Learning Objectives
By the end of this section, you will be able to:
- Discuss the impact of information technology on health care
- Identify ways that information technology transforms direct and indirect patient care
- Discuss the nurse’s role in fostering the use and advancement of technology in health care
In recent years, information technology has been at the forefront of revolutionizing numerous industries, and health care is no exception. The integration of technology into health-care systems has led to significant advancements, positively impacting patient care and outcomes. As the health-care landscape continues to evolve, nurses find themselves at the forefront of this digital transformation, playing a vital role in leveraging technology to improve health-care services.
Impact of Information Technology on Health Care
Information technology has revolutionized health care and will continue to do so in the future. Key areas of influence include:
- Communication: EHRs, telemedicine, and secure messaging systems have significantly improved communication between health-care providers and patients, enabling more timely and efficient exchange of information.
- Patient outcomes: Information technology has facilitated the use of advanced diagnostic tools, personalized treatment plans, and evidence-based practices, all of which contribute to improved patient outcomes. Real-time data monitoring and predictive analytics also help in early detection and prevention of medical conditions.
- Data utilization: The integration of big data analytics in health care allows for the collection, analysis, and interpretation of vast amounts of patient data, enhancing overall clinical decision-making, supporting research and development, and enabling health-care providers to deliver more accurate and effective care.
- Operational efficiency: Automation of administrative tasks, such as appointment scheduling, billing, and inventory management, has streamlined operations, reduced errors, and increased efficiency in health-care facilities.
- Patient engagement: Health information technologies, such as patient portals and mobile health applications, empower patients to take an active role in managing their health. These tools provide access to medical records, facilitate appointment bookings, and offer educational resources to support informed decision-making.
- Security and privacy: Advanced IT solutions have improved the security and privacy of patient information through the implementation of robust encryption protocols, access controls, and compliance with regulatory standards.
Communication
Information technologies have led to enhanced communication among the patient, provider, and care team. Through use of technologies such as EHRs, messaging systems, and patient portals, coordination of care has been enhanced. All parties can access the most up-to-date information, ask and answer questions, and review the plan of care to ensure understanding. Enhancing communication has resulted in benefits such as informed decision-making, stronger relationships, and decreased delays in care.
For example, patient portals allow patients to access their personal health information and provide two-way communication with their provider. Telemedicine has provided the opportunity for patients to receive care via real-time, two-way communication with a provider or via asynchronous transmission of patient information. Messaging systems allow nurses to quickly send medical updates and questions to the provider without causing interruptions to their workflow.
Other technologies have impacted communication during transitions of care. “Hand-off” communication tools have structured the reporting of patient-specific information from one caregiver to another. Discharge summaries provide a snapshot of the patient’s condition, care that was provided, necessary education, and home care instructions. Not only have discharge summaries enhanced communication for patients upon discharge, but they also serve to ensure continuity of care upon transfer to other levels of care, thereby protecting patient safety.
Patient Outcomes
Information technologies are a valuable tool for improving health-care quality and safety. Technology has improved the accuracy, speed, and accessibility of diagnostics and has the potential to decrease the severity of chronic illnesses due to earlier detection and intervention. Telehealth platforms, for example, leverage technology to remotely monitor and manage chronic conditions. Patients can use wearable devices to track vital signs, and health-care providers can access real-time data to make timely adjustments to treatment plans; these practices enhance accessibility to care, reduce the need for frequent in-person visits, and help manage chronic illnesses more effectively. It has also led to enhanced patient safety by reducing medication errors, reducing adverse drug reactions, improving compliance to practice guidelines, and enhancing care coordination.
For example, computerized provider order entry (CPOE) has allowed providers to enter medical orders directly into the patient’s electronic medical record. Not only has this practice reduced the human error in transcribing orders, but it has also been instrumental in catching possible medication order errors, such as prescribing a medication that the patient may be allergic to or a medication that is contraindicated. Clinical decision supports—such as notifications, alerts, reminders, clinical guidelines, condition-specific order sets, clinical summaries, documentation templates, and diagnostic supports—have supplied providers with the necessary information to make informed decisions to support patient care.
Other examples of how technology has impacted patient care can be identified within the medication administration process. Bar code administration has helped to ensure the right medication for the right patient. Smart pumps are programmed to reduce errors with intravenous (IV) administration. Automated dispensing cabinets are electronic drug cabinets that store and dispense medications at the point of care. Medications may be placed within the patient’s profile by the pharmacy, thereby reducing the risk of the nurse removing the wrong medication. Additional features—such as dual-sign off on “high risk” and controlled medications (e.g. insulin, heparin), use of red or tall lettering to identify look-a-like drugs, and providing access to only the intended medication—have been implemented to enhance medication administration safety.
Clinical Safety and Procedures (QSEN)
Leveraging Technology for Enhanced Health-Care Quality and Safety
Information technologies stand at the forefront of advancing health-care quality and safety, offering a myriad of benefits that positively impact patient outcomes.
- Patient-centered care: Innovative tools such as AI-powered diagnostics and genomic medicine accelerate diagnostic processes, enabling a patient-centered approach by swiftly identifying conditions and potentially mitigating the severity of chronic illnesses.
- Evidence-based practice: Embracing EHRs ensures adherence to practice guidelines, promoting standardized and evidence-based care. This technological integration reduces medication errors and adverse drug reactions, contributing to enhanced patient safety.
- Quality improvement: The use of technology in chronic disease management, including remote monitoring devices and telehealth platforms, fosters continuous quality improvement. Real-time data exchange allows for timely interventions, ultimately reducing the severity of chronic conditions and improving overall health outcomes.
- Safety: Electronic communication platforms and health information exchange systems play a crucial role in enhancing care coordination. By enabling real-time collaboration among health-care teams, technology contributes to a safer health-care environment, reducing the likelihood of errors.
By integrating these technological advancements, nurses are better equipped to provide patient-centered, evidence-based care, foster continuous quality improvement, and enhance safety measures, aligning with the core competencies outlined by the Quality and Safety Education for Nurses (QSEN).
Role of Data in Patient Care
Information technologies provide insightful data that can be analyzed to improve the delivery of health care for individuals and populations—for example, by investigating methods of improving the provision of clinical care, enhancing disease prevention, and measuring the effectiveness of various treatment options. Technologies that enable the collecting and storing of data in real time have led to improved decision-making, advancements in treatment analysis, production of research, and root-cause analyses when a breakdown in care is identified. By identifying warning signs in data, providers can implement interventions before a disease or condition worsens. Data collected during the COVID-19 pandemic, for example, allowed for contact tracing of the virus and tracking of “hot spots” that experienced a high incidence rate of the virus. In collecting and analyzing this data, public health officials could identify trends and put measures in place to decrease the spread of the virus.
Link to Learning
Read this article for more information about the benefits of data analytics in health care from Maryville University.
The role of data in health care cannot be underestimated. Data is needed for continuous improvement in what we do and how we do it. For data to be meaningful, however, it must be accurate, complete, reliable, relevant, and timely. Data must also be standardized to allow for a mutual understanding of the data and interoperability between systems. Four types of standards must be addressed (Table 37.3): terminology standards, content standards, data exchange or transport standards, and privacy and security standards.
| Type of Standard | Purpose | Example |
|---|---|---|
| Terminology | Ensure clarity of meaning, help to provide a mutual understanding of what is meant, and ultimately help to reduce miscommunication | ICD-10 codes to codify medical diagnoses |
| Content | Ensure that medical data is properly organized and represented in forms that are clear and easy to understand | Rules for structuring medical records or encoding data elements |
| Data exchange/transport | Facilitate the movement of information between different health systems | The exchange of direct personal health information from one provider to another |
| Privacy/security | Establish rules to protect sensitive health data | HIPAA |
Transforming Patient Care
New, innovative information technologies are transforming both direct and indirect patient care. The comprehensive integration and adoption of digital technologies, processes, and strategies across an organization to fundamentally change how they operate and deliver value, or digital transformation, gives health-care organizations the opportunity to gain a competitive advantage by modifying their business processes, culture, and customer experiences. Organizations can leverage digital technologies to improve operational decision-making related to patient flow, staffing, scheduling, and supply chain management. For example, a decision-support algorithm can be used to remove bias from operational tasks or predict the level of care a patient may need or the number of expected admissions, discharges, and transfers during a specified time period. Algorithms can also be used to predict nurse absenteeism to determine staffing patterns and needs. Data related to the timing of procedures, time spent in the post-anesthesia care (PACU), and timing of discharge education can be used to create scheduling algorithms. In terms of supply chain management, radio-frequency identification (RFID) technologies can be used to track and locate supplies and devices, and electronic databases can be used to keep track of supplied inventory, in both cases decreasing operating costs for the organization.
Information technologies have also improved the workload of nurses and other care providers. For example, the process of centralizing patient records into EHRs has eliminated time spent searching through paper charts, helped to clarify and streamline the documentation of care, and enabled the setting of electronic reminders for tasks that need to be completed. Such time-saving measures create more time for nurses and providers to spend with patients.
Technologies intended to improve safety, efficiency, and quality are also transforming how we deliver care and the resulting patient outcomes. The way care was delivered ten years ago is quite different than today, and the care we deliver today will look very different in ten years. Rapid advances in care will be revolutionized through evidence-based practice (EBP), research, advances in technologies, and federal regulatory organizations such as The Joint Commission and the Centers for Medicare and Medicaid Services.
Smart Beds
A smart medical bed is a highly innovative hospital bed with additional technical features that support best practice for patient care. They are a Class 2 medical device (which are subject to specific regulatory controls to ensure their safety and efficacy) and have become a gold standard in patient care. High-tech beds reinforce patient safety and improve patient care outcomes.
Available features depend on the type of bed purchased; however, most smart beds include fall prevention features. Bed alarms signal staff when the patient is getting out of the bed. Some beds are even programmed with verbal commands that will tell the patient not to get up until help arrives. As an added feature, the verbal prompts can sometimes be set in different languages to accommodate diverse patients. Additional safety features to prevent falls include motion-activated night-lights and reminders for the health-care staff, such as alerts if the wheels are not locked or the bed alarm is not set.
Data captured from smart beds can be used to improve patient care. For example, by conducting a debrief in the event a patient falls to determine which settings were activated, how long the bed alarm had been sounding, and how the patient had moved prior to the fall. The data may also be used to prevent falls: for example, by analyzing the patient’s movements to determine which bed alarm setting would be most appropriate for the patient.
Smart beds can also be used to reduce the prevalence of pressure ulcers. The latest mattresses include pressure-redistribution functions that help to redistribute weight over bony prominences. Some mattress surfaces are made of “microclimate” technology that reduces body heat and absorbs excess moisture, thereby preventing the breakdown of skin. Additional features may also include supports to help the care team turn the patient.
By utilizing special sensors, smart beds can also capture data that may be used to support clinical diagnostics. Some beds can detect the patient’s pulse, respirations, and temperature. If abnormalities are noted, the provider or health-care team is alerted to check on the patient. Smart beds can also capture patient weights—they can even be programmed to subtract the weight of the bed linens from the patient’s weight to ensure accuracy.
Other features enhance convenience for the patient: for instance, a call bell may be built into the side rails for use when the handheld call bell cannot be reached. Some beds also include USB ports for the patient to charge their electronics and storage compartments for easy access to their belongings. Additional features to support patient comfort include adjustable head and foot positions, back and leg massagers, and Bluetooth speakers.
Wearable Devices
A wearable device is a health monitoring device worn on the body to monitor health data. Using biosensors, wearable devices can collect data such as heart rate, blood pressure, respirations, sleep patterns, activity, blood glucose, and more. These devices can be used to monitor fitness, wellness, and disease management; to store patient health information; and to provide patient reminders (Smuck et al., 2021).
There are many different types of wearable devices on the market, with new technologies constantly being developed. Smartwatches, for instance, can detect oxygen saturations and pulse and provide ECG readings. While smartwatches cannot provide accurate blood pressure readings, there are blood pressure cuffs that will automatically connect to a smartphone to store data that can be shared with the provider. Fitness trackers can be used to measure heart rate, steps, activity, and sleep patterns. A continuous glucose monitor (CGM), a device to automatically estimate blood glucose levels, can be scanned to provide blood sugar readings (Figure 37.8). Sensors reduce the need for routine finger sticks (finger sticks are still needed for calibration and quality control) and allow blood sugar readings to be shared instantaneously with the provider. All these technologies enable patients to take a more proactive approach to their health and well-being, while also sharing important data with their providers.
Smart Pumps
A smart pump is an intravenous (IV) infusion device that combines computer technology and drug libraries to limit the potential for medication errors. Embedded software provides a drug library that stores usual concentrations, dosing, and dose limits for each medication. The nurse may search the drug library for the medication to be administered, automatically populating the pump settings. Safeguards can also be programmed to alert the nurse if the dose exceeds a predetermined limit. These features reduce the likelihood of the medication being programmed and delivered incorrectly.
Additional safety features of smart pumps include alerts of possible adverse drug reactions and the ability to input patient weight to determine the appropriate dose of medication. Smart pumps also provide a variety of alarms to alert the nurse of line occlusions, air bubbles, and completed infusions, as well as reminders to start the infusion and plug the IV pump into the power outlet.
Many smart pumps enhance interoperability by integrating the IV pump with the patient’s EHR. Bar code medication administration allows the medication to be verified within the patient’s orders. Once the medication is scanned, the EHR will then send the administration details (such as medication name, rate, dose) to the smart pump for the nurse to verify before initiating the administration. Following this process minimizes the risk of human error in programming the smart pump and promotes accurate documentation of medication administration in the EHR. Two-way communication between the smart pump and the EHR enables the pump to feed information (such as volume infused and rates of titratable drugs) back to the EHR, reducing the need for the nurse to manually input this information into the chart. Nevertheless, the nurse administering the medication is ultimately responsible for any errors that may occur, so they should always have a questioning and critical thinking mindset as they work.
Like other information technologies, smart pumps produce data that may be captured, stored, and analyzed. Drug libraries, for instance, detail the lower and upper bounds that govern each medication’s safe infusion rate—information that can be used to support point-of-care decisions. If a hard stop is overridden, data can be collected to determine the date, time, nurse, and reason selected for the override. In the event of a medication error, data can be reviewed to determine if the drug library was used to program the pump, if the correct medication was selected from the drug library, and if the pump was programmed correctly. Vital signs, such as continuous capnography of respirations and pulse-oximetry, can be collected when patient-controlled analgesia is used. These data can be automatically populated in the EHR, and the care team can be alerted of the potential for adverse reactions, such as narcotic-induced respiratory depression.
Role of the Nurse
Nurses play a vital role in fostering the use of technology and supporting the advancement of technology in health care. As nurses, we must embrace the reality that technology is here to stay and use it to our advantage to deliver the very best care possible. When we embrace technology, we open the door to possibilities that will transform the nursing profession and enhance the provision of quality outcomes in health care.
How nurses perceive technology will influence the perceptions of others and ultimately impact the usage and acceptance of technology within the health-care arena. It is important that nurses take the lead in the transformation of services and involve themselves in all aspects of designing, developing, and implementing technologies. The feedback from nurses regarding the performance of technology is invaluable in shaping the adoption and improvement of new tools in health-care settings. Nurse managers recognize the significance of frontline health-care professionals’ experiences and insights in assessing the practicality and effectiveness of technology. Nurses’ opinions serve as a crucial gauge of usability, functionality, and overall impact on patient care. This user-centric approach allows nurse managers to make informed decisions about technology adoption, ensuring that the tools align with the workflow, enhance efficiency, and contribute positively to patient outcomes. Regular feedback loops also empower nurses to play an active role in the iterative improvement of technology, fostering a collaborative and adaptive approach to health-care innovation.
Education
One of the primary roles of nursing is education. We educate our patients on all aspects of care, including technology. As nurses, it is our responsibility to educate our patients about the role of technology in health care, its benefits, and the ways in which it facilitates the delivery of care.
We should encourage patients to embrace technology and empower them to use technology to take an active role in their care. One way to do this is to educate patients on how to set up and use a patient portal. Engaging in discussion and offering to assist with setting up their account before leaving the visit will increase the likelihood of successfully creating their portal account. Once logged in, nurses can help patients to navigate the portal and locate important features they may frequently use. Similarly, we can help patients to set up telemedicine accounts and demonstrate how to request and access a visit. Patients should also be educated on what to expect during a telemedicine visit, as well as tips to enhance their experience, such as minimizing background noise and distractions and setting up audio and video in advance.
As patients take a more active role in their care, nurses may need to teach them how to locate credible sources of health information that are current, relevant, accurate, serve the right purpose, and are sourced by experts with authority in the topic. Even with the increased use of technology and the internet in today’s world, we need to be cognizant that not all patients have access to such digital advantages. The gap between those who have and those who lack access to the internet and such technologies is referred to as the digital divide. As health-care providers, we need to be aware that the digital divide exists and ask our patients if they have access to the internet before providing them with electronic and web-based information sources and options of care.
Nurses also play a role in educating fellow nurses and providers. A nurse who takes the lead in implementing new technologies can become a super user: a clinical end user who receives specific training that enables them to provide support and education to others. Not only do super users provide technical support, but they also serve to create excitement, engagement, and ownership in the implementation of the technology.
Informatics
From their position at a patient’s bedside, nurses are key informants about current trends, needs, ideal workflows, challenges, and gaps in care. By involving nurses from the beginning of the technology design process, technologies can be developed with the end user in mind to address actual health-care issues, which may sometimes be different than what developers originally planned to address.
Involving nurses in the development of technologies will enhance the user’s experience when interacting with an object, a product, or a service. The concept of user experience focuses on who the user is, what they need, what their abilities and limitations are, and if they value the product, system, or service. The goal of creating a good user experience is to maximize usefulness and pleasure in using the product, service, system, or interface. Nurses may also improve usability, the ease with which people can use a product to achieve a certain goal.
Strategies for Staying Current
As nurses, we must continuously strive to stay abreast of the most current and up-to-date methods for delivering care. This includes staying well-informed on current uses of informatics and information technology, implications for practice, and data usage, as well as future trends of care. As such, nurses should participate in continuing education opportunities as informatics and information technologies continue to be developed.
Several well-regarded organizations provide educational opportunities, advocacy, and continuing development within the realm of health-care informatics. The Healthcare Information and Management Systems Society (HIMSS) is the oldest nursing informatics organization. Created in 1961, this organization is the global leader in health innovation, public policy, and workforce development. Other professional organizations can be found in Table 37.4; they exist alongside many others that continue to develop as the specialty of health informatics accelerates. It is important for nurses to take an active role in these professional organizations to stay up-to-date on the continual evolution of health-care technologies and to bring the nursing perspective to conversations about the future of care.
| Professional Organization | Mission | Strategic Goals | Website |
|---|---|---|---|
| American Medical Informatics Association (AMIA) | “AMIA aims to lead the way in transforming health care through trusted science, education, and the practice of informatics. AMIA connects a broad community of professionals and students interested in informatics. AMIA is the bridge for knowledge and collaboration across a continuum, from basic and applied research to the consumer and public health arenas.” (AMIA, n.d., para 1) |
|
https://amia.org/ |
| American Nursing Informatics Association (ANIA) | “The purpose of ANIA is to advance nursing informatics through education, research, and practice in all roles and settings.” (ANIA, n.d., para 1) |
|
https://www.ania.org/ |
| Alliance for Nursing Informatics (ANI) | “To advance nursing informatics practice, education, policy, research and leadership through a unified voice of nursing informatics organizations.” (ANI, n.d., para 1) |
|
https://www.allianceni.org |
| American Health Information Management Association (AHIMA) | “AHIMA is the leading voice and authority in health information, wherever it is found. Our people work at the intersection of healthcare, technology, and business.” (AHIMA, n.d., para 1) |
|
https://www.ahima.org/ |
| International Medical Informatics Association (IMIA) | “. . . to bring people together from around the world to advance biomedical and health informatics science, education, and practice through mutual learning and exchange of knowledge, skills and ideas.” (IMIA, n.d., para 2) |
|
https://imia-medinfo.org/wp/ |
Another way nurses can stay well-informed about the evolving field of informatics is by reading current literature. Several journals that are geared toward health informatics include the Journal of Healthcare Information Management, Online Journal of Nursing Informatics, JAMIA (the Journal of the American Medical Informatics Association), and CIN: Computers, Informatics, Nursing, and International Journal of Medical Informatics. As the nursing informatics specialty continues to grow, new journals may be created to disseminate the important work and knowledge that result.
Nurses interested in a career in informatics may obtain an advanced degree or certification in the field. While some entry-level informatics positions do not require an advanced degree, earning a master of science in nursing (MSN) or a doctor of nursing practice (DNP) provides nurses with considerable professional opportunities. Most graduate nursing programs that provide a specialization in informatics focus on health information systems, data management, or health law/ethics. Upon completion of a graduate program, one may earn their certification in informatics nursing by sitting for a national certification exam such as the Informatics Nursing Certification Exam, established by the American Nurses Credentialing Center (ANCC). HIMSS has also established two exams: the Certified Associate in Healthcare Information and Management Systems (CAHIMS), for relatively new informaticists, and the Certified Professional in Healthcare Information Management Systems (CPHIMS), for more advanced informaticists.
Beyond Bedside
While all nurses are users of nursing informatics, it is important to note that nursing informatics is considered a nursing specialty. A nurse who works within this specialty is called an informatics nurse specialist (INS). This specialty of nursing is unique because it brings clinical knowledge to the world of technology to create useful and usable solutions to make nurses’ lives easier and patient care safer and more effective. Informatics nurse specialists have contributed to health care through the purchase, design, and implementation of information systems, as well as by developing, critiquing, and promoting standard terminology to be used in health-care informatics. According to the U.S. Bureau of Labor Statistics, employment for health informatics specialists is projected to grow 9 percent between 2020 and 2030 (U.S. Bureau of Labor Statistics, 2022).
With the advent of nursing informatics as a specialty, the American Nurses Association (ANA) developed scope and standards of practice for nursing informatics. There are a wide variety of roles in which nurse informaticists can apply the ANA scope and standards of practice. They can take charge of planning and managing informatics projects through a project manager role. They can become consultants and share their advice, opinions, and recommendations with others. They can be educators, developing and implementing trainings and educational materials for organizational systems or upgrades. They can create new informatics or clinical knowledge as researchers. They can design, produce, or market new informatics solutions or products as product designers or developers. As decision support or outcomes managers, they can work to ensure that data integrity and reliability are maintained. They can advocate for patients and support the development of health-care policy. As clinical analysts, they can function as liaisons between the worlds of clinical practice and information technology. Informatics nurse specialists may also become entrepreneurs, creating marketable business ideas, solutions, or products for the health-care market.
Not only do nurse informaticists have the potential to impact the delivery of health care, but they are also involved in what can be a very financially rewarding career. According to a 2020 survey conducted by the Healthcare Information and Management Systems Society (HIMSS), 49 percent of nursing informaticist salaries reached $100,000 per year and 10 percent of salaries reached $151,000 or higher (HIMSS, 2020). Obtaining a doctorate degree or certification in informatics contributed to the highest salaries, as did experience in the field.
Link to Learning
To learn more about nursing career opportunities in the field of informatics, read this interview with nurse informaticists from the Healthcare Information and Management Systems Society (HIMSS).