NURS 5051/ NURS 6051 week 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists
According to Glassman (2017), informatics is used by nurses to share patient information with colleagues and other staff, to store information, to abate mistakes, and to corroborate decision making. In the clinic setting, the electronic health record (EHR) is filled with an array of helpful data and directions in comparison to a paper chart. The helpful tools range from a daily schedule to a patient summary sheet comprised of a vital signs flow chart, all diagnoses chronic and historical acute, patient risk score, patient social history, family health history, past medical and surgical history, advance directives, allergies, current and historical medications, screenings, implantable devices, health concerns, goals, a list of all encounters, and messages.
On initiating a patient encounter, a notifications screen appears and if the patient is diabetic, has hypertension, or is of age for other screenings, an alert appears advising consideration of intervention. Next, an area for the patient’s chief complaint is labeled; followed by health concerns, last menses, and a vital signs flow chart with a calculated BMI on entry of the height and weight. Next on the encounter is a list of all historical diagnoses, allergies, medications, social history, and medical history. The provider note follows with a subjective, objective, assessment, and order space. In the order space, there are links for laboratory orders and imaging orders to be created. Included in the next aspect of the encounter is a segment for attachments to be submitted to the record. The observations aspect of the chart comes next and is comprised of functional status and cognitive status. Toward the end of the encounter is an attestation to diagnoses reconciliation and medication reconciliation. Next, an option to develop a care plan/ discharge instructions is available. The referral option is listed next, and this can be completed by a click which links to the directory, which houses all referral source and data related to telephone and fax numbers, as well as their address, and an option to send the referral from the EHR via fax. Lastly on the encounter, the option to create a superbill to include all diagnosis codes and all procedure codes for the visit can be completed.
A very important reason for utilizing an EHR is the reports which can be generated with a guided search. The reports include quality reporting, which comprises electronic clinical quality measures (eCQMs) used by Medicare and Medicaid for potential incentives to report using the Merit-Based Incentive Payment System (MIPS). Next on the page is a link for clinical reporting which can generated reports on chart notes, particular diagnoses, drug interactions, e-prescriptions report, continuity of care documents, medication reports, custom patient list reports, a prescription history from pharmacies and payers, history of all clinic prescriptions, and a report of all clinic referrals made. Finally reports pertinent to the practice management can be generated. Such reports include activity feed and audit reports, appointment reports, billing reports, payer reports, and prior authorizations.
Clearly, the clinical encounter has become very complex and better care is provided with the many alerts and safeguards in place. Furthermore, reports can be generated within minutes that would have previously taken days. A strategy that would improve informatics interactions in the primary clinic setting would be the option for diagnosis-specific templates to be clicked in with the option to check or circle selections or fill in as needed. The current EHR used in the clinic where I am requires typing out the information in the chief complaint, the subjective, objective, and the plan. The medications do appear in the plan automatically on sending the electronic prescription. There are likely such EHRs out there, but area task to explore; as most require registration of the clinic in order to watch a demonstration video. On registration in the past, sales personnel have called the clinic immediately and persistently.
In considering the impact of the continued emergence of new technologies might have on professional interactions, McGonigle and Mastrian (2017) advise that the EHR has a disordering effect on the patient encounter. However, they also advise that EHR technology provides efficacy and improvements in safety (McGonigle and Mastrian, 2017). Their suggestion is to find strategies that incorporate both the EHR and face to face care of patients (McGonigle and Mastrian, 2017).
Wang, Kung, and Byrd (2018) advise that the potential benefits of the EHR leave healthcare facilities little option in embracing the idea and moving forward to work toward strategies to combine the face to face encounter and the EHR in providing the best organizational care for patients. They say that data from EHRs can provide care pattern analysis, offer data analysis, offer decision guidance, provide predictive capacities, and provide traceability (Wang, Kung, and Byrd, 2018).
In the clinic where I am, I have witnessed frustration with the EHR requiring focused attention, while the provider would prefer face to face flowing interactions with the patient. A $2000 Dragon Medical Practice voice recognition tool was purchased for dictation to soon be laid aside in hopes of finding something that would work better. As the search continues for an EHR that offers a more comfortable way to provide duties of care in nursing science, such as healing conversations, providing attentive listening, providing a comforting touch and confirmation of understanding as patients seek for care to maintain, improve, or restore their mental and physical health as described by McGonigle and Mastrian (2017), providers and nurses must continue to embrace the EHR.
References
Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)
Wang, Y., Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting & Social Change, 126, 3–13. https://doi-org.ezp.waldenulibrary.org/10.1016/j.techfore.2015.12.019
Discussion: Interaction Between Nurse Informaticists and Other Specialists
Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.
Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.
In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.
To Prepare:
Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.
By Day 3 of Week 3
Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.
By Day 6 of Week 3
Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.
*Note: Throughout this program, your fellow students are referred to as colleagues.
NURS_5051_Module02_Week03_Discussion_Rubric
Grid View
List View
Excellent
Good
Fair
Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.
Demonstrates synthesis and understanding of learning objectives.
Communication is professional and respectful to colleagues.
Responses to faculty questions are fully answered, if posed.
Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.
Communication is professional and respectful to colleagues.
Responses to faculty questions are answered, if posed.
Provides clear, concise opinions and ideas that are supported by two or more credible sources.
Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.
Responses posted in the discussion may lack effective professional communication.
Responses to faculty questions are somewhat answered, if posed.
Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.
Responses posted in the discussion lack effective professional communication.
Responses to faculty questions are missing.
No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
My career as a nurse has allowed me to interact with individuals who hold different critical roles within my healthcare system. Nursing informaticists and technology specialists fill some of these roles. I must confess that my interactions with technology specialists and informatics nurses are not always some of my favorites. They are often filled with feelings of confusion and frustration. Often when I am communicating with a technology specialist during my work day, it is because something is not functioning properly at my job site. Sometimes it is software and sometimes it is hardware, but whatever it is, it is always frustrating. I call the IT department to see if they can fix my problem from behind their screen. Some of my frustration stems from that fact that our IT department is offsite so I never get to meet who I am speaking to. Also, I often have to hold because other people are on the line in front of me; meanwhile, I have patients who I need to take care of. Most times the IT specialist is able to fix my problem, but sometimes they have to elevate my issue to the “EPIC power team” to see if it can get solved. This process always takes more than a few minutes and can sometimes delay my patient care.
I think to improve upon some of these interactions, it would be nice to have a technology specialist on site to come assist us with our problems. Maybe they could carry a pager so they could come help us right away instead of troubleshooting an issue with me on the phone. I think I would feel less frustrated if someone actually came to help.
My interactions with informatics nurses have been different, yet somehow just as frustrating as working with offsite IT. My first interactions with informatics nurses occurred when my institution rolled out EPIC for the first time. We had all hands on deck from the EPIC support team. The nurses they sent in to help us were disengaged and far removed from the work we had to do on our unit. We felt like we had to beg for any help we could get and pull the informatics nurses away from their phones in order to be assisted. Recently, I have had to work with informatics nurses again to roll out a new EPIC program. The unit staff and I agreed that the nurses seemed too far removed from bedside nursing to understand some of the issues we were experiencing. They did not want to hear about our optimization requests because they just “wanted to give it time”. It is difficult to hear as a bedside nurse that a certain charting flow is being taken away because someone who does billing or chart audits wanted the program changed. Some of the nurses had cheerful attitudes which made the changes easier to take, but some of them had a “take it or leave it” kind of attitude that played into some of our frustration.
I think that Glassman (2017) made some great points on requirements of informatics nursing students. In order to be a quality informatics nurse, it’s important to understand the strengths and weaknesses of the technology system you are using. Some of my frustration recently was that the informatics nurse helping me with our new system simply would not agree with me, or the surgeon I was with, that the old way of doing something might have been better or less cumbersome than the new way. We just needed our feelings to be heard, but she refused to do that for us. I also like that Glassman (2017) added that taking the nurses’ input into account is an important aspect to being a nurse informaticist. It is essential to us to know that we are being listened to by those designing and assisting with new programs.
Another way to avoid poor interactions between bedside staff and technology staff, is to make sure that from the beginning, each system is being designed in a user-centered way (McGonigle & Mastrian, 2017). By keeping the end-user in mind during the creation and roll-out of programs, minimal effort and maximum efficiency can be achieved (McGonigle & Mastrian, 2017). This is what everyone wants in the end. Keeping nurses involved in the creation of new programs makes them feel heard and letting them be a part of the decision making process ensures that the end result is what they want.
I believe that as EHR systems are around longer, more optimization opportunities will arise. We will be seeing more informatics nurses and technology specialists buzzing around our units. I think that in the future every nursing unit may have an informatics nurse hired on staff to help with unit specific issues. Hopefully they can be trained to assist with both physician and nursing EHR documentation. Tele-health and Tele-nursing will be a larger part of our healthcare picture (Babes, 2019). The constant exchange of information and use of EHR/video systems will require more assistance than is currently offered through our facility. The role of the informatics nurse is growing and the demand will continue to increase as well (Babes, 2019). Our hospitals will have to prepare for an increased need in human technologist resources.
References
Babes, V. (2019). Informatics in nursing. Current and future trends. Applied Medical Informatics, 41(1). Retrieved from https://ami.info.umfcluj.ro/index.php/AMI/article/view/749
Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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