The use of informatics has become an essential component of providing quality healthcare. The Institute of Medicine (IOM) has elected the use of informatics as its fifth and final core competency for healthcare providers. The utilization of informatics has become the main stream approach for nursing care today. This fifth core competency is directly intertwined with the four previous competencies that have been outlined by the IOM. Patient centered care is the first of the core competencies. Utilizing informatics can assist nurses in providing patient centered care by decreasing the amount of time spent on documentation and searching for data. For example, by having an electronic medical record (EMR) available, less time is spent on searching for lab results and information needed to provide care for the patient. Results are more readily available and communication between nursing, ancillary staff and providers is more fluid. This time saver can allow the nurse to spend more time at the bedside. The second core competency is to work in inter professional teams. The use of informatics plays a large part in the effectiveness of this competency.
By focusing on electronic communication in which progress notes are available for everyone to see, it helps to ensure that everyone is up to date on the patient’s progress. This can be extremely beneficial when determining a safe discharge plan for the patient. By having progress notes readily available from the therapists, nursing, pharmacy and so forth, one can feel confident that the patient will be discharged safely. The patient may feel that they are able to handle being at home alone, when in fact the therapists are recommending an interim stay at rehab. By having informatics available it helps the interdisciplinary team approach work more effectively. Evidence based practice (EBP) is the third competency outlined by the IOM. “Utilizing evidence might impact interventions such as prevention, diagnostic tests, or therapy; affect the ability to compare alternatives; and in some cases, lead to the decision that no intervention is the best choice (Finkelman & Kenner, 2013, p. 338).” The use of informatics can help to increase the availability and use of EBP.
The use of EMR can help to ensure that all nurses are performing tasks and charting the same way. For instance, if a wound care nurse has discovered a new process for treating decubitus ulcers based on EBP, they can incorporate this into the EMR to ensure that everyone is charting the same information (after it has been approved). Quality improvement is the fourth core competency. Informatics can play a huge part in improving the quality of care. If a facility is trying to decrease the number of catheter acquired urinary tract infections (CAUTI), they can begin to track data directly from the EMR. The infection prevention nurse is able to set filters to track all of the patients that have Foley catheters in place, and how many acquire an infection during their hospitalization. This information can be extremely beneficial to determine if prevention measures are proving to be effective or not. This is just one example of how the use of informatics can make a huge difference in improving the quality of care that patients receive. Informatics Importance in Healthcare
Informatics can be defined as an integration of nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice (Finkelman & Kenner, 2013). The use of informatics has changed the way care is delivered by increasing communication between healthcare providers and with patients as well. More than ever information is available at everyone’s fingertips. Whether it is a patient accessing WebMD to find information regarding their diagnosis, or a physician looking into a new surgical procedure. There are many reasons as to why informatics is proving to be beneficial in the delivery of quality healthcare. The use of an EMR can help to streamline patient care. When results are readily available, a treatment plan can be put into in a timely manner. Some healthcare facilities have implemented a my health portal. This portal allows patients to communicate with their physician. This is extremely beneficial for patients that may have questions that do not warrant a clinic visit.
The portal also allows patients to look up recent lab results after they have been reviewed by their provider. If rolled out effectively, this system can increase the communication between physicians and their patients. The use of informatics can also help to reduce the amount of medication errors. The IOM states that as many as 98,000 people die each year from medication errors which in turns costs our healthcare system 29 million dollars annually (American Association for Justice, 2012). Some facilities are implementing a new way to administer medications to their patients. The use of automated medication dispensers along with bar coding is helping to decrease the amount of medication errors. This is effective because the medication orders for that patient are linked to their bar coded wrist band. If the medication selected does not match the patient’s bar code, it will advise the nurse to not administer the medication. The automated medication dispenser will only dispense medications that are specific to that patient. “Barcoding systems are expensive to install and maintain, but can make a difference in reducing errors (Finkelman & Kenner, 2013, p. 413)”. Examples of Healthcare Informatics
Computerized monitoring of adverse events can be very beneficial when trying to determine trends. If a facility is noticing that a lot of patients are being placed on certain units inappropriately, they can assess the incident reports that are submitted to identify trends. Is it a certain provider that continually admits patients to the wrong service? Do they need to provide more education? By collecting and analyzing the data, they can help to decrease the amount of adverse effects. This benefits nursing staff in many ways. If nurses are noticing trends they are able to document this information and submit it in one place. It is an anonymous way to let their voices be heard. A provider order entry system is another example of healthcare informatics. The major benefit of having this system in place is that it eliminates the legibility component. This also takes out the process of transcribing orders before they can be implemented. Physicians also have the capability of utilizing standardized order sets which makes their workflow more efficient.
When physicians are able to enter their own orders, it can alleviate stress from nurses. Nurses are still able to enter verbal orders if the physician is not by a computer, but the majority of the order entry should be coming from the providers. Nurse call systems have long been an important aspect of delivering quality care. Call systems come in many forms and vary between facilities. Most call systems have the ability to call into the patient’s room to determine their need, and vice versa, the patient/nurse can call out to the desk. Some systems may also include nurse locators. They are very beneficial in the fact that staff can be located throughout the unit. The locators can be programmed so each nurse can be assigned to their patients.
If their patient needs assistance, it will directly notify them. One major benefit of the call system is the ability to get in touch with as many individuals as possible during an emergency. Access to the patient record at the point of care is also an example of informatics. Nurses that are able to chart their assessment at the bedside are more likely to chart an accurate assessment. Bedside computers allow the nurse to chart her assessment while it is still fresh in their memory. It is also helpful to look up test results for the patient in their room. By having a bedside computer, it can help to open the lines of communication between the patient and staff. Physicians are able to go over scans with the patient; they are able to give them a visual as opposed to drawing diagrams. This is beneficial for patients that are visual learners. Documentation
The importance of documentation has come a long way. It is not only an important piece in providing safe care, but also for legal and reimbursement purposes as well. In today’s society, healthcare reimbursement is a hot topic. In order for a facility to receive optimum reimbursement, they need to be sure that each patient has thorough and accurate charting completed. Insurance companies and Medicare have the ability to reevaluate charts years later to determine whether or not an admission was valid. If not, that facility runs the risk of having to pay Medicare the difference. Financially this could be the fate of some facilities that are not compliant with charting and billing. In terms of legal issues, it is imperative that medical personnel chart every aspect of the care that they are providing. If it was not charted, it was not done. It is so important that nurses give themselves credit for the work that they do by documenting it.
Every aspect of healthcare is being scrutinized, especially by the public. Unfortunately in this day and age, more of the population has resorted to taking legal action if they do not receive the outcome that was expected. It is especially important for physicians to thoroughly document when they explain the risks/benefits for procedures and what the patient’s response was. Documentation can also play an integral part in tracking trends within a facility. Data collection is more accurate when utilizing the EMR. If the administrative team is wondering how many of their patients have experienced a sentinel event within the past year, that can be tracked. It is also helpful in gathering data to submit to the Center for Disease Control. Especially when tracking trends such as the number of patients are affected by CAUTI. Electronic Medical Record
The implementation of the EMR plays a vital role in decreasing errors and increasing quality of care. A lengthy planning process takes place before an EMR program can be implemented. During this process, data and information is collected to determine what should be included in every aspect of documentation and ordering tests. With this, order sets can be created to ensure standardized care. For example, if a patient comes into the emergency department with a diagnosis of an acute coronary syndrome (ACS), the physician can select the specific order set for this diagnosis. By doing this, a predetermined set of tests and orders will automatically be implemented. This helps to ensure that all core measures are being met pertaining to that diagnosis. This helps to ensure that all physicians are following the same protocols. The use of the EMR can also help with a hospitals throughput process. With the utilization of a bed board, the house supervisor is able to see the hospital as a whole. If implemented, the bed board will also detect when patients have discharge or transfer orders.
This comes into play when the hospital is full and movement needs to occur to facilitate incoming surgical patients and admissions. The bed board can also let the housekeeping department know when a patient is discharged. This ensures that the rooms get turned over in a timely manner. Provider entry is another aspect of the EMR that helps to improve patient care. Gone are the days when the nurses had to decipher a physician’s handwriting. Having the physician order medications and tests themselves, eliminates the possibility that the nurse may interpret the orders as they see fit. It gives the nurses less responsibility in transcribing orders. It also is beneficial that a physician is able to enter orders from home if need be. When physicians enter their own orders, they eliminate the unnecessary phone calls from nurses wondering what they really ordered. Confidentiality and Informatics
Confidentiality is a major component of delivering quality care. Every patient should have the right to keep their medical history and record private. The use of informatics can help to determine when healthcare workers are unnecessarily looking into patient records. Some EMR systems have the ability to put extra security on patient records that are employees of the facility. This is in place to ensure that people are not looking into the chart because they are curious. Another benefit of the EMR is that they are able to track each and every individual that looks into a chart. This in itself can help to decrease the amount of curious individuals. With and EMR system in place, there are usually multiple computers available for the staff to utilize.
It is so important that every time an employee is done with a computer, they log out. That is one of the downfalls of the EMR. If you do leave your computer unattended, it is easy for someone to access information through your username. Logging out is a habit that every healthcare worker needs to adopt. One thing that has not changed with the increased availability of informatics is the importance of confidentiality. Patients are still not allowed to access their own medical record without permission form the physician. Families are also not permitted to look at their loved ones record without consent from the patient. More than ever these particular rules still stand. Response
we have been fortunate enough to have our EMR for the past year and a half. If has definitely had a positive impact on the way that we deliver care. For my job in particular, it has had a huge impact. It has allowed me to manage the patient flow a lot more effectively. At any time throughout the day I am able to see exactly what is going on. It has been beneficial not only for me but for our patients as well. We are excited to have our new patient portal called “My Health”. This has proved to increase the communication between patients and their providers. Soon we will be implementing online appointment scheduling as well. All of these initiatives help to improve the experience for the patient. The more accessible we can make healthcare, the happy the patients are going to be. I do feel that anything that we can do to increase communication will elevate the patient’s experience.
American Association for Justice. (2012). Preventable medical errors, the sixth biggest killer in america. Retrieved from http://www.justice.org/cps/rde/justice/hs.xsl/8677.htm Finkelman, A., & Kenner, C. (2013). Professional nursing concepts: Competencies for quality leadership (2nd ed., pp. 3-51). Burlington, MA: Jones and Bartlett Learning.