The Use of Informatics as a Tool of Practice and the Major Issues for Nursing in Its Uptake - Essay Example

Nursing and Health Informatics Over the past several years the framework of healthcare has seen enormous changes, with focus shifting from the provider in the institution to the patient at home. These changes are conditioned by several drivers, major ones are the economic need to control the costs spent on healthcare in an ageing community setting at the time when institutional care and technology costs are escalating, increasing consumerism leading to the appearance of the "informed patient" and, finally, the extraordinary innovations in communication technology and the Internet evolution. Due to the latter, clinical care can now be delivered electronically which triggered emergence of such subject as health informatics and "Australia is at the leading edge of these developments" (Yellowlees, Brooks, 1999, 4) As Coiera writes, "If physiology literally means 'the logic of life', and pathology is 'the logic of disease', then health informatics is the logic of healthcare. It is the rational study of the way we think about patients, and the way that treatments are defined, selected and evolved. It is the study of how clinical knowledge is created, shaped, shared and applied. Ultimately, it is the study of how we organise ourselves to create and run healthcare organizations." (Coiera, 2003, 1) Health informatics is about clinical guidelines, information and communication systems as Internet, formal health languages. However, all this is only a means to achieve the goal - to deliver the best healthcare possible. Advances in computer technology fuelled the growth and importance of health informatics as a clinical discipline, which resulted in new ability to manipulate health knowledge at fundamentally higher abstract level and to develop effective communication systems to support and take care of the healthcare process. Thus, health informatics can be defined as "the study of information and communication systems in healthcare." (Coiera, 2003, 3) There are a lot of directions in which healthcare IT industry can develop and recent years have seen new trends emerging in this field. New radio frequency identification (RFID) technologies are among the key developments. While bar coding which is already being used is perfect for medication management and an important supplementary tool for other purposes, newly emerging active RFID is very well suited for tracking the flow of patients and personnel as well as physical assets. (Hagland, 2005) The electronic health record (EHR) is fast progressing toward its adoption. EHR is "the deep, digitized, contextual and lifelong patient record that clinicians can access in-house to facilitate better care" which can be accessed and added to by patients without their being able to edit or change machine- or physician-generated data. (Featherly, 2005, p. 42) In order to identify high-risk patients disease management programs are used these days, which use computerized patient registries with patient-service checklists and even electronic alerts on patients who miss tests or services. So disease management is another facet of modern healthcare, which includes programs that combine "patient education, behavioral-change initiatives and clinical care regiments that help providers, patients and payers achieve the long-term goals of chronic care." (Tabar, 2005, p. 38) Biosurveillance (syndromic surveillance) software is going to take an important place in healthcare, being able to identify contagious disease outbreaks with great precision and accuracy. It has the huge potential and advantage for public health officers, as biosurveillance software is able to detect disease outbreaks an average 18 days sooner than human experts can. It is a perfect tool to detect bioterrorism. (Baldwin, 2005) These are only few out of practically limitless possibilities in health informatics field. Among other possible developments are integration and interoperability of picture archiving and communication systems (PACS), IT and biomedical devices, patient-centric portals, telehealth etc. (Healthcare Informatics: Nine Tech Trends, 2005) Australia is well placed in keeping ahead with these innovations, especially with the funding provided by the Federal Government of the Cooperative Research Center for Distributed Systems Technology to the Center for Online Health at the Queensland University for a long-term research program. There is support for related activities in private industry as well as on the national level the great assistance for the integration of information and health technology industries is shown by the Collaborative Health Informatics Center. (Yellowlees, Brooks, 1999) As Parliamentary Secretary for Health, Trish Worth, says in her opening speech for "the Nursing in a Technological World" Conference (2003), "in Australia, as in many other countries, health care involves both the public and private sectors, and multiple levels of government. Without national collaboration, there is a real risk that we could end up with fragmentation, duplication, and the development of incompatible information systems" and indicates the Commonwealth Government initiatives which are being developed and utilized on the national level. (Worth, 2003, 9) The major strategic plan for health information management throughout Australia is Health Online, which visualizes a health system transformed and significantly improved by better use of health information, re-defined health services and the cost-effective information and communication technologies use. (Worth, 2003) Endorsed by the National Health Information Management Advisory Council (NHIMAC), Health Online: A Health Information Action Plan for Australia provides the basis for "a national strategic approach to health information, involving new ways of delivering health services." Its main goal is to provide a common vision and purpose while placing information management at the heart of the healthcare system and seeking new communication and information technologies that will improve information flow and support and empower consumers and communities. (NHIMAC, 2001, p. 3) HealthConnect is a government initiative that provides health professionals with secure and quick access to important medical information. It is basically a network of electronic health records created in order to improve the information flow across Australia's health sector. (About HealthConnect, 2004) An important component of HealthConnect is MediConnect, its medication counterpart, developed to ensure improved prescribing and medication management. (Worth, 2003) "Computer support reduces serious prescribing errors by 55%, and overall prescribing errors by about 83%", which takes care of the medication error, the most common reason for adverse clinical events. Now about 70% of Australian general practitioners prescribe electronically. (Coiera, 2001, 2) The Commonwealth-sponsored Internet site - HealthInsite - provides reliable up-to-date health information through a single Internet gateway. More and more Australians nowadays are turning to the Net to obtain health information and while a lot of it is useful, some information is of questionable quality. To tackle this issue and to address the increasing consumer potential to get health information on the Internet and the absence of quality control of web services, Government developed the strategic plan to deliver services via the Internet - HealthInsite. (The HealthInsite Concept, 2004) Now, "HealthInsite links to more than 65 information partners, has over 10,000 individual resources and is viewed by more than 3,000 visitors per day." (Worth, 2003, 20) So, as can be seen from the above information, there's been a profound transformation of service practices and a lot of advances in information technology systems in the Australian healthcare setting. The sector has received a substantial funding and the degree of investment is the proof that policy makers strongly believe in the ability of information management systems to significantly improve patient care and to produce quality health outcomes. And as it is noted in "A Framework for Nursing Informatics in Australia" (2004), "to maximize a return on a considerable information technology investment in the health sector, it is essential that the nursing profession is engaged in all stages of planning. This will ensure its information and knowledge management needs are met, and that it has the knowledge and skills to engage with and use the new technologies." (NIA, 2004, p.1) Nursing profession should be involved in each and every planning stage of technology development and appropriate support and training should be provided to nurses as only then will the health sector receive the potential benefits and financial and human resources will be utilized in the best way possible. (NIA, 2004) Health informatics is very important to the future of nursing as it affects nursing theory, practice, education and research. Over the last decade there've been considerable advances of technology in nursing in terms of treatment technology (high frequency ventilators) as well as communication technology (computerized medical records). Technological innovations give rise to a whole range of challenges faced by nursing which include education and training, understanding and managing the technology, even dealing with ethical questions that arise from the possibilities offered by new technologies. (Worth, 2003) In this paper, I am going to discuss the importance of health informatics in nursing field, the history of nursing informatics, government initiatives created to develop the new tools of information technology for nursing, challenges that are present in this sphere as well as opportunities and advances of health informatics in nursing practice in Australia. In a situation of rapid change during recent years, the existing and future capability of healthcare workforce is being questioned. Some of the reasons for such concern are an ageing population, appearance of new diseases and new treatments and technologies, changing and improving employment patterns, a much needed focus on indigenous and rural health, litigation trends, the limited growth in the workforce of Australia. (AIHW, 2004) In this respect, nursing in the whole healthcare industry is the most important and "the largest single group of health professionals who directly influence the quality and outcomes of most health services." (NIA, 2004, p.8) Out of 450,711 health workers employed in Australia in 2001, more than half - 244,473 (54%) were employed in nursing field. (AIHW, 2004) This number has grown since and at present constitutes more than 250,000 members. Nursing is also "one of the few professional groups caring for patients around the clock, seven day a week, across all settings." (NIA, 2004, p. 8) Nurses are also the only group to provide continuity of care; they are able to affect a patient's stage of treatment in terms of quality outcomes and safety, which depend on them so much that it sets them apart from other health workers. Historically, nursing has been the interface between other health professionals and now, it has grown to become the central unifying component of the health care delivery system in the 21st century. (Queensland Nursing Council, 2002) However, the development and improvement of health informatics naturally triggers technological advances in healthcare and the latter gives rise to a whole range of challenges for nursing to deal with. Considerable changes in health industry require nurses to be adequately educated and trained. "Technological innovation has implications for the nature and shape of nursing workforce. A more highly skilled workforce is required to meet demand. The implications for competency standards and education are far reaching." (Worth, 2003, 26) Another problem is the lack of nursing staff in Australia. Partly, it is explained by new treatment technologies that allow rapid assessment, treatment and discharge of patients from hospitals, which results in patients coming back to the community with more complicated healthcare needs. This, in its turn, leads to an increased demand for nursing personnel in community health, outside hospital facilities and general practice. "The shortage of nurses is a worldwide phenomenon, and Australia is also suffering the effects of challenges in nursing recruitment and retention, which both shape, and are shaped, by recent technological change." (Worth, 2003, 32) Even though nursing informatics in Australia started developing around 1984, there is still a lot of concern about the practically non-existent visibility of nursing in information agenda and very small amount of opportunities for nurses to engage in, or respond to, specific health informatics initiatives. It is acknowledged that nursing professionals are the primary source to observe and report their patient's conditions changes, to alert the other health practitioners to these changes and therefore their communication encompasses all other care providers. And still, "they are involved in IT implementations more by serendipity than as the target group." (NIA, 2004, p.4) That's why the crucial step in the development of nursing informatics in Australia has been the establishment of an Informatics Management Center for Nurses. Created by Nursing Informatics Australia (NIA), a special interest group of Health Informatics Society of Australia (HISA), Informatics Management Center for Nurses aims at eliminating fragmentation of the response to eHealth initiatives and disengagement of nurses in them; the Center will try to avoid waste of money, effort and time spent for stand-alone projects that are not able to address the needs of nursing generally, as these are the problems experienced at present by nursing informatics undertakers. Australia lacks an infrastructure to promote collaborative work on a national level that will also ensure greater nursing professional participation in adoption of health informatics initiatives. "Australia has emerged as a world leader in the sharing of clinical information between providers via the HealthConnect program; however, nursing has not been involved to the extent that it should. The program requires greater nursing participation and a structured program to support nursing and to ensure its success in nursing informatics capacity building. Without these measures, nursing will not be fully engaged and HealthConnect and Australian Health Information Council (AHIC) projects will be jeopardized." (NIA, 2004, p.13) To address all these issues the Informatics Management Center for Nurses is created so that nursing is provided with service delivery that is able "to traverse locations and geographical settings" and also provide help to achieve cost-effective, quality patient outcomes on a national or statewide basis. (NIA, 2004, p.5) This is what is being done on a national level, but on a more local and personal one, basically the vital role of nurses is to ensure a patient's safety, and while providing high-quality, safe patient care they often face a lot of challenges, which are being tackled now by nursing informatics. At present, it is quite difficult for nurses to ensure consistently safe, quality patient care, as care processes are still predominantly manual. In such environment, "'silos' or barriers exist between the nurse, physician and other care providers resulting in less than adequate collaboration and communication, inefficiency, and an absence of an interdisciplinary approach." (Patient Safety and Nursing, 2004, p.2) Today, nurse has to deal with an enormous amount of paperwork and red tape, which lessens the time for patient care. Here is when nursing informatics comes to help. Automation and the right information technologies can drastically improve the nursing practice and help achieve the best patient outcomes in the safest way and give better opportunities for nurses to care for their patients. (Patient Safety and Nursing, 2004) According to HIMSS Nursing Informatics Survey (2004), "Patient safety is a well-documented priority for healthcare organizations. Reflecting this emphasis, a recent survey has identified CPOE, clinical information systems and bar coded medication management as three top applications that healthcare organizations will focus on in the next several years." And nurses play the critical role in adoption and implementation of these systems. (HIMSS, 2004, p.8) Ideally, the modern workplace for a nurse will be computerized to reduce the time spent on paperwork in favor of the direct patient care, and will look approximately like this: CPOE - computerized provider order entry MAR - medication administration record Kardex - a check-in record (HIMSS, 2002, p.8) Case studies also prove the effectiveness of such approach. For example, case study conducted by Agency for Healthcare Research and Quality, confirms that computerized information system can considerably reduce the time spent by nurses on documentation. The research centered on the effects of computerized medical information management system in ICU, recording and comparing all the tasks performed by ICU nurses before and after the system's installation. "The results showed a decrease in the time spent on documentation from 35.1 percent of the nurses' time to 24.2 percent of their time. This equates to saving 52 minutes in an 8-hour shift or more than one hour in a 12-hour shift. At the same time, the researchers documented an increase in time spent on direct patient care from 31 percent of nurses' time to 40 percent of their time." (AHRQ, 2003, 2) As the number of clinical systems in health care organizations of Australia is increasing, there is a need for the new kind of professionals who are literate both in nursing and IT. So a new profession appeared, that of a nurse informaticist. A lot of healthcare providers are now employing nurse informaticists "to help educate their biggest group of clinical information systems users - nurses." (Schuerenberg, 2005, 19) The expanding role of nurse informaticists provides health industry with "a resource that has the knowledge and skill necessary to identify and implement innovative solutions." (HIMSS, 2002) The nursing profession is a combination of various practitioners working in numerous settings. Information technology can and does significantly redefine the boundaries between these settings as it provides support to healthcare workers by ensuring access to timely, quality data and information. Nursing informatics creates a variety of new possibilities for the use and dissemination of information that enable Australian government initiatives, such as HealthConnect to show improved performance and outcomes in nursing field as well as across the whole health sector. (NIA, 2004) References: About HealthConnect. (2004). A Health Information Network for All Australians. Retrieved June 8, 2005 from A Framework for Nursing Informatics in Australia. A Strategic Paper. (2004). Nursing Informatics Australia (NIA). Retrieved June 8, 2005 from Baldwin F.D. (2005). Emergency Preparedness. Healthcare Informatics Online. Retrieved June 8, 2005 from Case Study Finds Computerized ICU Information System Can Significantly Reduce Time Spent by Nurses on Documentation. Press Release. (October 10, 2003). Agency for Healthcare Research and Quality (AHRQ), Rockville, MD. Retrieved June 8, 2005 from Coiera E. W. (2001). Health Informatics. Updates in Medicine. The Medical Journal of Australia. Retrieved June 8, 2005 from Coiera E. (2003). Introduction to health informatics - the systems science of health care. Guide to Health Informatics 2nd Edition. Retrieved June 8, 2005 from Commonwealth of Australia. Australia's health. (2004). Australian Institute of Health and Welfare (AIHW), Canberra. Retrieved June 8, 2005 from Featherly K. (2005). Electronic Health Record. Healthcare Informatics Online. Retrieved June 8, 2005 from Hagland M. (2005). Bar Coding and RFID. Healthcare Informatics Online. Retrieved June 8, 2005 from Healthcare Informatics: Nine Tech Trends. (2005). Healthcare Informatics Online. Retrieved June 8, 2005 from Health Online: A Health Information Action Plan for Australia. Second Edition. (September 2001). National Health Information Management Advisory Council (NHIMAC). Retrieved June 8, 2005 from 2004 HIMSS Nursing Informatics Survey. (2004). HIMSS. Retrieved June 8, 2005 from Patient Safety and Nursing: Transforming the Work Environment with Technology. (2004). McKesson Corporation. Retrieved June 8, 2005 from Queensland Nursing Council. Application of the framework in nursing practice. (2002)., Brisbane. Schuerenberg B.K. (2005). Nurses' New Duty: Caring for I.T. Health Data Management. Retrieved June 8, 2005 from Tabar P. (2005). Disease Management. Healthcare Informatics Online. Retrieved June 8, 2005 from The HealthInsite Concept. (2004). An Australian Government Initiative. Retrieved June 8, 2005 from Using Innovative Technology to Enhance Patient Care Delivery. American Academy of Nursing Technology and Workforce Conference. (2002). Healthcare Information and Management Systems Society (HIMSS). Retrieved June 8, 2005 from Worth T. (2003). Nursing in a Technological World Conference: Evidence, Practice, Future. Australian Government. Department of Health and Ageing. Retrieved June 8, 2005 from Yellowlees P. M., Brooks P. M. (1999). Health online: the future isn't what it used to be. The Medical Journal of Australia. Retrieved June 8, 2005 from Read More