According to Merriam-Webster, informatics is “the collection, classification, storage, retrieval, and dissemination of recorded knowledge.” With a mandate for health care providers to switch to electronic medical records and achieve “meaningful use” by 2014 looming, informatics is a hot career field for nurses.
The American Medical Informatics Association estimates that employers need about 70,000 health informatics specialists to install and maintain new systems and train staff to use them.
While the increased demand for specialists is relatively new, the field is not. Nurses have been helping hospitals adopt technology to work smarter since before the specialty even had a name.
Nancy Stockslager, who became a nurse in 1983, worked in neonatal intensive care units until she was presented with a unique job opportunity in 1995. A health care corporation was buying products to create a clinical technology records system. When she was asked to help build the system, she accepted the challenge and never looked back.
Today, as director of clinical informatics at Gwinnett Medical Center, Stockslager, RN, MSN, is responsible for implementation, process analysis, training and maintaining all the health care network’s clinical technology systems. Gwinnett Medical already has adopted electronic medical records and is working toward computerized provider order entry, in which physicians enter their own orders.
“Informatics has been a very exciting journey and I love it, but it’s a constant challenge. There is never a dull moment,” she said.
According to Stockslager, informatics developed in two stages — an evolutionary stage and a revolutionary period.
“Electronic medical record systems have been around for 30 years, constantly changing and improving, but many organizations had not adopted them, in large part because of the cost. The people working with them were mostly learning on the job,” Stockslager said. “Now that everyone needs these systems quickly, the dynamics have changed. There are a lot more job opportunities and federal money available for training health information technology specialists.”
A growing field
Four years ago, Stockslager was rarely asked to serve as a preceptor for a nursing informatics student. Today she has more requests than she can handle.
Gwinnett Medical had been on the evolutionary path of adding and updating systems, but is now part of the informatics revolution.
“Since I came in 2010, we have been going from 0 to 60. It’s been a whirlwind and with everyone working on the same deadline, my job is to make sure we get there — and successfully,” Stockslager said.
She can remember a time when clinicians would often say, “if they make me use a computer, I’m going to retire,” but she rarely hears that anymore. Technology is here to stay in health care because it helps organizations deliver high-quality, standardized care and improve patient safety.
“As we move to more advanced systems and levels of utilization, it is impacting clinical decision-making, improving practice and preventing error,” she said. “Technology can be very complicated, but my job is to make sure it’s not complicated.”
As a nurse, Stockslager is uniquely qualified for the job.
“I consider myself a translator. I translate the clinical world into technology and technology into the clinical world,” she said. “A well-rounded informaticist must have well-developed critical-thinking skills and be able to solve problems, and that’s a key trait of nursing.
“Sometimes trying to resolve an issue is like trying to find a needle in a haystack, but nurses are trained to identify issues. They are organized and pay attention to detail. It’s a nice skill set to have and so necessary for this job.”
Nursing knowledge
Another strength that many nurses have is the ability to communicate with other clinicians. They understand the workflow and know how to coordinate patient care, said Sandra Lucius, RN, MSN, assistant vice president of nursing operations at WellStar Kennestone Hospital.
“A good system has to be user-friendly for all end-users, and because of their background, nurses know how to bridge gaps and see the big picture,” she said.
A nurse for 33 years, Lucius left her job as a clinical nurse specialist to become an entrepreneur in health care information consulting in the early 1990s.
“It was the bleeding edge of informatics. We didn’t even use the term information technology yet. We talked about software development,” she said.
An early application helped cardiac physicians enter catheter information into a computer. The trick was getting that data back and entering it into a report that could help improve patient outcomes.
“We couldn’t even add an application to a PC without it conflicting with another. We have come light years since then,” Lucius said.
The goal of increasing access to information to improve communication and care hasn’t changed.
“At WellStar we are implementing a world-class, single-patient record system that will standardize best practices in a team-based approach. Everything will be patient-centered,” she said.
With electronic medical records in place, WellStar is now working on the “meaningful use” component of the mandate and plans to take the system live next December.
“The idea is to have all information from every provider funneled onto one screen, so everyone can see it,” Lucius said. “The whole purpose of our records is to document and tell the story of a patient. The story provides information to help us make clinical decisions. If everyone knows the whole story, the patient is better off. A single-patient record system touches everything we do — from scheduling to staffing to integrating appointments.”
'Efficiencies in care’
When physicians enter their own orders into the system, implementation is streamlined. She’s seen a physician order an X-ray and the technician arrive at the patient’s room almost immediately.
“Having everyone on the same page achieves efficiencies in care which can lead to fewer days in the hospital, greater patient safety and fewer duplicated tests,” Lucius said.
Another example is a closed loop medication administration system that can decrease human error. When a nurse screens the bar codes on a patient’s arm band and on the medication, the system performs a safety check to ensure that a patient is receiving the right medication, as well as the correct dosage and frequency.
“If there is any mismatch, it will sound the alert to prevent patient harm,” Lucius said. “Nurses will tell you that it has prevented mistakes and absolutely reinforces quality care.”
Today’s electronic medical systems are costly — the hardware, software and computers for a midsize hospital could mean a $35 million investment — but Lucius believes they’re worth it.
“The whole purpose behind informatics is to provide a safer environment for the patient and to give clinicians the support they need at the bedside to make right decisions,” she said. “We used to talk about having a magic wand that we could wave over the patient and access his information. Look where we are today; we’re so close.
“It’s been exciting to watch this field evolve, and it will keep growing, because the benefits just go on and on.”
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