Chapter 11: Nursing Informatics and Healthcare Policy Policy is defined as a course of action that guides present and

future decisions. Healthcare policy is established on local, estate, and national levels to guide the implementation of solutions for the population's health needs. Healthcare Policy and Nursing Informatics as a Specialty As early as 1970s, Nurses have contributed to the purchase, design, and implementation of Information System(IS). In 1992, the American Nurses Association (ANA) recognized NI as a specialty. A specialty that integrates, nursing science, computer science to manage and communicate data, information and knowledge in nursing practice. To be acknowledge as a SPECIALTY within nursing, informatics had to Demonstrate a differentiated practice base Identify the existence of educational programs in the field Show support from nationally recognized organizations Develop a research agenda Domain of Nursing Informatics Focused in data and its structures, information management, and the technology, including databases, needed to manage information effectively. Also includes significant use of theory from linguistics, human-machine interface, decision science, cognitive science, communication, engineering, library science and organizational dynamics. The knowledge base is so extensive, informatics nurses tend to develop expertise in one aspect of the domain. Differentiated and Interdisciplinary Practice NI focuses on knowledge and skill on information and information management techniques. Informatics nurses should assist with The development and implementation of technology tools for clinical practice Evaluation of the effectiveness of technological tools on nurses work Help prepare nurses to use information technologies

The NI community believes it is essential to practice within and interdisciplinary team. For example the Vocabulary Summit held annually at Vanderbilt University since 1999 that is spearheaded by Judy Ozbolt. The NI supports interdisciplinary education. An example of this is the collaborative effort between the medical informatics(MI) and NI programs at the University of Utah. Preparation for Specialty Practice To become a specialty, it was necessary for NI to show that educational programs are available to prepare nurses to practice in the field According to Style (1989),on of the criteria for specialization should include the need for identifying a research focus.. A final requirement for a specialty is representation by at least one organization.

Philippines Manila, Philippines (June 29, 2010) -The Philippine Nursing Informatics Association (PNIA) took its first step to be recognized as a sub-specialty organization when it paid a courtesy call to the Philippine Nurses Association (PNA) PNIA envisions the advancement of nursing informatics in the Philippines through practice, education, research, and public awareness. The inclusion of informatics as an integral part of the undergraduate curriculum has been one of the most influential factors for the increased awareness and interest in this field of nursing. However, the contents of the curriculum were adapted from international materials which do not match the local needs. It is also a major thrust to support the use of health information standards in the Philippines and to have nursing informatics specialists in every hospital in the country. Healthcare Policy Impact on Nursing Informatics Practice Policy - course of action that guides present and future decisions Health care policy established on local, state and national levels to guide the implementation of solutions for the populations health needs IMPACT AND ISSUES: Nursing Shortage and Nursing Informatics Patient Safety Nursing informatics

Issue # 1. Nursing shortage and nursing informatics In 2002 HRSAs National Center for Health Workforce Analysis = a shortage projected for 2007 and already occurred by 2000. = causes projected: older nursing workforce, increased number of graduates with associated degrees than baccalaureate degrees, availability of more attractive career opportunities for women, decreased interest in nursing as a career, and difficult working environments. The Bureau of labor statistics (BLS) = is predicting registered nurse positions will increase more than 600,000 between 2002 and 2012 = to cover these new positions and replace retiring nurses 1.1 million more nurses are needed by 2012 (BLS,2004) Solutions to the Problem: Shortened program lengths and accelerated programs for baccalaureate degrees by schools and colleges of nursing Advocacy for increasing federal funding for program expansion, student loans, scholarships, and incentives by nursing organizations AAN advocacy of IT systems to support care and lighten the workload of nurses; development of a multiphase project to develop IT; IT as a marketing tool for nurses. IT as the Solution: Benefits decision support technology, streamlined, and integrated documentation support, measurement capability built into systems for determining intensity of care and outcomes, and workflow management tools use of portable and handheld devices, incorporate Internet capability to over come distance barriers of care and improve access to knowledge acquisition IT as the Solution: Benefits Wireless technology and personal digital assistants (PDA) that support nurses workflow Bar-coding of medications, use of speech recognition, and fine-tuning the user interface of systems to support nurses

Integration of clinical data repositories, multidiscipline documentation, and point of care devices help nurses share and access information in their work environments ISSUE #2: Patient Safety According to A Safer Place for Patients(National Audit Office, HC 456 Session2005-2006) The most common patient safety incidents in hospitals after patient injury (due to falls) relates to medication errors, record documentation error and communication failure. IOM report (1999)Between 44,000 and 98,000 patients die each year from medical errors. Surveys confirm that concern for patient safety is the biggest factor driving IT (Anderson, 2004). Over 600 participants in Health Data Managements annual CIO survey (2004), list prevention of errors as the main reason for increasing IT budgets. IT as the Solution: Benefits Computerized physician order entry (CPOE) systems reduce medication and communication errors Reduction of medical errors and improvement of quality and efficient care as advocated by Leapfrog Group, National Alliance for Health Information Technology(NAHIT), and Markle Foundation Clinical automation/information system Philippine Nursing Informatics Association (PNIA) Founded in 2010, PNIA is an association of Registered Nurses with a common vision to promote the use of Information and Communications Technology (ICT) to improve Nursing Practice, Education, Administration and Research in the Philippines. PNIA envisions the advancement of nursing informatics in the Philippines through practice, education, research, and public awareness. National Informatics Initiatives and Nursing Informatics Executive Order for National Interoperable Information System Incentives for the Use of Health Information Technology and Establishing the Position Coordinator (April 27, 2004) by Pres. George W. Bush states:

(1) Establishing a national health information technology coordinator position (2) Developing a nationwide interoperable health IT infrastructure that will reduce medical errors improve quality and communication of information and reduce healthcare costs (3) Developing, maintaining, and implementing a strategic plan for implementation of interoperable health IT in both public and private sectors All informatics professionals will need to help health care workers accept IT and push for implementation of CPOE. National Health Information Infrastructure (NHII) A 3-staged process of national voluntary initiative intended to improve the effectiveness, efficiency, and overall quality of health and health care in the United States Vision: development of a comprehensive, knowledge-based networks that integrate clinical, public health, and personal health information to improve decision-making behaving information available to providers Health Insurance Portability and Accountability Act (HIPAA) It was enacted under Pres. Bill Clinton in 1996 Act of 1996 which requires to improve public and private health programs by establishing standards to facilitate the efficient transmission of electronic healyh information. Significant impact on information also known as ADMINISTRATIVE SIMPLIFICATION. Timetable in HIPAA Oct. 16,2002 Electronic healthcare Transaction and Code setsall covered entities (except small health plans) April 14,2003 Privacy (except small plans) October 16, 2003 Electronic Healthcare Transaction- small health plans April 14, 2004 Privacy small health plans June 30, 2004 Employer Identifier Standard (except small health plans) April 21, 2005 Security Standard (except small heath plans) August 1, 2005 - Employer Identifier Standard small health plan April 21, 2006 - Security Standards small health plans of

security involving unsecured patient May 23, 2008 - National Provider Identifier small health plans

Privacy Standards New regulation effective Sept 23, 2009 require all physicians who are covered by HIPAA to notify patients if there are breaches f security involving unsecured patients information. Finalized rules adopting the HIPAA standard unique health identifier was published by CMS in FEDERAL REGISTRAR ( jan. 23, 2004) Privacy rule of HIPAA was published in Decmber 2000 and became effective April 14, 2003 Regulations requires the ff: Health plans Health care clearing houses Health care providers to protect and guard against misuse of identifiable ealth information. Informatics Nurses

Responsible for understanding and helping to implement the HIPAA regulations. Also in the position to research potential impact of regulations in patients can impact regulation by offering comments during the public comment period after the rules are published National Agenda for Nursing Informatics NNIWG make recommendation to the NACNEP for setting nursing information agenda NNIWG members are experts in decision support, distance education, informatics education, IS, language and taxonomies, and telecommunications 5 Assumptions to be the basis of NI initiatives 1. 2. 3. 4. 5. Learners are students, faculty and clinicians NI must be considered within an interdisciplinary context of partnerships and collaboration Efforts should target disadvantaged and undeserved populations Initiatives should be responsive to other government funding priorities Collaboration among federal agencies and between federal and private entities is necessary

5 Key directions recommended for informatics nursing Education and practice

has and which health measurements are required: Blood pressure Blood oxygen Pulse Blood sugar Weight Temperature Peak flow

1. Educate nursing students and practicing

2. nurses in core informatics content Prepare nurses with specialized skills in information Enhance nursing practice and education through informatics projects Prepare nursing faculty in informatics Increase collaborative in NI

3.
4. 5.

5 Strategies direction in NI 1. 2. 3. Include core informatics knowledge and skill in all undergraduate, graduate and continuing education programs. Increase the number of nurses with specialized skills in informatics. Enhance nursing practice and education through informatics projects. Improve faculty skills in NI so that they in turn can promote the development of informatics competency in students. Increase collaborative efforts in NI Telehealth and Nursing Informatics What is Telehealth?

Because of Telehealth services, tens of thousands of patients are accessing healthcare remotely from: Arctic villages Native American reservations Rural communities Prisons And urban areas that are medically underserved in the US.

4.
5.

Telehealth is the use of electronic information and telecommunications technologies to support longdistance:

Clinical healthcare Patient and professional Health-related education Public health Health administration

HOW IT WORKS? Telehealth can give an accurate and regular picture of a patients health and enables clinicians to identify trends, take more timely action to address issues and prevent exacerbations. The Telehealth equipment is simple to use and comes complete with all the appropriate devices used to monitor your health measurements. An installation engineer will install the monitor in your home and will train the patient in how to use the equipment. The monitor is connected to an ordinary telephone line and is programmed with a free phone number, so there is no cost to the patient. The data is sent through the telephone line to to a secure computer within minutes. A trained clinician (with appropriate access permissions) can then view the data and monitor the patient's progress remotely. This enables the clinician to build up a pattern of readings for each

Telehealth is a system that is installed in a patients home to enable them or their career to take a set of health measurements on a daily basis.

This technology allows us to remotely monitor people with long term conditions, The equipment given to the patient is dependant upon the Long Term Conditions (LTCs) that the patient

individual patient and identify changes in the patient's condition(s)

If any readings have fallen outside of acceptable limits for the individual patient, the clinician can then take an appropriate course of action. This may include:

ringing the patient directly to request more information or additional readings. speaking with others involved in the care of the patient arranging a home visit.

WHO CAN USE IT? Chronic Obstructive Pulmonary Disease (lung disease) Type 2 Diabetes Heart failure Hyper Tension