Welcome to Mastering Informatics: A Healthcare Handbook for Success, written by a team of professionals who are passionate about what they do—and it shows in the chapters that follow. The authors are on the front lines performing the work they write about, and they have the experience to know what works, what does not work, and what to avoid while implementing evidence-based best practices. The science and evidence surrounding the use of clinical systems is still relatively young but growing. Informatics began within the lifetime of most of us currently working in the health-care field, driven by the invention and implementation of the electronic health record (EHR). In this book, the authors combine the available evidence with their experience in order to disseminate best practices. Contained within these chapters are concepts that lay the foundation for strong informatics practice, and content that covers several emerging trends. The primary goals for this book are to:
Provide readers with an understanding of the essential concepts of informatics in the healthcare environment
Provide readers with an understanding of emerging trends in healthcare informatics
Provide readers with resources, guidelines, ideas, and tools that can be applied to current informatics practice
Although EHRs and clinical systems in general have been in existence for decades, their use has been limited to the larger, more-aﬄuent healthcare systems and academic medical institutions. With the signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, however, EHRs have seen a significant increase in adoption. Many organizations have already benefited from the CMS incentive program and have received millions of dollars for the meaningful adoption of these systems. With increasing adoption, the need for informatics resources has also increased. Many nursing and clinical informaticists transitioned into their positions from super-user roles during or after a system implementation. They proved themselves during the process and found themselves enjoying the work. These informatics workers possess "on the job" experience, but lack the applied science that exists in the field of informatics. Informatics has evolved into a specialty that possesses a unique body of knowledge backed by science, and this book provides an essential guide to surviving in many of these new and emerging roles. The emphasis here is on practical application of informatics concepts, an area where current literature is still evolving.
An estimated 8,000 nursing informatics specialists are practicing in the United States, but this is more than likely an underestimation. Nursing informatics specialists—whether a new informatics nurse receiving on-the-job training or an experienced nursing informaticist looking for the latest evidence and experience to improve practice—will find this book's tools and practical information helpful. Additionally, this book will be helpful for the hundreds of newly emerging healthcare IT professionals moving into the field of informatics as a result of the funding from the HITECH Act. The Oﬃce of the National Coordinator for Health Information Technology (ONC) Workforce Development Program has conducted multiple initiatives to increase the training capacity within a network of more than 90 academic institutions. More than 17,000 healthcare IT professionals have now graduated from the Community College Consortia, and another 1,747 from university-based training programs (ONC, 2013). This book focuses on key informatics concepts to increase knowledge and credibility as informaticists grow in their roles. The core concepts in this book transcend care settings and clinical disciplines. The information is intended to assist nurses, physicians, pharmacists, and other clinicians who are employed in informatics roles at primarily operational levels and are responsible for the management of clinical systems across all care settings—acute care, ambulatory settings, and home health, among others.
The book begins with the components or phases of the system development lifecycle (SDLC). These phases include Planning and Analysis, Design and Usability, Testing, Training, Implementation, Maintenance, and Evaluation. Each phase is defined, described, and explored. Ensuring a solid foundation of knowledge of each phase provides the best chance of success throughout the life of any clinical system. A firm grasp in each of these areas is essential regardless of whether you are an informatics nurse, physician, pharmacist, dentist, dietician, or other clinical professional. With a sound working knowledge of each phase, your value to the organization only increases.
As the chapters progress from planning to evaluation, it may appear that systems follow a linear path as they proceed through their lifecycle. The truth is that although a system generally follows this pathway, it can go backward or forward to any phase, depending on the scenario. For example, in a system that has been in place for years, you may go back to the design phase to improve usability and streamline a process that takes a user multiple clicks with navigation through many screens. Or, it becomes apparent that education needs to be reinforced in a particular area, and end users are re-trained. Or, after an unexpected downtime, the system needs to be tested to ensure appropriate functioning. To add complexity, you may be dealing with several of these phases concurrently. The bottom line is that each phase is essential to your informatics practice. The first eight chapters will help develop your background knowledge in these areas and provide multiple resources to use as your skills continue to develop.
Following the SDLC content, chapters address informatics infrastructure essential to the optimization, maintenance, and safety of clinical systems. For example, Chapter 9 covers evidence-based guidelines for success that include information adopted from the principles supported by the Project Management Institute (PMI). Chapter 10 covers key concepts to ensure that these systems are secure and backed up appropriately, and provides best practices in the area of ensuring privacy and appropriate access to clinical systems. Chapter 10 also addresses system interruptions, a hot topic today, as organizations look for guidance on how to negotiate the dreaded system downtime.
The introductory chapter (Chapter 11) on clinical decision support (CDS) provides definitions and descriptions of how it can be used to impact care delivery. This broad topic can encompass many things and truly does include a wide array of concepts, many proven to be successful. In this chapter, CDS is defined along with examples for implementation and evaluation. Chapter 12 discusses the importance of integrating standard terminologies into the EHR. We are at a point in EHR evolution where this is important, but lack the knowledge on where to start. This chapter provides methods for informaticists to begin to incorporate standard terminologies into their systems. The final chapter in this section (Chapter 13) discusses healthcare IT and patient safety, which has received increased attention recently. After the Institute of Medicine report was published in November of 2011, the ONC developed and published the Health IT Patient Safety Action & Surveillance Plan. Components of this plan are presented, along with tools to use during configuration that can assist in the improvement of patient safety. The chapter also covers methods that informaticists can implement that have proven to increase patient safety that pen-and-paper charts were just not able to do.
The final chapters include some of the newer and still emerging informatics concepts, also known as "hot topics." With the increasing availability of personal health records (PHRs), we are seeing a push for improving consumer engagement. These tools are being supported by the ONC in the form of the "Blue Button," where consumers can download their healthcare data in electronic form. Chapter 14 on patient engagement covers these concepts and provides tools to inform our patients as we encourage access to personal data. Other trends in healthcare IT are covered that include technology training for our healthcare workforce in general, not just training for our informatics specialists. Additionally, healthcare is seeing a trend toward less of a focus on acute care, and more of a focus on care outside the walls of the hospital. Clinical information systems are now being used in ambulatory care settings as well as home care, long-term, and hospice care. With limited evidence and knowledge in this area, as well as limited software vendor focus, we had diﬃculty finding an informatics subject matter expert to write Chapter 15, but we finally succeeded! The resources, links, and subject matter unique to the non-acute setting in this chapter will prove to be very helpful as we all attempt to transform our informatics practices to incorporate population-based care, changing payment models, and care across the continuum. Chapter 16 covers the concept of data analytics, population health, or predictive analytics—referred to as Big Data. A key underpinning for the informatics specialist is the ability to manage data. We have never had the capacity to acquire and manipulate data like we have today. The promise of Big Data is overwhelmingly seen as key to making improvements in a learning health system. This chapter addresses how informatics specialists can take advantage of data to improve care to patients both in acute care settings and throughout the entire care continuum. Chapter 17 covers mobile technology and access to data anywhere, anytime. With the ubiquitous nature of smart phones and tablets, we are slowly seeing these devices infiltrate the healthcare world. How this is occurring successfully is presented, along with ideas on how informaticists may take advantage of these technologies in their workplace.
This book is not intended to be put on a shelf to collect dust, but instead have pages that have dog-eared corners and stains as readers find the tools useful enough to reference again and again. We hope readers will find it useful and practical, and will recommend it to colleagues as they continue to advance their own informatics practice.