The continued integration of information technology within the nursing profession is resulting in the development of nursing informatics as a distinct specialty. As with other specialty areas, nursing informatics has unique foundational documents, concepts, competencies, and functions. How might information technology competencies pertain to your professional practice?
This week focuses on the core competencies and scope and standards of practice in nursing informatics. If you are not specializing in nursing informatics, some functional areas will be more relevant to your professional role than others. Therefore, this week you will analyze the key functional areas of nursing informatics and consider competencies that would be useful in your professional role. In addition, you assess how information technology skills can improve nursing practice.
By the end of this week, you will be able to:
• Analyze the key functional areas of nursing informatics
• Formulate a personal plan to improve health information technology competencies appropriate for your professional role
• Assess how information technology skills can improve nursing practice
Please proceed to the Resources.
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Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.
Readings • American Nurses Association. (2008). Nursing informatics: Scope & standards of practice. Silver Springs, MD: Author.
o “Functional Areas for Nursing Informatics” (pp. 16�€”31) This section describes the key functional areas of nursing informatics. It also clarifies the roles of informatics nurse specialists and informatics nurses.
o “Informatics Competencies“ (pp. 33�€”43) This section details an informatics competencies matrix that has been developed by reviewing research. It outlines best practices for successful use of health information technology.
• McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge (Laureate Education, Inc., custom ed.). Burlington, MA: Jones & Bartlett Learning.
o Chapter 8, “Nursing Informatics Roles, Competencies, and Skills” This chapter details the roles, competencies, and skills that ensure effective nursing informatics practice. The text also details the future of nursing informatics.
o Chapter 9, “Information and Knowledge Needs of Nurses in the 21st Century” In this chapter, the author emphasizes the need for embedding the core concepts and competencies of informatics into the practice of nurses. The chapter describes how this integration of concepts and competencies is necessitated by the integration of clinical information technologies into nursing practice.
• Wakefield, M. K. (2008). The Quality Chasm series: Implications for nursing. In R. G. Hughes (Ed.),Patient safety and quality: An evidence-based handbook for nurses (Vol. 1, pp. 47�€”66). Rockville, MD: U. S. Department of Health and Human Services. Retrieved fromhttp://www.ahrq.gov/qual/nurseshdbk/docs/WakefieldM_QCSIN.pdf o Pages 12�€”19 This chapter discusses four of the Institute of Medicine’s reports on the quality and safety of health care.
Specifically, the chapter focuses on the issues, concepts, findings, and recommendations of To Err Is Human, Crossing the Quality Chasm, Health Professions Education: A Bridge to Quality, and Quality Through Collaboration: The Future of Rural Health Care.
• Cheeseman, S. E. (2011). Are you prepared for the digital era? Neonatal Network, 30(4), 263�€”266. Retrieved from the Walden Library databases.
This article explores the application of health information technology (HIT) in neonatal intensive care units. In addition, the article highlights national initiatives advocating for the implementation of HIT throughout the health care delivery system.
• AMIA. (2012). AMIA. Retrieved fromhttp://www.amia.org/ This homepage of AMIA (formerly known as the American Medical Informatics Association) details the activities of the AMIA, including its publications, programs, events, and policies.
• Healthcare Information and Management Systems Society. (2012a). Healthcare Information and Management Systems Society. Retrieved fromhttp://www.himss.org/ASP/index.aspThis homepage of the Healthcare Information and Management Systems Society displays research conducted by HIMSS and introduces various tools, events, and resources for professional development.
• Healthcare Information and Management Systems Society.(2012b). Resources/reports. Retrieved fromhttp://www.thetigerinitiative.org/resources.aspx
This page of the TIGER website contains a list of resources and reports related to the development and implementation of technology informatics. • Healthcare Information and Management Systems Society.(2012c).
The TIGER initiative. Retrieved fromhttp://www.thetigerinitiative.org/ This site includes information on the phases of the TIGER Initiative and includes related resources and reports, opportunities for strategic partnerships, and general information about TIGER. • Technology Informatics Guiding Educational Reform. (2009).
TIGER informatics competencies collaborative final report. Retrieved from http://tigercompetencies.pbworks.com/f/TICC_Final.pdf This text details foundational informatics competencies that nurses should possess in order to meet standards of providing safe, quality, and competent care. In particular, this article specifies requirements for nurses in the areas of basic computer competencies, information literacy, and information management. • The TIGER Initiative. (2009).
Informatics competencies for every practicing nurse: Recommendations from the TIGER collaborative. Retrieved fromhttp://www.thetigerinitiative.org/docs/TigerReport_InformaticsCompetencies.pdf This report supplies the findings and recommendations of the Informatics Competencies Collaborative Team. The text describes the background, methodology, findings, and recommendations for future work as stated by the team.
• Quality and Safety Education for Nurses. (2012). Quality and Safety Education for Nurses. Retrieved fromhttp://www.qsen.org/ This homepage supplies information on quality and safety competencies, teaching strategies, faculty resources, pilot schools, and QSEN Consultants. Media
• Laureate Education, Inc. (Executive Producer). (2012d). Health information technology competencies. Baltimore, MD: Author. This video features interviews of Katie Skelton, Doris Fischer, Carina Perez, Shannon Mori, and Carmen Ferrell. They explain key skills and competencies that will allow nurses to capitalize on the benefits of health information technology in the health care setting. Optional Resources
• Schleyer, R. H., Burch, C. K., & Schoessler, M. T. (2011). Defining and integrating informatics competencies into a hospital nursing department. CIN: Computers, Informatics, Nursing, 29(3), 167�€”173. Retrieved from the Walden Library databases. Please proceed to the Discussion.
Return to top NURS 6051: Transforming Nursing and Healthcare through Information Technology “Introduction to Nursing Informatics” Program Transcript [MUSIC PLAYING] NARRATOR: Nursing informatics is a fast-growing discipline that is radically changing the face of the health care system. By integrating new nursing informatics and technology, organizations can become more efficient and effective in providing quality health care.
In the following media segment, Doris Fischer, Richard Rodriguez, Carina Perez, and Carmen Farrell explain nursing informatics and its relevance to today’s health care system. DORIS FISCHER: Because technology right now centers namely around the computer and the systems that are documented within that context– government bringing on their push towards a full of electronic medical record– nurses do need competencies within the computer realm in order to be able to know how to use the mouse, how to open and use a computer, the data that’s within, and all of that. But it goes beyond that. It goes into where technology is, and information flow. How do you use that information? How do you bring it to the bedside?
How do nurses grasp that information in a manner that they can understand and apply it to the patient? And that is really nursing informatics. You have the paper documentation, where people were comfortable with it, but no information flowed from point A to point B. It was a very cumbersome way to utilize information. And then you have the new school, which is instantaneous flow of information. New nurses coming on right now are so used to picking something up and having it instantly, what they need at their fingertips. That’s what we need for nurses also, to move ahead and to be able to say, I see this going on with my patient. How can I know what that is, and how can I treat it? © 2012 Laureate Education, Inc.
1 RICHARD RODRIGUEZ: Information systems give us the tools in order to collect this data real-time, put it into our system. And then it allows other clinicians, other nurses involved with patient care, to access that information immediately.
In the past, when writing your paper, half of the battle was trying to find patient charts. So you would have a nurse running around, looking for a patient chart so she can document her assessment. You would have a nursing assistant looking for the chart so that the nursing assistant could document their vital signs.
And then ultimately, you’d get the doctor coming in, trying to look for a chart. And they weren’t as nice when they couldn’t find the patient’s chart. So now that we’re documenting electronically, multiple people can access the patient’s chart electronically and get the information that they’re looking for.
CARINA PEREZ: The nursing informatics analyst is really a linguist. They are a linguist for clinical and technical. They are in the design and build phase. They are translating information from the bedside into the system. And then in the training and implementation phase, they are now translating that information, that technical piece, from the computer system into real live environment at the bedside.
I think what a lot of end users don’t understand, the why– why do we have to do this? Why do we put it in? Because they’re going to look at the data. “They” as in the whole nation is going to look at the data that we’re pumping in, and saying, which hospitals are providing the best outcomes? What can we get from care?
So you’re now able to look at real-time data and research that’s being done, and say, hey, in this hospital can improve their AMI return rates, then why don’t we go ahead and implement it at this hospital? And so, we’re saving dollars. We’re improving patient care and health. © 2012 Laureate Education, Inc. 2 CARMEN FERRELL: Nursing informatics is a way to capture the information that nurses normally do at the bedside in an electronic format. So what does that mean? Well, it means that normally– in the olden days, I would say– we used to document everything by hand.
We had either flow sheets, or progress lists, or something to capture everything that we did by hand. Nursing informatics takes all of that and puts it in electronic format. And the reason that’s an important piece is because now we’re able to capture that information and able to send it electronically to other places.
So it goes from a hospital setting to a clinic, or to a government agency, or to an insurance company. So it’s an easier way to transform the normal data that we collect and get it out to the people who actually need it. We also are able to transform that data into a medical record that the patient can easily see.
The nursing informatics specialist– or “analyst,” as we call it here at this hospital, and it’s often called an analyst out in the field, as well– is to try to understand nursing. And again, translated into that electronic world, but look at it from different perspectives. One of them is the workflow.
Nurses have a certain workflow that they must do with every single patient. Well, when you add informatics to it, that workflow may change, because now you’re documenting everything you’re doing right at the bedside. Whereas, it used to be that you could document it on a piece of paper or something, and at a later time, put it on your document.
That doesn’t work very well when you’re doing informatics. So how does the workflow change? That’s a huge component. Also, the analyst needs to think about the machine that that nurse is going to have to use at the bedside. How is that going to work for them? Is it going to be a system where it could easily maneuver around the patient bedside or not?
Am I going to have to think about the nurse’s ability to think through and say, how do I organize my day for today so I can pass out meds in a timely manner, but still hit all those safety factors that I used to hit before this documentation piece came in with electronics? How’s that helping me?
Also from the quality perspectives point, I used to collect all of this information on checklists, either during my shift, at the end of my shift, or do some chart © 2012 Laureate Education, Inc. 3 reviews. Now that’s being collected for me, so how am I going to collect, as an analyst, that data from the spreadsheet that I put together for that nurse, to be able to enter data initially?
So as nurse leaders become clinical informaticists, they are actually changing the way that health care is being delivered today. And what I mean by that is, again, they’re the ones that are taking that lead in shifting the culture in a hospital, or clinic, or wherever they’re at, and going from a manual delivery system to an automated delivery system. And taking all the workflow that goes with how you deliver care in the manual setting and now into an electronic setting. And how you pull that information back out, and make it more quality focused.
So the whole focus of that leader is to make sure that they bring people together to look at what they currently do and what would the future look like for them, with the limitations of whatever program they’ve chosen or equipment they’ve chosen, but understanding enough about both to be able to get them to that next system. Workflow is probably the key piece of making this role a success, understanding that that has to change. © 2012 Laureate Education, Inc.
4 Today’s fast-paced health care environment demands nurses to be skilled not only in their clinical practice or specialty area but in the use of technology tools that improve practice and lead to better patient care. Basic and advanced technology competencies are required and expected as technology increasingly touches and changes the job of every nurse.
Numerous organizations, including the American Nurses Association (ANA), the American Medical Informatics Association (AMIA), and Healthcare Information and Management Systems Society (HIMSS), have developed nurse-specific technology competencies. The challenge for nurses is to identify both needs and training opportunities. In this Discussion, you identify the role informatics plays in your professional responsibilities. You pinpoint personal gaps in skills and knowledge and then develop a plan for self-improvement. To prepare:
• Review Nursing Informatics:
Scope and Standards of Practice in this week’s Learning Resources, focusing on the different functional areas it describes. Consider which areas relate to your current nursing responsibilities or to a position you held in the past. For this Discussion, identify one or two of the most relevant functional areas. • Review the list of competencies recommended by the TIGER Initiative.
Identify at least one skill in each of the main areas (basic computer competencies, information literacy competencies, and information management competencies) that is pertinent to your functional area(s) and in which you need to strengthen your abilities. Consider how you could improve your skills in these areas and the resources within your organization that might provide training and support. Post on or before Day 3 the key functional area(s) of nursing informatics relevant to your current position or to a position you recently held, and briefly describe why this area(s) is relevant.
Identify the TIGER competencies you selected as essential to your functional area(s) in which you need improvement. Describe why these competencies are necessary and outline a plan for developing these competencies. Include any resources that are available to you within your organization and the ways you might access those resources.
Assess how developing nursing informatics competencies would increase your effectiveness as a nurse. Read a selection of your colleagues’ responses. Respond on or before Day 6 to at least two of your colleagues on two different days using the following approach: Assume the role of a consultant. Respond to your colleagues as someone who can offer advice on improving their skills on the competencies they identified as needing improvement.
I HIS COLUMN IS THE FIRST A in a series that explores health information technology (HIT) in the NICU. This column describes the national initiatives driving the adoption of information technology throughout the health care delivery system, as well as initiatives to establish requisite informatics competencies for nurses in practice. To engage plan for the United States. The strategic plan includes four major goals to be accomplished by 2014:
• Encourage the widespread adop- tion of EHRs.
• Interconnect clinicians so that data and information can be shared more easily
. • Personalize care through the use of personal health records and telehealth.
• Improve public health through accessible information. The National Coordinator’s detailed report, titled The Decade of Health Information Technology: Delivering Consumer-centric and Tnformation-rich Health Care^ reit- erates the role of information systems and technologies in improving the quality and safety of patient care. The drive to implement HIT accelerated in 2009 when the American Recovery and Reinvestment Act, also known as the “Stimulus Bill” or the “Recovery Act,” was signed into law. The Recovery Act allocated more than billion to encour- age the adoption of HIT.
The portion of the Recovery Act called the Health Information Technology for Economic and Clinical Health Act, or HITECH Act, will support the devel- opment of the electronic HIT infrastructure that will improve the efficiency of health care and all Americans’ access to it. The money being provided by the HITECH Act is not a direct payment to practices and hospitals that adopt infor- mation technology; instead, payments will be made in the form of increases in Medicare and Medicaid reimbursement to those health care providers that meet the “meaningful use” rules and regulations defined within the HITECH.
The Medicare and Medicaid EHR incentive program will provide incentive payments to eligible professionals and eligible hos- pitals as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology. In a series of regulations, the Recovery Act specifies three main compo- nents of “meaningful use”^:
• The use of a certified EHR in a meaningful manner (e.g., e-prescribing);
• The use of certified EHR technology for electronic exchange of health information to improve quality of health care; and
• The use of certified EHR technology to submit clinical quality and other measures. The final rule, including definitions for meaningful use, was published on July 28, 2010, and is available at http:// www.cms.gov/EHRIncentivePrograms/. The rapid advancement of health care technology accelerates the need to ensure that all health care providers obtain the com- petencies needed to work with HITs, including basic computer skills, information literacy, and an understanding of informatics and information management capabilities.
Technology itself HEALTH INFORMATION TECHNOLOGY fully in the digital era of health care, practicing nurses must master informatics competencies. Subsequent columns in the series will provide information and resources for developing informatics knowledge and skills to meet recommended competencies, and will explore health information and com- munication technology applications in the NICU. Informatics knowledge and skills are no longer “nice to know” but are now essential to job performance. Nurses in the NICU are expected to deliver highly specialized, safe, and effective care to the neonate, infant, and family in an increas- ingly technical and digital environment.
Implementation of HIT, including electronic health care records (EHRs), is escalating rapidly, driven by national initiatives. Nurses are directly engaged with information systems and technologies in the NICU as the foundation for evidence-based practice and as clinical-decision support tools. Nurses practicing in this digital era need a minimum set of informatics knowledge and skills, categorized as basic computer competencies, information literacy, and information management.
NA TIONAL HIT INITIA TIVES Since 2000, interdisciplinary teams of scientists, practitioners, and administrators convened by the Institute of Medicine (IOM) have advocated the use of HIT. These teams believe that informatics offers the potential to reduce errors, better manage knowledge and information, and enhance decision making and communication. Effective use of information systems and provider order entry can reduce errors. Online and on-site databases can facilitate management of knowledge and information, as can EHRs. Computerized decision support systems can enhance decision making. Finally, EHRs and electronic communication tools such as e-mail can improve communication efficiency and the exchange of information.
In Health Professions Education: A Bridge to Quality,^ the IOM articulated this vision: “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics” (p. 3). In 2004, the Office of the National Coordinator for Health Information Technology was created within the Department of Health and Human Services to promote an aggressive HIT Accepted for publication January 2011. VOL. 30, NO. 4 , JULY/AUGUST 2011 Are You Preparea for tne Digital Era? EDITOR SusanE.Cheeseman,DNP,APRN, NNP-BC 30 $ EONATAL WORK: 2011 Springer Pubiisiling Company 2 6 3 DOI: 10.189 1/0730-08126.96.36.1993 will not transform health care. It will take skilled practitioners with the informatics knowledge and skills to use HIT, includ- ing EHRs, to deliver safer, more efficient care.
NURSING INFORMA TICS Informatics is a science that combines computer science (a domain science) with information science and cognitive science (the science of knowing). Simply stated, informatics is the science of turning data into information. Nursing informatics is a discipline-specific informatics practice under the broader category ofhealth informatics where the domain science is nursing science. As defined by the American Nurses Association* (ANA):
• Nursing informatics is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. • Nursing informatics supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology, (p. 1) Nursing informatics promotes the generation, manage- ment, and processing of relevant data in order to use infor- mation and develop knowledge that supports nursing in all practice domains including clinical practice, education, administration, and research.^
The concepts of data, information, knowledge, and wisdom are integral to communication and decision making for all nurses. The neonatal nurse handles large amounts of data and information and applies knowledge appropriately (wisdom) when providing direct patient care or working as an adminis- trator, educator, researcher, or in another role in the NICU. An understanding of these basic concepts provides the foundation for how nursing informatics can assist in the interpretation of data and information to develop new nursing knowledge. Data are discreet observations that are not interpreted, organized, or structured.
Examples of data include ah infant’s vital signs and the ambient or set temperature of an incubator. Other examples of data include an infant’s length of stay, the number of parents attending a CPR class, or nurse-to- patient staffing ratio. A single piece of datum has little significance. However, a collection of data can be organized and interpreted to show patterns and trends.
Information is data that have been interpreted, organized, or structured to give them meaning; for example, recording an infant’s physical and neuro-muscular findings on the New Ballard Score helps to determine the infant’s gestational age. Plotting growth parameters (admission weight, length, and head circumference) against gestational age on a standard growth chart yields information concerning the infant’s growth in relation- ship to standards for gestational age: (a) appropriate growth for gestational age (AGA),
(b) small for gestational age (SGA), or (c) large for gestational age (LGA). A single datum (i.e., an infant’s temperature) can be determined to fall within a normal range, but the collection of several values over time creates a pattern that may demonstrate gradual rise or fall in values (information) indicating a need for further investigation. Knowledge is the synthesis of information derived from several sources to identify relationships that provide further insight to an issue or subject area.
Knowledge is dynamic and derives meaning from its context. Examples of knowledge include implementation of a glucose monitoring protocol for the infant determined to be LGA or application of the most effec- tive nursing strategies for the prevention of ventilator-associated pneumonia. Wisdom occurs when knowledge is used appropri- ately to manage and solve problems
* For example, although a number of interventions might be appropriate for the relief of pain in the neonate, wisdom would help the practitioner decide which options are most appropriate for a specific neonate. The concepts of information and knowledge differ, but as a whole they are typically referred to generically as information.
Informatics provides tools to process, manage, and analyze data to provide information to support communication, decision making, and building new nursing knowledge to support evi- dence-based practice. An understanding of current and evolving technology for the management and processing of nursing information allows nurses to play an active role in transforming health care by using informatics tools to make health care safer, effective, efficient, patient centered, timely, and equitable.
The only way for nurses to engage actively in the digital era is to integrate informatics competencies into their practices. INFORMA TICS COMPETFNCIFS The term competency describes the knowledge, skills, and attitudes that underlie competent performance.^ Competency standards specify the level of achievement expected and the tasks and contexts of professional practice in which the compe- tency is demonstrated.”
Staggers and colleagues^ define informatics competencies as “the integration of knowledge, skills, and attitudes in the performance of various nursing informatics activities within prescribed levels of practice” (p. 306). Informatics competencies are essential for ensuring safe, effective care in an increasingly technical and digital environment. These competencies add to the profession’s knowledge base and provide the infrastructure that supports evidence-based practice, reduces variation in practice, and prevents errors.^’^*^
Nurses currently in practice face unique challenges in gaining informatics competencies. At nearly three million, practicing nurses are the largest segment of the health care workforce. The average age of a practicing nurse in the United States is 47 years. These individuals grew up in the pre-digital age. One writer describes them as “digital immigrants,” adopting technology later.^^
They may lack education and confidence in the use of technology compared with “digital natives,” younger individuals who have spent their entire lives surrounded by computers, theInternet, mobile phones, and MP3 players.
There are a number of digital immigrants in the NICU who have not mastered the requisite informatics com- petencies to use HIT effectively and efficiently to enhance the nursing care of neonates, infants, and their families. 264 JULY/AUGUST 2011, VOL. 30, NO. 4 EO WORK: As early as the 1970s, researchers and professional orga- nizations recommended that nurses develop knowledge and skills in computer literacy, information literacy, and the use of information technologies.^’^^’^^’^*
To date, there is no consensus on a single consolidated hst of informatics com- petencies across educational levels or as a reference list for employers.1*’^^’^^’^^ Curran^^ identified informatics competencies for nurse practitioners. Desjardin and colleagues incorporated competencies for information literacy to support evidence-based practice. The Quality and Safety Education for Nurses (QSEN) Initiative created competencies for
pre- licensure nursing programs in response to the IOM’s vision: (a) patient-centered care, (b) teamwork and collaboration, (c) evidence-based practice, (d) quality improvement, and (e) informatics, plus safety.^ The competencies are designed for implementation in undergraduate nursing programs, and the work thus far is available athttp://www.qsen.org. developed a comprehensive list of foundational competencies
it recommends all practicing nurses and graduating nursing students possess in order to meet the standard of providing safe, quality, and competent care.^° Informatics Competencies for Every Practicing Nurse: Recommendationsfrom the TIGER Collaborative groups recommended competencies into three categories:
(a) basic computer competencies, (b) information literacy, and (c) information management. Basie computer competencies indudc training and certification in: • Concepts of information and communication technology • Using the computer and managing files • Word processing • Spreadsheets
• Presentation • Web browsing and communication Information literacy competencies recommended by the TIGER Initiative are consistent with those identified by Nursing Informatics: Scope and Standards of Practice’^ pro- the American Library Association’^ and described earlier. vides a matrix of competencies based on the earlier work of Staggers and colleagues.
^* The ANA categorizes competen- cies into three overall categories: computer literacy, informa- tion literacy, and professional development/leadership for the beginning nurse, experienced nurse, informatics nurse, and informatics nurse specialist. Computer literaey eompeteneies knowledge-wisdom continuum. These competencies are related relate to the psychomotor use of computers and other techno- to current and evolving technology for the management and logic equipment.^^ Information literaey competencies^^ deal with information and retrieval knowledge and skills and include: • Knowing when there is a need for information;
• Identifying the information needed to address a given problem or issue;
• Locating and evaluating the needed information; and
• Organizing and using the information effectively to address the problem or issue. Professional development and leadership eompeteneies refer to the ethical, procedural, safety, and management issues for informatics solutions in nursing practice, education, research, and administration.^
Otie national initiative receiving a great deal of attention is the TIGER Initiative, an acronym for Technology Informatics Guiding Education Reform. This multidisciplinary, multisub- specialty group of leaders from nursing administration, practice, education, informatics, technology, professional organizations, and government is raising awareness ofthe need to engage nurses in the national effort to prepare the health care workforce for adoption of HITs. The TIGER Initiative^^ focuses on increas- ing awareness among nursing stakeholders in three areas: • Develop a U.S. nursing workforce capable of using EHRs to improve the delivery of health care.
• Engagemorenursesinthedevelopmentofthenationalhealth care information technology (NHIT) infrastructure.
• Accelerate adoption of smart, standards-based interoper- ability technology that will make health care delivery safer, more efficient, timely, accessible, and patient centered. The integration of informatics competencies into nursing practice is a priority for the TIGER initiative. The initiative has processing of nursing information, specifically the EHR. Each category of informatics competencies for nurses is aligned with an existing set of competencies maintained by standard development organizations or de facto stan- dards.
Within each standard development organization are resources for education and certifying exams to demonstrate proficiency (Table 1). Work continues on developing addi- tional strategies for implementing competencies for nurses currently in practice based on the following goals: • Identify educational resources and affordable programs within the practice setting that foster IT innovation and adoption. TABLE 1
• TIGER Nursing Informatics Competencies: Resources for Training and Certification VOL. 30, NO. 4, JULY/AUGUST 2011 265 Information management competencies TLTC based on the informa- tion management process: (a) collecting data, (b) processing the data, and (c) presenting and communicating the processed data as information or knowledge.
As described earlier, the concept underlying information management is the data-information- Competency Basic computer competencies Information literacy Information management Resources European Computer Driving License Foundation (ECDL) (www.ecdl.org) CSPIacement (official distributor of ECDL within the U.S.) (www.csplacement.com) Healthcare Information Management System Society (HIMSS) (www.himss.org) American Library Association (www.ala.org) Health Level Seven (HL7) (www.hl7.org) European Computer Driving License Foundation (www.ecdl.org) Adapted from: The TIGER Initiative. (2007). Informatics competencies for every practicing nurse: Recommendations from the TIGER collabora- tive. Retrieved fromhttp://www.tigersummit.eom/uploads/3.Tiger. Report_Gompetencies_final.pdf WORK:
• Create competency-based, cost-effective staff development and continuing education programs and training strategies specific to informatics knowledge, skills, and ability. • Improve and expand existing nursing/clinical/health infor- matics education programs by collaborating with industry, service, and academic partners to support and enhance the use of technology and informatics in practice.
The final report of the TIGER Initiative will be available on the TIGER website athttp://www.tigersummit.com. National initiatives are driving the implementation of HITs, specifically the EHR. Advances in information technology highlight the need for all nurses to be more knowledgeable about health information concepts and the technology designed to manage and process information. Informatics competencies provide t h e requisite knowledge and skills to allow nurses to engage actively in the digital era. Comprehensive informatics competencies for nurses cur- rently in practice are valuable for many reasons:
• Access to health information is changing, as a result of advances in technology and national initiatives to ensure that all Americans have EHRs by 2014. Nurses at all levels of practice must be able to retrieve and enter data in an electronic format and to analyze and interpret electronic information as part of planning patient care. In addition, they must be able to use electronic communication tools effectively.
• Sophisticated informatics tools employed in direct patient care activities�€”such as barcode medication administra- tion, automated drug dispensing systems, and smart IV pumps�€”require that nurses be proficient in their use to ensure safe and effective application.
• Evidence-based practice requires knowledge and skill in locating and retrieving electronic sources of information, including research evidence, systematic reviews, and clini- cal practice guidelines.
• Quality improvement activities require nurses to be famil- iar with spreadsheets and statistical software and analysis. • Administrators need skills to use organizational databases and information systems for collection and interpretation of statistical data on patient care, including length of stay, staffing, patient acuity, budgets, and resource ordering.
• Employers need HIT knowledge to develop job descrip- tions and manage the expectations for nurses in all areas of practice. REFERENCES
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3. Centers for Medicare & Medicaid Services. (2010, November 30). Electronic health record incentive programs: Meaningful use. Retrieved from https:// www.cms.gov/EHRIncentivePrograms/35_Meaningful_Use.asp 30$
4. American Nurses Association. (2008). Nursing informatics: Scope and standards ofpractice. Silver Spring, MD: Author.
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Barton, A. J. (2005 ). Cultivating informatics competencies in a community of practice. Nursing Administration Quarterly, 29, 323-328. 16. Curran, C. R. (2003). Informatics competencies for nurse practitioners. American Association of Critical Care Nurses Clinical Issues, 14, 320-330. 17. Desjardins, K. S., Cook, S. S., Jenkins, M., & Bakken, S. (2005). Effect of an informatics for evidence-based practice curriculum on nursing informatics competencies. International Journal of Medical Informatics, 74, 1012-1020. doi:10.1016/j.ijmedinf2005.07.001 18.
American Library Association. (2000). Information literacy competency standard for higher edueation. Retrieved fromhttp://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfm 19. The TIGER Initiative. (2007a). Collaborating to integrate evidence and informaties into nursing practice and edueation: An exeeutive summary. Retrieved fromhttp://www.tigersummit.com/uploads/TIGER_Collaborative_Exec_Summary_040509.pdf 20. TheTIGERInitiative. (2007b). Informatics competenciesfor everypracticing nurse: Recommendations from the TIGER collaborative. Retrieved fromhttp://www.tigersummit.eom/uploads/3.Tiger.Report_Competencies_ final.pdf About the Author SusanE.CheesemanisaNeonatal
NursePractitionerinalevelHI NICU at St. Luke’s Children’s Hospital in Boise, Idaho. She obtained her MSNandNNPfromtheUniversityofPennsylvania,Philadelphia,PA andherDNPfromtheUniversityofUtah,SaltLakeCity,UT.Shealso holds a Nursing Informatics Post Master’s Certificate from the University of Utah. In addition to her clinicalpractice, she isAdjunet Faculty with the Univeristy of Utah and teaches an online Information Technology course for nurses in advanced practice programs at the College of Nursing. 266 JULY/AUGUST 2011,VOL. 30, NO. 4 :NEONATAL WORK: C
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The Summary Report includes additional information about the TIGER Informatics Competencies Collaborative and provides much information about TIGER and its eight other initiatives. Introduction Nurses are expected to provide safe, competent, and compassionate care in an increasingly technical and digital environment.
A major theme in this new healthcare environment is the use of information systems and technologies to improve the quality and safety of patient care. Nurses are directly engaged with information systems and technologies as the foundation for evidence-based practice, clinical-decision support tools, and the electronic health record (EHR). To help practicing nurses be responsive to the changes in their practice environments, a new specialty called Nursing Informatics has emerged over the past 20 years.
The most recent 2008 American Nurses Association Nursing Informatics Scope and Standards defines nursing informatics as the integration of nursing science, computer and information science, and cognitive science to manage communication and expand the data, information, knowledge, and wisdom of nursing practice. Nurses certified in Nursing Informatics are: *
skilled in the analysis, design, and implementation of information systems that support nursing in a variety of healthcare settings * function as translators between nurse clinicians and information technology personnel * insure that information systems capture critical nursing information These specialized nurses add value to an organization by: * increasing the accuracy and completeness of nursing documentation *
improving the nurse’s workflow * eliminating redundant documentation * automating the collection and reuse of nursing data * facilitating the analysis of clinical data, including Joint Commission indicators, Core Measures, federal or state mandated data and facility specific data While Nursing Informatics is a highly specialized field, there are foundational informatics competencies that all practicing nurses and graduating nursing students should possess to meet the standards of providing safe, quality, and competent care.
The Technology Informatics Guiding Education Reform (TIGER) Informatics Competency Collaborative was formed to develop informatics recommendations for all practicing nurses and graduating nursing students. Following an extensive review of the literature and survey of nursing informatics education, research, and practice groups, the TIGER Nursing Informatics Competencies Model consists of three parts, detailed in this document:
* Basic Computer Competencies
* Information Literacy * Information Management TIGER Informatics Competencies Collaborative Final Report �€” August 2009 1 Approach and Strategy The TIGER Informatics Competency Collaborative (TICC) did an extensive review of the literature for informatics competencies for practicing nurses and nursing students. TICC also collected informatics competencies for nurses from over 50 healthcare delivery organizations. The results of these efforts are available on the TICC Wiki (http://tigercompetencies.pbwiki.com).
This resulted in over 1000 individual competency statements. This body of competencies was synthesized to create the three parts of the TIGER Nursing Informatics Competencies Model: Basic Computer Competencies, Information Literacy, and Information Management.
Once we developed the model, we aligned each component with an existing set of competencies maintained by standard development organizations or defacto standards. We found very good fits with the existing standards of the European Computer Driving Licence Foundation, the Health Level 7’s electronic health record functional model clinical care components, and the American Library Association information literacy standards respectively.
All of these sets of competencies are standards maintained by standard setting bodies or organizations. Finding sets of competencies that are maintained by standard setting bodies allow the TIGER Informatics Competency Collaborative (TICC) to recommend standards that are relevant to nurses and ones that will be sustainable as these bodies evolve the standards as necessary. Of equal or perhaps greater importance, these standard-setting bodies all have pu
t tremendous thought, energy and expertise into there recommended competencies. When those competencies aligned with the informatics competency needs for nurses, we adopted theirs, thus adding strength, rigor, and validity to the TICC recommendations.
Component of the TIGER Nursing Informatics Competencies Model Standard Standard-Setting Body Basic Computer Competencies European Computer Driving Licence European Computer Driving Licence Foundation Information Literacy Information Literacy Competency Standards American Library Association Information Management Electronic Health Record Functional Model – Clinical Care Components Health Level Seven (HL7) European Computer Driving Licence – Health European Computer Driving Licence Foundation TIGER Informatics Competencies Collaborative Final Report �€” August 2009
2 Basic Computer Competencies A “digital native” has grown up with digital technology such as computers, theInternet, mobile phones, and MP3. A “digital immigrant” grew up without digital technology and adopted it later. There are a substantial number of digital immigrants in the nursing workforce who have not mastered basic computer competencies. Many digital natives have gaps in their basic computer competency skill set. Europeans realized this shortcoming in the workforce across many industries and acted on it.
The European Computer Driving Licence (ECDL) Foundation set basic computer competencies in the late 1990s and again in this decade. About seven million Europeans have now taken the ECDL exam and become certified in basic computer competencies. The ECDL syllabus is effectively a global standard in basic computer competencies. The modules of ECDL basic computer competencies are: Module 1: Concepts of Information and Communication Technology (ICT) Module
2: Using the Computer and Managing Files Module 3: Word Processing Module 4: Spreadsheets Module 5: Using Databases Module 6: Presentation Module 7: Web Browsing and Communication The TIGER Informatics Competency Collaborative (TICC) has adopted the ECDL competencies and is recommending them for all practicing nurses and graduating nursing students. ECDL certification requires 30+ hours of study and costs more than some institutions may be able to afford.
Therefore, we have ranked the relative importance of ECDL syllabus items and recommend the following as a first step to basic computer proficiency for all practicing nurses and graduating nursing students. These are feasible and affordable and will provide basic computer competencies for nurses and allow them to go on to obtain other TICC competencies. Module 1: Concepts of Information and Communication Technology (ICT) Module 2: Using the Computer and Managing Files Module 3, Section 3.1: Word Processing: “Using the application” Module
7: Web Browsing and Communication TIGER Informatics Competencies Collaborative Final Report �€” August 2009 3 Recommendation Timeline for Adoption All practicing nurses and graduating nursing students gain or demonstrate proficiency in ECDL modules 1, 2 and 7, as well as ECDL Category
3.1 By January 2011 All practicing nurses and graduating nursing students become ECDL certified or hold a substantially equivalent certification. By January 2013 Resources European Computer Driving Licence (ECDL) Foundationhttp://ecdl.com The ECDL syllabus is maintained and periodically updated by the not-for-profit ECDL Foundation. The ECDL Foundation makes arrangements with entities in various countries to localize the ECDL syllabus. Outside of Europe, ECDL is known as International Computer Driving Licence. ICDL is available in the United States through CSPlacement. CSPlacementwww.csplacement.com – Offers CSP Basic, an e-learning course and a certification exam that is substantially equivalent to the TICC recommendation of a first and significant step towards basic computer competency. - Offers CSP, an e-learning course and a certification exam that is substantially equivalent to the entire ECDL syllabus.
Healthcare Information Management System Society (HIMSS) www.himss.org – Has a new certificate called Health Informatics Training System (HITS). The HITS program of e-learning, testing, and certification contains content that is substantially equivalent to the TICC recommendation of a first and significant step towards basic computer competency, as well as other content.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 4 Information Literacy Information literacy builds on computer literacy. Information literacy is the ability to – identify information needed for a specific purpose - locate pertinent information - evaluate the information – apply it correctly Information literacy is critical to incorporating evidence-based practice into nursing practice.
The nurse/provider must be able to determine what information is needed. This involves critical thinking and assessment skills. Finding the information is based on the resources available, which can include colleagues, policies, and literature in various formats. Evaluating or appraising the information also involves critical thinking and the ability to determine the validity of the source. The actual implementation of the information results in putting the information into practice or applying the information. The evaluation process is necessary to determine whether the information and its application resulted in improvements.
Thus, information literacy competencies are fundamental to nursing and evidence-based practice. Recommendation Timeline for Adoption All practicing nurses and graduating nursing students will have the ability to: 1. Determine the nature and extent of the information needed 2. Access needed information effectively and efficiently 3.
Evaluate information and its sources critically and incorporates selected information into his or her knowledge base and value system 4. Individually or as a member of a group, use information effectively to accomplish a specific purpose
5. Evaluate outcomes of the use of information By January 2011 As some institutions may find these competencies difficult to implement in their entirety immediately, as a first and significant step towards information literacy in nurses, the TICC recommends focusing on the first three competencies for the first year. Once these are achieved by nurses in a particular organization, the other two can be added so that by January 2011, all nurses have all five competencies and incoming nurses demonstrate or are helped to obtain all five.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 5 Resources American Library Association The ALA’s report “Information Literacy Competency Standards for Higher Education” identifies the competencies recommended above as standards.
The report also lists performance indicators and outcomes for each standard. A faculty member or instructor can effectively use this report to create a more detailed syllabus and or lesson plan(s) to implement the TICC information literacy competencies.http://www.ala.org/ala/mgrps/divs/acrl/standards/informationliteracycompetency.cfmThe Information Literacy in Technologyhttp://www.ilitassessment.com The iLIT test assesses a student’s ability to access, evaluate, incorporate, and use information. It is a commercially available test and may be of use in demonstrating proficiency in information literacy.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 6 Information Management Information management is the underlying principle upon which TICC Clinical Information Management Competencies are built. Information management is a process consisting of 1) collecting data, 2) processing the data, and 3) presenting and communicating the processed data as information or knowledge. An underlying concept for information management is the data-information-knowledge continuum. Data are discrete, atomic-level symbols, for example, the number 120. Information is data that is grouped or organized or processed in such a way that the data has meaning, for example a blood pressure of 120/80.
Knowledge is information transformed or combined to be truly useful in making judgments and decisions. An example of knowledge is that a blood pressure of 120/80 is dangerously hypertensive in a neonate. Information is managed by nurses in a variety of ways, but more and more the preferred or required method is through information systems. We define an information system as being composed of human and computer elements that work interdependently to process data into information.
The most relevant, important, and fundamental information management competencies for nurses are those that relate to the electronic health record system (EHRS). Using an EHRS will be the way nurses manage clinical information for the foreseeable future. However, nursing responsibilities are not changing in the shift to increased use of EHRSs. For example, nurses are still required to exercise due care in protecting patient privacy. But the manner in which these responsibilities to patients and communities are upheld may be different.
Therefore, all practicing nurses and graduating nursing students are therefore strongly encouraged to learn, demonstrate, and use information management competencies to carry out their fundamental clinical responsibilities in an increasingly safe, effective, and efficient manner. The most rigorous as well as practical work on enumerating the relevant parts of the EHRS for clinicians was done by Health Level 7 (HL7) EHR Technical Committee and was published in February 2007 as an approved American National Standard (ANSI) publication is titled “The HL7 EHR System Functional Model, Release 1,” known as ANSI/HL7 EHR, R1-2007.
The direct care component of the HL7 EHR System Functional Model serves as a basis of information management competencies for practicing nurses and graduating nursing students (see Appendix). Although these clinical information management competencies are numerous, they merely make explicit competencies for proficient use of EHRS clinical nursing responsibilities that practicing nurses and graduating nursing students are responsible for today in a paper information management environment or a mixed paper and electronic environment.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 7 However, the direct care component of the HL7 EHR System Functional Model is not quite sufficient by itself to cover the information management responsibilities of nurses in the digital era. What is needed in addition is a set of competencies that address the importance of electronic health record and like systems to nurses and the “due care “ that nurses need to take in managing information via these systems.
Again, the European Computer Driving Licence Foundation has come up with a set of items that address these concerns, with ECDL-Health. Here are the ECDL-Health syllabus items Concepts Health Information Systems HIS Types Due Care Confidentiality Access ControlSecurity User Skills Navigation Decision Support Output Reports Policy and Procedure Principles These items are complimentary to the HL7 EHRS model items, except for User Skills. The User Skills section overlaps completely with HL7 EHRS model items. Here are the ECDL-Health syllabus items transformed into TICC competencies:
The nurse will: Concepts Verbalize the importance of Health Information Systems to clinical practice Have knowledge of various types of Health Information Systems and their clinical and administrative uses Due Care Assure Confidentiality of protected patient health information when using Health Information Systems under his or her control Assure Access Control in the use of Health Information Systems under his or her control Assure theSecurity of Health Information Systems under his or her control User Skills Have the User Skills as outlined in direct care component of the HL7 EHRS model, which includes all of the ECDL-Health User Skills of Navigation, Decision Support, Output Reports and more.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 8 Policy and Procedure Understand the Principles upon which organizational and professional Health Information System use by healthcare professionals and consumers are based. Recommendation Timeline for Adoption Schools of nursing and healthcare delivery organizations will implement the information competencies listed in Appendix.
By January 2012 Schools of nursing and healthcare delivery organizations will implement the transformed ECDL-Health syllabus items listed above. By January 2012 Resources HL7 EHR System Functional Modelhttp://www.hl7.org/EHR/ This ANSI standard can be used by nursing instructors in schools of nursing and healthcare delivery organizations to develop curriculum to impart the recommended information management competencies to all practicing nurses and graduating nursing students. ICDL-Health Syllabus http://www.ecdl.com
A significant portion of the HL7 EHR System Functional Model is covered by the ECDL- Health Syllabus. The ECDL-Health Syllabus was developed by the ECDL Foundation to extend the foundation of basic computer competency skills that are not industry specific into the healthcare industry. Digital Patient Record Certification (DPRC)http://dprcertification.com The DPRC Program was developed with a panel of U.S. informatics subject matter experts and is endorsed by the American Medical Informatics Association.
The DPRC web site states that it assesses a healthcare professional’s ability to accurately, dependably, and legally manage patient records in a digital environment. Health Information System Management Societywww.himss.org The HITS program, sponsored in the United States by the Health Information System Management Society, uses a more international version of the ICDL-Health syllabus. Both the DPRC and HITS certifications are a substantial first step towards achieving clinical information management competencies for U.S. nurses and graduating nursing students.
TIGER Informatics Competencies Collaborative Final Report �€” August 2009 9 References American Library Association (2000) Information Literacy Competency Standards for Higher Educationhttp://www.ala.org/ala/mgrps/divs/acrl/standards/informationlit