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Clinical Nursing Skills

4.3 Informatics

Clinical Nursing Skills4.3 Informatics

Learning Objectives

By the end of this section, you will be able to:

  • Explore the advantages, disadvantages, and capabilities of an EHR
  • Define meaningful use and list the main components of meaningful use legislation
  • Identify standard regulations relating to HIE

The field of healthcare informatics, or the field that incorporates health care and computer and information sciences, has drastically transformed the way the healthcare profession interacts (HIMSS, 2021). Communication is now transmitted through smartphones and web conferencing. Implementation of the EHR is one example of how the healthcare industry took advantage of this new digital platform. The seamless flow of information created by EHRs has changed the way patient care is delivered and how provided services are compensated. A few examples of how informatics has improved healthcare delivery include improved patient care outcomes, increased patient participation in health management, and improved care coordination among healthcare teams (Reid et al., 2021).

Real RN Stories

Nursing Informatics in Practice

Nurse: Gerald, CNS
 Clinical Setting: Pediatric acute care
 Years in practice: 28
 Facility location: Major metropolitan area in southern Louisiana

Nursing informatics today is more important than ever in the clinical nursing world. As clinicians, we must adapt to the ever-evolving EHR. From the bedside nurse to the executive leadership of a large hospital system, we use informatics to drive clinical practice and improve patient care outcomes. Often people wonder what the informatics nurse does behind the scenes.

As the Clinical Nurse Specialist of a large hospital system, let me tell you that informatics nurses are the bridge that connect hands-on clinical practice and information technology. They drive patient care outcomes and population health statistics and report data for government organizations, such as the Centers for Medicare and Medicaid Services.

One of the biggest drivers for me is patient satisfaction. Data gathered on real perceptions of patient experiences. The data are broken down into categories for improvement on a monthly basis. These experiences include things such as quiet at night, recommendation to others of the services provided by the hospital, education received about medications, and interactions with clinicians. Informatics nurses disseminate surveys to all the patients and then collect data to be analyzed. They then compare results to state and national averages. My department uses this information for quality improvement projects and unit-based policy changes.

Another important aspect of nursing informatics is improving workflow for the EHR based on users’ recommendations. Hospitals have regulatory bodies that complete accreditation visits in person on an annual basis, if not biannually. The accrediting bodies want data and the ability to review patient charts. As a Clinical Nurse Specialist, I would not have the ability to paint the full picture of what was done to the patient, their positive outcomes, and financial revenue without the use of informatics.

Capabilities of an Electronic Health Record

The ability to share real-time patient information means the physician can access critical data no matter their physical proximity to the patient. A provider can be in their offsite office and access the hospital’s EHR system remotely to analyze critical diagnostic results. The healthcare team can confidentially and securely share information about the patient’s status change or vital health history. A decreased likelihood of errors exists because all providers have access to the patient’s most current medication list. For example, if a patient is seeing one primary physician and three specialty physicians, they can all have access to all prescriptions, resulting in a decreased probability of duplicative treatment and medication errors. Patients receive a more tailored and individualized plan of care because of real-time data exchange. Fewer forms are needed if the patient is transferred between facilities, as the electronic version is constantly updated and transferred with the patient.

One of the newest capabilities of the EHR is patient engagement. Many providers give patients access to their EHR, allowing a more patient-centered approach to care. This permits patients the capability to answer their own questions immediately, instead of waiting for office personnel to return a call. Patient access to the EHR also allows for direct and private messaging to their providers.

Advantages

According to the American Nurses Association, care coordination among interdisciplinary healthcare members can be enhanced with incorporating electronic health records (Nelson & Parker, 2019). All departments have access to “real-time data” of vital information, without the need to wait for data transfer between departments. Primary care providers can easily distribute patient information to referrals or specialty care providers, without the previous lags in delivery. Clinical reasoning is improved because of access to more patient data, allowing for more well-informed decision-making and reduced safety risks. Additional advantages include efficient documentation that is legible; ability to collect and store data to be used for analytics; and built-in features, such as clinical decision support tools, electronic prescribing, and real-time data transfer to patient portals.

Disadvantages

Among the widespread advantages of EHRs, there are a few disadvantages. Technical challenges required health-care entities to develop their own information technology departments to handle these issues when they arise. Incorporation of the EHR has brought forth the need for policy revisions, organizational restructuring, and financial investment. These challenges, while adaptable, can be overwhelming to healthcare institutions. One of the most notable disadvantages of the EHR is related to user-related issues and design flaws. While informatics leadership has said that improved training and healthcare clinicians incorporated in the design process can alleviate these issues, it is still worth mentioning as one of the most cited disadvantages (Green, 2019). EHRs may also be a barrier to patients, particularly those who are unfamiliar with technology.

Meaningful Use and the Health Information Technology for Economic and Clinical Health Act

The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was signed into law on February 17, 2009. The main purpose of the HITECH Act is to promote meaningful ways to incorporate health information technology while still protecting patients’ privacy rights. It is important to note the HITECH Act played a significant role in the adoption of EHRs. They developed five main goals to help achieve this objective:

  • The first goal is aimed at improving how, why, and where information technology should be incorporated.
  • The second goal focuses on patients being active team members in their own care.
  • The third goal was designed to improve care coordination among various interdisciplinary team members.
  • The fourth goal is focused on improving population health through health information technology.
  • The fifth goal ensures privacy standards are incorporated through evaluation of security measures when using electronic health information.

Using electronic health information in a meaningful way to improve patient care is known as meaningful use. The U.S. government developed minimum standards defining ways in which healthcare information could be used. These standards outline how the exchange of information among providers, patients, and insurers should take place. There are five pillars of health outcomes that support meaningful use (Figure 4.11) (Particle Health, 2023).

A color graphic with five columns representing the CDC's Five Pillars for Meaningful Use. Above each column is text. That text from left to right is as follows. Ensure Privacy and Security; Improve Population Health; Improve Safety and Quality; Engage Patients and Families; Improve Coordination of Care.
Figure 4.11 The five pillars for meaningful use defines the exchange of healthcare information between providers, patients, and insurers. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Releasing Health Record Information and Health Information Exchanges

Release of information (ROI) in health care is critical for quality patient care and positive patent care outcomes. The ROI plays a role in reporting between entities, researching current best practice standards, and billing for services provided. The Department of Health and Human Services’ Office of Civil Rights (OCR) ensures HIPAA privacy laws are applied to the release of healthcare information and the surrounding usability. The term usability refers to the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency, and satisfaction in a specified context of use. A few of the steps involved in ROI include following quality control regulations between sender and receiver, validating data being released, and sending the information in a timely manner. Failure to follow the guidelines outlined by the OCR and incorrectly releasing health information can violate privacy policies and result in noncompliance penalties.

Health Information Exchange

A health information exchange (HIE) allows for the exchange of health-related information among all stakeholders involved. HIE allows patients and healthcare team members to exchange information safely and securely. The healthcare entities must be extremely careful when releasing a patient’s health information. Nurses should verify that consents to release information are signed by the patient. Nurses should pay particular attention to release requests involving anyone under the state’s designated age of majority.

There are currently three identified rationales for health information exchange: directed exchange, query-based exchange, and consumer-mediated exchange (ONC, 2019). Directed exchange is used for sending public data regarding immunizations to local and state public health organizations or for direct reporting to CMS for the purpose of quality control initiatives. Directed exchange is also used for sending pertinent health data between providers. Query-based exchange is used to research best practice standards and clinical sources by providers when delivering patient care. For example, if a provider is faced with a disease or condition they are not accustomed to treating, they can access the research databases on current practice guidelines. Consumer-mediated exchange allows the patient access to their own health information. This form of HIE allows the patient the ability to monitor their own health, identify any mistakes in the demographic information, and make sure billing information is current.

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