NURSING INFORMATICS
AND HEALTHCARE
POLICY
HEALTHCARE POLICY AND NURSING
INFORMATICS AS A SPECIALTY
 Nurses have contributed to the purchase,
design, and implementation of IS since the
1970s.
 In 1992, the American Nurses Association
(ANA) recognized NI as a specialty.
 Attempts in 1989 to be recognized as a
specialty failed, but political forces within ANA
supported the requests when it was repeated
in 1992.
 To be acknowledged as a specialty with nursing,
informatics had to demonstrate a differentiated
practice base, identify the existence of
educational programs in the field, show support
from nationally recognized organizations, and
develop a research agenda.
Nursing Informatics (NI)
-The term NI first appeared in the literature in the
1980’s.
-The definition of NI has constantly evolved since
that time, molded by the maturation of the field
and influenced by health policy.
 NI was defined as the combination of nursing,
information, and computer sciences to manage
and process nursing data into information and
knowledge for use in nursing practice.
 A specialty that integrates nursing science,
computer science, and information science to
manage and to communicate data, information,
and knowledge in nursing practice.
 The domain of NI is focused on data and it’s
structures, information management, and the
technology, including database, needed to
manage information effectively
 Also include significant use of theory from
linguistics, human-machine interface, decision
science, cognitive science, communication,
engineering, library science and organizational
dynamics.
DIFFERENTIATED AND
INTERDISCIPLINARY PRACTICE
 As the document emphasizes, NI brings an
added dimension to nursing practice that
focuses on knowledge and skill in information
and information management techniques.
 NI practice differentiates itself from other
areas of nursing practice but emphasizes its
interaction with informatics disciplines such
as mathematics, statistics, linguistics,
engineering, computer science and health
informatics.
 NI has been described as one example of a
specific domain of informatics that falls under
a broader umbrella of health informatics
 Other examples of domain- specific
informatics practices are medical informatics,
dental informatics and consumer informatics
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.
 Between 1988 and 1992 the Division of
Nursing (DN), Health and Human Services
Administration (HRSA), funded two Master’s
NI programs, University of Maryland and
University of Utah and one doctoral program
in NI at the University of Maryland.
 Finally, in 1997, an NI specialty program was
implemented at Duquesne University in
Pittsburgh
 The field of NI has slowly expanded since
1992.
HEALTHCARE POLICY IMPACT ON
NURSING INFORMATICS PRACTICE
NURSING SHORTAGE AND NURSING
INFORMATICS
• Nursing has experienced a number of
shortages in recent history.
• It is predicted that the shortage will result in a
large deficit of nurses
• Unless something is done the shortage will
rise from 6% in 2000 to 29% in 2020, or more
than 800,000 nurses short of the number
needed
 To cover these new positions and replace
retiring nurses 1.1 million more nurses are
needed by 2012.
 Nursing organizations have been actively
advocating for increased federal funding to
expand programs and increase loans,
scholarship, and incentives to attract more
young people into nursing.
 In 2002 the AAN Commission on Workforce
launched a multiphase project to develop IT
that will help support nurses in their day-to-day
Work, thereby reducing the demands of their
jobs.
*Given the average age of nurses is 45.2,
technology devices would enable some
nurses to stay in their careers longer.
PATIENT SAFETY AND NURSING
INFORMATICS
 The IOM determined that adverse events
(injuries caused by medical management)
occurred in 2.9 and 3.7% of admission
 Among other strategies the report
recommended the implementation of
computerized physician order entry (CPOE)
systems to reduce medication errors.
 A follow-up report, strengthens the arguments
for using technology to improve patient safety.
 Proposals to increase patient safety with IT
have been made by a variety of groups.
 The National Alliance for Health Information
Technology (NAHIT) is a partnership of
diverse healthcare leaders who are working
to influence the use of technology to improve
the patient safety, quality and efficiency.
NATIONAL INFORMATION INITIATIVES
AND NURSING INFORMATICS
 Clinical information systems (CIS) were
introduced in some form during the 1970s
and informatics professionals have discussed
the need for system improvement,
integration, and wider dissemination since
that time.
 Escalating healthcare costs and the
availability of improved and cheaper CIS are
additional driving forces.
 An additional IOM report states even more
emphatically that electronic medical records,
using standard data elements, are a critical
tool to improve patient safety
 On April 27, 2004, Pres. George W. Bush
issued an executive order “ Incentives for the
Use of Health Information and Technology
and Establishing the Position of the National
Health Information Technology Coordinator.
 Components of the order are (1) establish a
national health information technology
coordinator position; (2) work to develop a
nationwide interoperable health IT
infrastructure; and (3) develop, maintain, and
direct implementation of strategic plan to
guide implementation of interoperable health
IT in both public and private sectors.
NATIONAL HEALTH INFORMATION
INFRASTRUCTURE
 Another national initiative that will impact NI is
the National Health Information Infrastructure
(NHII). This voluntary initiative, involving a
three-stage process over 10 years, is
intended to improve the effectiveness,
efficiency and overall quality of health and
healthcare in the US.
 The vision and process for building the NHII
is outlined in a report “Information for Health
Information Infrastructure released in Nov.
2001
 NHII calls for comprehensive knowledge
based networks that integrate clinical, public
health and personal health information to
improve decision making by having
information available to providers.
HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT (HIPAA)
 HIPAA was passed in 1996 and is intended to
improve public and private health programs
by establishing standards to facilitate the
efficient transmission of electronic health
information (Public Law,104-191, 1996)
 HIPAA preempts state law and payer-specific
variations of data standards; and mandates
input from private, standard-setting
organization.
 The law also designates financial setting
penalties for noncompliance with standards
related specific transactions.
 To avoid further duplication of effort, the law
requires the DHHS to adopt standards from
those already approved by private standardssetting organizations.
 HIPAA has a significant impact on informatics;
IT must be designed to comply with Title II of
the act.
NATIONAL AGENDA FOR NURSING
INFROMATICS
 The DN, HRSA is responsible for settg
national policy to guide the preparation of the
nursing workforce, including preparation in
the area of NI.
 The DN recognized the importance of
information management and technology long
before the title NI was used to describe the
field of practice and has funded projects
focused in this area since 1972.
 Although the DN supported NI projects, the
nursing workforce has continued to be
deficient in informatics skills.
 As a result, in 1997 the DN convened the National
Nursing Informatics Work Group (NNIWG) to make
recommendations to the National Advisory Council
for Nurse Education and practice.
 The first strategic direction of NI is to include core
informatics knowledge and skill in all
undergraduate, graduate, and continuing education
programs.
 The second strategic direction of NI is to increase
the number of nurses with specialized skils in
informatics. Having more opportunity to complete
advanced informatics preparation has increased the
number of NI specialists in practice, but more are
needed.
 A third strategic direction of NI is to enhance
nursing practice and education through
informatics projects.
 The fourth strategic direction for NI is to
improve faculty skills in NI so that they in turn
can promote the development of informatics
competency in students.
TELEHEALTH AND NURSING
INFORMATICS
 Telehealth is the use of electronic information
and telecommunications technologies to support
long distance clinical healthcare, patient and
professional health-related education, public
health, and health administration
 There has been a significant disconnection
between telehealth and informatics. Telehealth
organizations such as te American Telemedicine
Association are largely separate from informatics
organizations, such as AMIA; the two entities
need to become better aligned or promote
development to seamlessly document telehealth
events.
 Informatics nurses need to help to integrate
telehealth technologies and IS so that patient
encounters became part of the computerized
patient record and informatics issues such as
standards and language are systematically
addressed.
 Informatics nurses need to become involved
in telehealth and inform other nurses about
uses of telehealth technologies