NUR 514 Informatics in Health Care Discussion

DQ1 In what ways can informatics help health care providers overcome current or emerging barriers to care and increase access to safe, quality health care? Include a discussion of the value and challenges of clinical provider order entry (CPOE) and clinical decision support systems (CDSS) in providing safe patient care in your response.

What is Nursing Leadership in Healthcare Informatics?

The role of the nursing leader encompasses clinical and managerial responsibilities that may vary depending on clinical setting or placement in the organizational hierarchy. In looking at nursing leadership literature through the context of informatics, it is apparent that leaders are pivotal to technology integration in every arena of nursing practice (Honey & Westbrooke, 2016; Hussey, Adams & Shaffer, 2015; Kerfoot, 2015; Technology Informatics Guiding Education Reform, 2014). Healthcare’s continuous state of transformation now requires nurse leaders to develop informatics skills and competencies; it is no longer optional if one wants to lead effectively in the technological age (Collins et al., 2017; Honey & Westbrooke, 2016; Hussey & Kennedy, 2015; Hussey, Adams & Shaffer, 2015; Kerfoot, 2015; Lloyd & Ferguson, 2017; Phillips et al., 2017; Remus, 2016; Simpson, 2013; Staggers et al., 2018; Strudwick, 2016; Technology Informatics Guiding Education Reform, 2014; Troseth, 2014). Nursing leaders who develop informatics competencies can work more effectively in ensuring the “successful selection, development, and competent use of devices and clinical systems” (Kerfoot, 2015, p 342). Additionally, nurse leaders with informatics competencies and knowledge will be needed at higher levels to inform policy and decision making related to ICT implementation (Honey & Westbrooke, 2016; Hussey et al., 2015; Simpson, 2013; Strudwick, 2016; Technology Informatics Guiding Education Reform, 2014).

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Given their clinical background, nurse leaders are also positioned to provide a holistic perspective when organizations move to develop integrated models of care that leverage technology, such as telehealth, to transform patient care delivery (Hussey et al., 2015; Hussey & Kennedy, 2016; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014). The intertwining of technology and nursing practice creates an interdependency that, when leveraged properly by nursing leaders, can create project synergy and bolster their ability to advocate for ICT solutions that meet patient needs and yield sustainable quality patient outcomes (Honey & Westbrooke, 2016; Hussey & Kennedy, 2015; Hussey et al., 2015; Remus, 2016; Technology Informatics Guiding Education Reform, 2014; Troseth, 2014). To put it simply, leaders who develop and adopt informatics competencies can help bridge the gap between clinical nursing practice and IT (Hussey et al., 2015; Hussey & Kennedy, 2016; Lloyd & Ferguson, 2017; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014).

Nursing Leadership in Healthcare Informatics Drives Interoperability

While the use of ICTs has become more widespread and new models of care emerge that capitalize on technological advancements, nurses continue to have usability issues related to ICTs in practice (Staggers et al., 2018). Common issues reported include EHR designs that do not support how nurses document or interact with patient information, computerized provider order entry (CPOE) systems that do not account for nursing activities, or lack of interfaces with biomedical devices and other patient data collection systems (Hussey & Kennedy, 2016; Staggers et al,. 2018; Technology Informatics Guiding Education Reform, 2014). For nurses this could translate into challenges with electronic documentation in the EHR, delays in care if physicians are required to enter nursing orders, or the need to access multiple systems for information to develop a comprehensive understanding of the patient picture (Hussey & Kennedy, 2016; Staggers et al., 2018; Technology Informatics Guiding Education Reform, 2014). Ultimately, lack of consideration for nursing workflows during planning and design can result in a fragmented system that functions contrary to the TIGER recommendation for professional interoperability- the sharing of expertise and knowledge across disciplines in a meaningful and transparent way (Technology Informatics Guiding Education Reform, 2014). According to Staggers et al. (2018) this “means nurses become the human interface and integrator among disparate systems” (p 192). As such, nurse leaders need to develop a deeper understanding of nursing informatics and merge it with their clinical knowledge to effectively inform, influence or lead technology related initiatives that impact nursing workflow at the point of care (Hussey et al., 2015; Hussey & Kennedy, 2016; Kerfoot, 2015; Lloyd & Ferguson, 2017; Simpson, 2013; Technology Informatics Guiding Education Reform, 2014).

Technology is an indispensable part of today’s health practice, with many procedures giving way to machines and programmed software. Amid this, the evolutionary impacts of informatics are far-reaching, with the overall health practice outcomes improving immensely. Informatics reduces wastage, increases patient participation in health care delivery, and enhances coordination, among other significant outcomes. It is an evolution that will be critical in health care delivery for a long time as health care providers continue to seek ways of improving patient outcomes.

Concerning informatics’ role in overcoming barriers to care and increasing access to safe, quality health care, medication errors have been greatly reduced through informatics. With the consequences of misdiagnosing a patient or the wrong drug prescription being regretful, informatics prevents harmful treatment and prescription errors. Doing so prevents incomplete treatment of diseases and other medical-related harms such as improper use of medical equipment and incorrectly reading patient data (Stanhope & Matthews, 2019). In medication error reduction, clinical provider order entry (CPOE) systems are usually integrated with clinical decision support systems (CDSS) to enhance patient safety. Here, errors related to medical ordering and dispensing are avoided to improve safety. A typical CDSS identifies the values of drug doses and administration routes, among other sophisticated features (Patient Safety Network, 2019). However, the process also experiences some challenges. For instance, higher rates of adverse drug events are experienced in some hospitals despite using computerized order entry systems. In other cases, usability testing reveals that CPOE systems and CDSS still allow the entry and processing of some unsafe orders.

Generally, informatics is vital in enhancing safety and quality of care by reducing medication errors. Skochelak (2020) described informatics as a way to patients’ knowledge since it improves understanding of patients’ problems through knowledge sharing. It also helps to personalize care and increase coordination. Such outcomes are instrumental in the provision of safe and quality care.

NUR 514 Informatics in Health Care Discussion References

Patient Safety Network. (2019, Sep 7) Computerized provider order entry. https://psnet.ahrq.gov/primer/computerized-provider-order-entry

Skochelak, S. E. (Ed.). (2020). Health systems science e-book. Elsevier Health Sciences.

Stanhope, V., & Matthews, E. B. (2019). Delivering person-centered care with an electronic health record. BMC Medical Informatics and Decision Making, 19(1), 1-9. https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-019-0897-6