[Recommended] - NURS-6051N Discussion: Interaction Between Nurse Informaticists and Other Specialists

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Informatics Week 3 discussion
     When electronic records came to the Iowa Department of Corrections, Ill be honest, I was very skeptical, and everyone resisted the change from “how we do business.” According to Gaines (2020), nursing informaticist is a specialty area that combines nursing and technology to help with electronic records and other varies health technology areas. (Gaines, 2020) In reading another discussion post, I am quite jealous that they have a Nurse Informaticist. Our system was developed by an outside technology company and did have a “help desk.” Unfortunately, we have to go through other management to be able to call and get assistance. It cost money every time they are called. From my understanding, it would be cost-effective to have a Nurse Informaticist working for the IDOC.
   Another frustrating issue with not having a NI is that nurses that use the program every day do not get a say in what needs added or taken out of the medical record program or the medication administration record. Some of these decisions are made at nurse manager meetings, which many are not as familiar with using the program as nurses at the forefront of patient care. If we had a NI, those ideas could be developed into more efficient ways of documenting and possibly decrease medication errors. Medical errors cost nearly $40 billion every year in healthcare, and many can be prevented from having an NI in the healthcare system. (Rupp, 2016)  The NI could visit every institution and listen to the concerns of nurses, which would decrease stress and make the program better. It is incredibly frustrating to have a program that assessment and plan of care are sometimes inaccessible together without consulting a physician to write as orders.
    By having an NI, new employees can be trained on the system by that nurse instead of a line staff nurse that is trying to care for patients as well as train a new nurse. That new nurse would learn the program much quicker and correctly by having NI do training.
     I’m excited to see how using nurses in this role in the future helps develop and improve patient care! There are so many places that NIs can be of benefit. Base salaries for informatics nurses are increasing to be a pretty substantial wage at sometimes 100,000. One excellent concept of this up and coming career option is that these nurses can be developing programs that still advocate for the bedside nurse. I can be supportive and educate older nurses that may not be “technically inclined” yet teach the newer nurses how to use to use the technology efficiently. (Rupp, 2016)

References
Gaines, K. (2020, July 22). nurse.org Career Guide Series: Nursing informatics. nurse.org. http://nurse.org
Nelson, T. L. (2019, March 12). Nursing informatics: The EHR and beyond. American Nurse.com. http://myamericannurse.com
Rupp, S. (2016). How Nurses Are Using Health Informatics to Improve Patient Care. Electronic Health Reporter. https://doi.org/http://electronic health reporter.com

Whenever there is a change in computer systems, even something as simple as an upgrade, there is bound to be push back and difficulties with the change. At my current place of employment there are nursing super users with each change. The managers, coordinators, and floor educators are automatically put in super user classes. The management can then ask 3-4 floor nurses to become super users as well. These super users are expected to attend a longer more in-depth class with the IT teams. These classes are set up by management as well as the higher-level informatics officers. One of the informatics officers is a nurse, she is also management of IT. This setup is similar to the framework of decision making in informatics proposed by Mosier et al (2019), in that there is a defined timeline and defined roles of all those involved.
This system is important because management is not on the floor at all times. Having super users from both shifts available is a very useful asset. We upgraded the computer system last month and there was a large change in the care plan section. There was required online training, but everyone still had a really hard time adjusting. The super users were able to help and their helpful tricks filtered through the floor like a ripple effect. This made the transition much more-smoothly for everyone. Nurses are knowledge workers, and this is evident at a time of new technology (McGonigle & Mastrian, 2017). Nurses tend to be great learners; they catch on fast and teach each other well.
One informatics change I would like to see implemented is a further use of the mobile devices. There are a handful of things we can complete on the iPhone we use for texting physicians, charting vitals, and printing lab slips. As discussed by Ng et al (2018), mobile devices have a huge benefit for population in health. There is so much we can do with mobile devices now related to healthcare. There should also be a nursing portion of the health reminders. These could be flags for medications, or reminders for vitals rechecks, or some sort of integration with the new computer system we have started. There could be a way to progressively chart the care plan section as the day goes by, on a mobile device. There is no reason mobile device advancements should only be for patients and the population. Decreasing the amount of time nurses need to sit at a desk to chart, would increase the time patients are able to see them. This is a benefit to hospitals. I am hopeful for advancement in our mobile charting soon, with the further advancement of other healthcare apps.
References
McGonigle, D., & Mastrian, K. (2017). Nursing Informatics and the Foundation of Knowledge. Jones & Bartlett Learning.
Mosier, S., Roberts, W. D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions. JONA: The Journal of Nursing Administration, 49(11), 543–548. https://doi.org/10.1097/nna.0000000000000815
Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of Mobile Health Applications in Health Information Technology Initiatives. CIN: Computers, Informatics, Nursing, 36(5), 209–213. https://doi.org/10.1097/cin.0000000000000445

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.
Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.
In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.
To Prepare:
Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.
By Day 3 of Week 3
Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.
By Day 6 of Week 3
Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

Collaboration with Nurse Informaticists
I can honestly say I have never seen the nurse informaticist that works within my healthcare organization. I have heard that there is one that works down in information technology (IT) and occasionally makes changes in the electronic health record (EHR) but I have never interacted with her. I feel that there needs to be more nurse informaticists and more professional collaboration between them and the rest of the hospital. Nobody really talks about nursing informatics at my hospital and that is starting to become a problem. I currently work in the heart and vascular ICU where we have been overburdened with high-acuity patients and a significant shortage of staff. One strategy I offer for improvement is to simply have the nurse informaticist come up to the unit and start interacting with the staff. Another strategy is to increase training and education for nurses in the field of informatics. Sipes (2016) states that nurse informaticists must be competent in over 200 skills now. This will require an increase in training and education programs to better prepare them to improve clinical practice (Sipes, 2016). Now is a better time than ever to implement these changes. Ideally, they will benefit interprofessional collaboration and, ultimately, improve patient outcomes.
Informatics, technology, and Professional Interaction
Technology has made dramatic progress in the past four decades and has forever changed the way that healthcare is delivered (Elsayed et al., 2016). The field of nursing informatics has also come a long way considering that it has only been a specialty since 1992 (Cummins et al., 2016). Technological advancements in nursing informatics have benefited the way we interact with other professionals as well as the patients we aim to serve. Advancements include the electronic health record (EHR), handheld digital devices, upgrades in computer systems, and much more (Elsayed et al., 2016). It is estimated that nurses spend about 50% of their time at work documenting and charting (Elsayed, 2016). That being said, informatics has come to their rescue with the above advancements in technology such as the EHR. As technology continues to improve, collaboration with other professionals will benefit as well. Advancements in hands-free devices, telecommunications, and telehealth could forever change the way nursing is done (Fathi et al., 2017). As nursing informatics and technology continue to make strides, the end goals will be to enhance the delivery of healthcare, increase interprofessional collaboration, and improve the clinical outcomes of the patients.
References
Cummins, M. R., Gundlapalli, A. V., Murray, P., Park, H. A., Lehmann, C. U., & Gundlapalli, A. V. (2016). Nursing Informatics Certification Worldwide: History, Pathway, Roles, and Motivation. Yearbook of Medical Informatics, 25(01), 264–271. https://doi.org/10.15265/iy-2016-039
Elsayed, I. A., El-Nagger, N. S., & AzimMohamed, H. A. (2016). Evolution of Nursing Informatics: A key to Improving Nursing Practice. Research Journal of Medicine and Medical Sciences, 11. https://www.academia.edu/29974363/Evolution_of_Nursing_Informatics_A_key_to_Improving_Nursing_Practice.
Fathi, J. T., Modin, H. E., & Scott, J. D. (2017). Nurses Advancing Telehealth Services in the Era of Healthcare Reform. The Online Journal of Issues in Nursing, 22(2). https://10.3912/OJIN.Vol22No02Man02
Sipes, C. (2016). Project Management: Essential Skill of Nurse Informaticists. Nursing Informatics 2016, 225. https://doi.org/10.3233/978-1-61499-658-3-252

Recently this writer has spent a great deal of time reflecting on my experiences and interactions with Information’s Technology and those who make it all happen. Early on in this writer’s career, I was exposed to the emergence of new software, programs, and even the implementation of electronic medical records for the first time in a facility or agency.
When beginning a career as an RN at Beaufort Memorial Hospital (BMH), a rural hospital in Beaufort, SC, I was asked to participate as a “Superuser” when BMH went electronic, less than a year into my working there. According to Bullard (2016), a superuser is vital to the implementation, upkeep, and affordability of any electronic health record (EHR) system. As this writer progressed in my career, I have found myself in the center of every committee or orientation process related to health information technology. Reflecting on the implementation of the EHR at BMH, specifically the excellence of care that now, after experiencing other hospital systems was greatly influenced by the presence of bedside computers in every patient room. The electronic version of the flow chart and head to toe assessment including the timely documentation, the ability to quickly access information for the patient including evidenced-based practice (EBP) standards, education materials, and the ability to print these documents for the patients later use were all elements that shaped the nurse I am today.
As a Certified Nurse Assistant (CNA) and then a Licensed Practical Nurse (LPN) for a grand total of only eighteen months prior to graduating to the novice Registered Nurse (RN), this writer can attest to the difference in a new graduate-level of skills including presence, versus those of the seasoned nurse as discussed by (McGonigle, 2017). However, many years of bedside charting and then a transition to home care and eventually hospice care gave this writer a different perspectives regarding the presence and documenting in an (EHR) in the home. This the writer now understands the perspective of the executive leader as discussed by Mosier et al., (2019). A while later this writer landed in the middle of a complete software revamp when the company to which employed agreed to be the pilot agency for software designed for homecare but also being implemented in hospice. At the executive level, this writer spent many hours, at least 50% of my day either building workarounds or literally working on the necessary changes to the software needed to not only qualify for reimbursement form insurers but also to pass a state survey.
A strategy proven to improve patient outcomes as well as employee morale and financial stability within an organization is to include the nurse in the design and decision making of your EHR (Bullard, 2016). Many frustrations this writer experienced at a Long-Term Acute Care (LTAC) assignment recently could have been avoided. The lack of acknowledgment of nurse feedback regarding much-needed changes to the EHR, especially regarding lack of presence and an incredible amount of time spent documenting redundantly rather than caring for the patient were discovered to be cultural. This writer intended to share ideas and proven improvement learned throughout my career and the evolution of technology, but it was not reciprocated. As Nursing Informatics evolves into a specialty all its own, this writer believes the culture mentioned earlier will have to change.
After the recent interactions or lack thereof at that last assignment and taking a heap of assessments on various job boards, this writer was actually a bit surprised to find that the only areas in which I am more than “very proficient” is in areas that include IT and Management, all scoring in the “excellent” category. Long story short, as of last Friday, I have changed my concentration of major to HIT. This is my strategy.

References
Bullard, K. L. (2016). Cost-Effective Staffing for an EHR Implementation. Nursing Economic$, 34(2), 72–76.
McGonigle, D. (20170317). Nursing Informatics and the Foundation of Knowledge, 4th Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781284142990
Mosier, S., Roberts, W. D., & Englebright, J. (2019). A Systems-Level Method for Developing Nursing Informatics Solutions: The Role of Executive Leadership. JONA: The Journal of Nursing Administration, 49(11), 543-548.

Excellent
Good
Fair
Poor
Main Posting

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.

Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness

Posts main post by day 3.

Does not post by day 3.

First Response

Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.

Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.

Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Second Response

Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.

Participation

Meets requirements for participation by posting on three different days.

Does not meet requirements for participation by posting on 3 different days.

The purpose of this discussion is to gain insight into aspects of interdisciplinary informatics in healthcare. Informatics in healthcare is the exchange of digital information utilizing technology across a multitude of medical disciplines in order to facilitate a continuum of care. The digital age of informatics has advanced since the creation of the Office of the National Coordinator for Health Information Technology (ONC) within the US Department of Health and Human Services (Desalvo et al., 2015). Further advancing informatics was the passage of the e-Health Information Technology for Economic and Clinical Health (HITECH) Act, which prioritized financial allocations for the advancement of healthcare technology development (Desalvo et al., 2015). This funding allowed for the creation of the Meaningful Use (MU) Act, designed to completely digitize the healthcare record (Desalvo et al., 2015). This digitization allows for the scrutinization of the healthcare delivery landscape, enabling for identification of poorly performing processes, thus enabling the proficient delivery of patient-center, evidenced-based, quality healthcare delivery. The following is a discussion pertaining to the role of informatics in interdisciplinary collaboration.
The Emergency Department is a unique setting in that it allows for data to be simultaneously accessed and utilized across a number of independent patient care areas. Information regarding patients presenting must be accessed by lab technicians, imaging technologists, radiologists, ED physicians, intensivists, and other ancillary staff. The information available across these disciplines represents the patient and their acute and chronic health status. Interventional decisions can then be directed to allow for evidenced-based care. These decisions are made by utilizing the Foundation of Knowledge, which is the base for (Marstrian & McGonigle, 2019). The Foundation of Knowledge is the base healthcare providers use to make appropriate interventions based on empirical evidence and evidenced-base practice. Below are strategies designed to allow informatics to function in an interdisciplinary healthcare environment (Marstrian & McGonigle, 2019).
In order for biomedical informatics to be effectively utilized across the vast array of interdisciplinary demands present in the clinical setting, the focus must be on both the members of the interdisciplinary team and the health systems’ ability to maintains the technological infrastructure utilized to access clinical data. Team members must possess leadership quality, maintain a clear vision and goal, focus on efficient time management, and excel in prioritizing initiatives to continually improve the delivery of patient-centered care (Holden et al., 2018). It is also essential to have defined roles for informaticians across the interdisciplinary team and ensure informatics education supports the established defined interdisciplinary decision process (Holden et al., 2018).
Predictive medicine is believed to the future of healthcare and is affords it’s attainability to the advancement of biomedical informatics (Jen, 2019). Intercollarborative practice success will be destined to parallel the advancement of biometric informatics. Visual analytic tools and informatic collection systems will continue to evolve, with the dissemination and subsequent analyzation of patient data allowed to be more concisely presented (Wu et al., 2019). New evaluation tools will provide us with more data that will allow insight into the acute and future health of our patients (Wu et al., 2019). Another future component of healthcare delivery that will is deep learning of health informatics (Ravì et al., 2019). Deep learning aims to accelerate algorithm calculations in order to hasten diagnostic intervention and prescriptive medicine by analyzing data and learning from patterns represented in the clinical informatics (Ravì et al., 2019). The promise for more effective healthcare delivery is bright for both providers and patients utilizing informatics and interdisciplinary collaboration.
References
DeSalvo, K. B., Dinkler, A. N., & Stevens, L. (2015). The US Office of the National Coordinator for Health Information Technology: progress and promise for the future at the 10-year mark. Annals of emergency medicine, 66(5), 507-510. http://doi.org/10.1016/j.annemergmed.2015.03.032
Holden, R. J., Binkheder, S., Patel, J., & Viernes, S. H. P. (2018). Best practices for health informatician involvement in interprofessional health care teams. Applied clinical informatics, 9(1), 141. https://doi.org/10.1055/s-0038-1626724
Jen, M. Y., & Teoli, D. (2019). Informatics. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470564/
Mastrian, K., & McGonigle, D. (2019). Informatics for health professionals. Jones & Bartlett Learning.
Ravì, D., Wong, C., Deligianni, F., Berthelot, M., Andreu-Perez, J., Lo, B., & Yang, G. Z. (2016). Deep learning for health informatics. IEEE journal of biomedical and health informatics, 21(1), 4-21. https://doi.org/10.1109/JBHI.2016.2636665
Wu, D. T., Chen, A. T., Manning, J. D., Levy-Fix, G., Backonja, U., Borland, D., … & Kandaswamy, S. (2019). Evaluating visual analytics for health informatics applications: a systematic review from the American Medical Informatics Association Visual Analytics Working Group Task Force on Evaluation. Journal of the American Medical Informatics Association, 26(4), 314-323. https://doi.org10.1093/jamia/ocy190

Nursing informatics is a field of nursing that incorporates nursing, computer, and information sciences to maintain and develop medical data and systems to support the practice of nursing, and to improve patient care outcomes (Whithers, 2020). As a Nurse, I see data and technology on a daily basis. We utilize nursing informatics in almost everything we do. Staying up-to-date with this growing concept is vital in ensuring patient safety.
Nurses aren’t the only profession to utilize and benefit from data and technology. From my observation, nurse informatics have a great impact in the interaction with other professions. The mental health hospital where I currently work has new technology of electronic health records. The EHR allows those healthcare providers designated by the patient to obtain healthcare information related to past episodes of healthcare. It is hoped that such a record will eventually be a birth-to-death electronic healthcare record (Vasilescu, 2015).The IT department works with all professions within the workplace, which includes Nurses, Doctors, Clinicians, Therapists, Secretaries, and so forth.
A strategy on how the interaction between IT and these professions can improve is by continuous education of the electronic healthcare records. Learning the HER can be complicated, but with the right training, the system can and should run smoothly. IT must be aware of the healthcare staff’s level of computer competency in order to effectively educate. Super users can assist with this training. Super Users answer questions, help end users navigate through the system, and report issues to the project team to support prompt resolution (Epic@UNC 2015).

Whithers, F. (2020, May 08). What is Nursing Informatics & How to Become a Nurse Informaticist. Retrieved September 15, 2020, from https://www.registerednursing.org/nursing-informatics/
Vasilescu, A. (2015). Informatics: The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves? Retrieved September 16, 2020, from http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/ElectronicHealthRecord.html
Epic@UNC. (2015, December 22). Retrieved September 16, 2020, from http://news.unchealthcare.org/epic/training/super-user-responsibilities

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