MSN, RN, DPNAP, FAAN, Chief Professional Practice Officer – Elsevier Clinical Solutions, USA
There is no question we are living in a time of exponential growth of technology. Many Asia Pacific (APAC)countries are investing heavily in Health Information Technology (HIT) which has significant impact on the healthcare workforce. In APAC, like other regions in the world, the nursing profession comprises the largest workforce delivering patient care so to prepare and engage nurses is critical to advance the transition to digital health.
This was recognised in the United States when the country began to lay out a plan to focus on digitalising the health system. While structures were beginning to be put in place to support a collective shift towards healthcare technology, the significance of having nurses at all levels and areas engaged became glaringly apparent. The first and most impactful grassroots effort was the launch of the TIGER (Technology Informatics Guiding Education Reform) Initiative. TIGER began as a grassroots initiative in 2006 within the US nursing community, convening a Summit, with support from over 70 contributing organisations including HIMSS, two grants from the Robert Wood Johnson Foundation and a personal endowment. Today, the TIGER Initiative is a part of the HIMSS organisation focusing on education reform and fostering international community development. The spirit of TIGER is to contribute to a learning health system that maximizes the integration of technology and informatics into seamless practice, education, and research resource development.
Elsevier Clinical Solutions was one of the contributing organisations of the TIGER Summit in 2006 and has continued to support the TIGER efforts in several ways, including supporting my engagement in various leadership roles for TIGER to advance the vision and mission set forth a decade ago.
At Elsevier Clinical Solutions we are focused on integrating evidence-based content and technology to enable knowledge, clinical decision support and adoption of new ways of delivering care across the continuum. My recent visit to several APAC countries during and following HIMSS AsiaPac 2016 was filled with stories of the hopes
and challenges of technology and specifically how current trends are evolving the roles of nursing.
Nursing informatics is a recognised nursing specialty and has been gaining momentum as health information technology advances. The American Nursing Association (ANA) recognised Nursing Informatics as a specialty in 1992. Nursing Informatics (NI) integrates nursing science with multiple information management
and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice. NI supports nurses, consumers, patients, the inter-professional healthcare team, and other stakeholders in their decision-making in all roles and settings to achieve desired outcomes. This support is accomplished through the use of information structures, information processes, and information technology. (Nursing Informatics: Scope and Standards of Practice, 2nd Edition, ANA 2015).
Informatics competencies are needed by all nurses whether or not they specialise in informatics. As nursing practice environments become more ubiquitous computing environments, all nurses must be both information and computer literate. One of the first priorities of the TIGER Initiative was to develop a collaborative workgroup to establish the minimum set of informatics competencies for all practicing nurses and graduating nursing students. The minimum set of competencies are organised into three categories: basic computer skills, information literacy, and information management (including use of the electronic health record).
In 2015, the TIGER International Committee, with representatives from 21 countries, began comprehensive activities to compile recommendations for “core international informatics competencies”. Their activities included a compilation of international case studies and development of a survey to evaluate and prioritise a broad list of core competencies. Based on the results of the survey, TIGER will identify the core informatics competencies of healthcare professionals in five domains:
• Nursing management
• IT management in nursing
• Quality management
• Inter-professional coordination of care
• Clinical care
The next phase was the creation of a competency harmonisation matrix that outlines shared and country-specific competencies (including the United States) to provide guidance to the TIGER community and beyond. To stay connected to this exciting work follow the TIGER International Informatics Competency Synthesis Project.
With the proliferation of capturing data in the electronic health record and mobile devices, nurses and other professions will need to develop competencies on big data analysis as well. Nurses will also need to be advocates for capturing sharable and comparable nursing data. For APAC regions that are just beginning the electronic health care record journey, there are lessons to be learned from other regions that have had the outcome of data that is difficult to collect and impossible to compare due to lack of standardisation and coded data elements. This is important because big data and analytic tools / data visualisation are imperative to drive operational efficiency and improving patient safety and quality of care.
Recognising the challenges of sharable and comparable data in the US, the University Of Minnesota School Of Nursing convened a group of experts in 2013 and 2014 to participate in the Nursing Knowledge: Big Data and Science to Transform Health Care consensus conferences.The goal is to build national consensus on a plan for sharable and comparable data so that big data research could be accomplished to continuously improve clinical practice and patient outcomes. This nursing big data initiative has continued in 2015 and 2016 with expanded stakeholders; including professional nursing organisations, government, education, research, industry, terminology experts and more. There has also been intentional alignment of efforts by other major nursing organisations such as the American Academy of Nursing Expert Panel of Informatics and Technology, the Alliance of Nursing Informatics, HIMSS Nursing Community with the nursing big data initiative. In 2015, the HIMSS CNO-CNIO Roundtable formed a workgroup that further developed recommendations on how nursing can help advance and use big data by providing Guiding Principles for Big Data in Nursing.
Elsevier Clinical Solutions has been actively engaged in the above work efforts because a big part of our contribution is standardised evidence-based content leveraging a professional practice platform embedded in multiple electronic health record platforms. In addition, to integrate with other clinical disciplines when automating clinical documentation and care planning, the Elsevier Clinical Practice Model Framework advances big data beyond nurses, to include other health professional providers caring for the same patients and families as described in the linked article (Christopherson, Troseth & Clingerman, 2015).
As care shifts from provider-centric care to patient-centered care, how the nurse leverages technology and information is rapidly changing as well. Patients are becoming more engaged in their care as they have access to the internet and come to rely on other technologies in their day-to-day life such as smart phones, automatic banking, and on-line shopping. The next generation will demand tools that integrate their voice and health IT tools with their providers to increase collaboration and shared decision-making. As an emerging trend, nurses have the opportunity to lead efforts to promote patient engagement.
Patient engagement is ultimately about the patient and provider working together to improve the health and well-being of the patient. A patient’s greater engagement in his or her care contributes to improved health outcomes, and health information technologies can support engagement.
One resource is the HIMSS Patient Engagement Framework which is designed to guide healthcare organisations in developing and strengthening their patient engagement strategies through the use of eHealth tools and resources. There are multiple touch points for nurses to play important roles moving from informing patients to totally engaging them and their community with eHealth tools.
Health information technology tools that nurses can leverage in their engagement with patients are:
• Patient portal adoption (encouraging use and accessing information for care provided)
• Providing interactive patient education across the continuum of care
• Advocating for collaborative tools to enhance shared decision making
• Integrating self-management tools into the care process.
There are also culture changes nurses can advocate for and role-model that are critical for patient engagement:
• Integrating patient values and preferences into care planning and education (a critical element of evidence-based practice)
• Establishing patient/family advisory councils
• Assessing patient/family health literacy.
In summary, it is an exciting time for APAC as it shifts to full digital healthcare. It is my hope that we can learn from each other as the informatics revolution evolves in APAC and the role of nursing is recognised as a critical success factor for the adoption of health information technology to improve health outcomes.
Michelle is the Chief Professional Practice Officer of Elsevier Clinical Solutions. She has over 25 years of experience in co-designing and implementing evidence-based practice and technology infrastructures to support patient-centered care and interprofessional integration at the point of care across hundreds of healthcare settings.