as links for you to explore where your interest lies. The first section is a discussion on the history of informatics. If you are someones less historically inclined you can scroll past to the infographic I created as an overview. 

The History and Development of Nursing Informatics

Florence Nightingale was highly educated and passionate about collecting and interpreting data from a young age. When she volunteered in 1853 for the Crimean war as the "Superindenent of the female nursing establishment," she was appalled at the condition of the hospitals and the records. Nightingale understood that standardized data would allow for accurate compilation and interpretation of vital healthcare statistics that can be used to drive evidence based practice and result in better outcomes for the patient. In 1958 she published Notes on Matters Affecting Health, Efficiency, and Hospital Administration of the British Army after working tirelessly to compile comprehensive notes and analyze her statistics to demonstrate poor outcomes for the soldiers due to the condition of the hospitals. She devoted her life to improving the nursing profession but also improving public health through the use of knowledge derived from statistical data. Florence Nightingale called for standardization of documentation over 150 years ago, laying the groundwork for the nursing informatics revolution that began to emerge 100 years after her sojourn into the Crimean war.

In the 1950s Harriet Werley, employed as the first dedicated nursing researcher at Walter Reed Amy research Institute, was approached by IBM to consult on the possible use of computer in the healthcare field. She, like Nightingale, immediately recognized the need for the collection of standardized information. In the 1960s computers began to make data aggregation more accessible and Werley convinced the ANA to focus on Nurses' use of information and communication in decision making. There remained no data or language standardization limiting the use of computer functionality for the healthcare data. 

The 1970s showed the first emergence of discussion of computer applications in nursing noting the potential for more efficient, complete, and quality documentation. This decade also produced the first comprehensive hospital information system which allowed planning, documentation, and feedback to be adjusted to each patient's specific needs. Home Healthcare created standardized data and forms which helped with newly increased reporting requirements demonstrating the value of standardized collection. 

The 1980s was the dawn of personal computers made information systems more accessible to the general population. Informatics was introduced into the nursing educational system and 16 standardized data elements were agreed upon including; nursing diagnosis, nursing intervention, nursing outcome, and intensity of care.

The 1990s produced mobile devices permitting access to knowledge databases from outside the hospital in settings such as home care. Although there remained no official standardized language some systems were emerging; Clinical Care Classification System, Omaha System, and nursing concepts were integrated into SNOMED. Even with the recommendation to utilize standardized language there was minimal adoption and many organizations utilized personalized language to document.

In the early 2000s SNOMED was established as the international reference term standard, electronic health records were mandated by 2014, and healthcare reform was initialized. Read more about SNOMED here in a previous post about Standardized Language.

For more resources:

Florence Nightingale: The Compassionate Statistician

Nursing Informatics History Project

 

Informatics Today

Technology understood and used in purposeful, informed, and constructive approach can elevate a manager to a true transformational leader by addressing patient safety, quality of care, nursing workflow, staff satisfaction, and a healthy work environment. We discussed in a previous post how a nurse leader can utilize informatics to address staffing challenges.

 Understanding Data

The first step to understanding how to use data and turn it into knowledge is to understand where and how the data is collected. Nurse Leaders and administrators who have this basic understanding will understand how to leverage informatics to collect the data they need, and utilize the information for improving patient care and nursing work flow.

Data sets are related information complied and able to be analyzed by a computer. Data is collected, stored, sorted, and then interpreted. With the high volumes of data collected in EHRs it is important that the data is entered in an efficient, accurate, and standardized manner to analyze and apply in meaningful ways.

Missing Data

Nursing Data is traditionally notes and other similar documentation which remains largely unregulated and non-standardized making data collection difficult. Therefore traditional means of data collection may be inadequate to capture the nursing knowledge from within the EHR.
Text data mining helps address that problem by extracting key words or phrases and connecting concepts. This allows the extraction of nursing knowledge overlooked in the typical data mining process.

 Application of Data

Once the data is collected nurse leaders, administrators, researchers, and government entities can use analysis of the data to find benchmarks, note trends, or measure the efficacy of an intervention.
Here is an example of a Nurse Leader applying statistical results to the clinical setting in order to communicate with bedside staff about the progress toward desired goals.

 

 

 

Other Applications

As we have discussed in other posts, Nursing Informatics is not just about data or the EHR. Technological applications can also contribute to the nursing work flow, patient safety, and quality of care. Sometimes this technology interacts with the EHR through interoperability, and sometimes they function independently. 
Some telemetry monitors are compatible with EHR and permit the automatic exchange of vital sign and cardiac waveform data, the same can be applied to fetal monitoring. This application potentially improves documentation, nursing workflow, and increases quality of care by allowing the trending of more real-time data on the patient. Blood Glucose machines and lab analyzers can also populate the data directly into the record again allowing for real-time information on the patient and a reduction in the risk for transcription error. 
Medication dispensing from a pharmacy robot or automated medication cabinet also reduces the risk for error. Below is an infographic on BCMA, another common application associated with medication administration.

The Future of Informatics

Informatics will continue to identify ways to improve patient care and nursing workflow through the use of technology. Currently much of the focus is on the EHR and achieving interoperability. To achieve true interoperability standardized documentation and terms will need to be addressed, as well as continued concerns about patient privacy and possibly a personalized national health identification number.
The TIGER project was initially started as a committee to advocate for the ideal EHR, in 2008 the group identified the following 9 areas of focus to improve healthcare delivery and patient outcomes:

1. Standards and Interoperability
2. Healthcare Information Technology National Agenda/Policy
3. Informatics Competencies
4. Education and Faculty Development
5. Staff Development/Continuing Education
6. Usability/Clinical Application Design
7. Virtual Demonstration Center
8. Leadership Development
9. Consumer Empowerment/Personal Health Record 

                                                                                                                       (Dulong, 2008) 
Now an interdisciplinary council, the TIGER project remains focused on education, innovation, and improved care through the use of technology. 
The Human-Technology Interface will continue to expand and possibilities we could never imagine will begin to emerge. Nursing Informatics is growing in demand as organization see the value in dedicated informatics qualified staff that can not only help achieve meaningful use of the EHR but also value into other applications. 

For more reading:
Informatics and the Future of Nursing Practice
Nursing Informatics; Designing the Healthcare of the Future




What other informatics applications can you name? 

Were you suprised that computers were used in nursing as early as the 1970s?

What can be done to create more standardization in nursing documentation without loosing the human essence?

Where do you think the future of Nursing Informatics will lead us?

Let us know your thoughts below.



References

Biddle, S., & Milstead, J. A. (2016). The intersection of policy and informatics. Nursing management, 47(2), 12-13.

 

Collen, M. F., & Walker, P. H. (2015). Nursing Informatics: Past, Present, and Future. In The History of Medical Informatics in the United States (pp. 385-406). Springer London.

 

DuLong, D. (2008). Informatics: the TIGER project. Online Journal of Issues in Nursing, 13(2).

 

Ozbolt, J. G., & Saba, V. K. (2008). A brief history of nursing informatics in the United States of America. Nursing outlook, 56(5), 199-205.