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NI Lecture Part II

NI Lecture Part II

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Published by: Filamae Jayahr Caday on Apr 26, 2011
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DIVINE WORD COLLEGE OF LAOAGSCHOOL OF NURSINGNURSING INFORMATICSISSUES IN INFORMATICSNursing Informatics and Healthcare Policy as a Specialty-
in 1992, American Nurses Association (ANA) recognized NI as a specialty-NI first appeared in the literature in 1980’s and has constantly evolved and molded by maturation of the field and influenced by health policy.-NI is the combination of nursing, information and computer sciences to manage and process nursingdata into information and knowledge for use in nursing practice (Graves and Corcoran, 1989).-NI is a specialty that integrates nursing science, computer science and information science to manageand communicate data, information and knowledge in nursing practice.- NI facilitates the integration of data information and knowledge to support patients, nurses and otherproviders in their decision making in all roles and settings.
NI Differentiated Interdisciplinary Practice:
-An informatics nurse demonstrates specialized knowledge of information and technology.-Informatics nurses should assist with the development and implementation of technology tools forclinical practice, evaluation of the effectiveness of the technological tools on nurses works and helpprepare nurses to use information technologies.-NI differentiates itself from other areas of nursing practice but emphasizes its interaction withinformatics disciplines such as math, statistics, linguistics, engineering, computer science and healthinformatics.-NI is a specific domain of informatics that falls under a broader umbrella of health informatics (othersare medical informatics, dental informatics and consumer informatics)-NI community believes it is essential to practice within an interdisciplinary team. (ex. AnnualVocabulary Summit in Vanderbilt University-that brings together nursing and medical informaticsvocabulary experts to explore how further language development in nursing can facilitate theintegration of computerized languages among healthcare disciplines)
Preparation for Specialty Practice
Educational Programs-
the Division of Nursing (DN), Health and Human Services Administration (HRSA)funded two Master’sNI programs, University of Maryland and University of Utah and one doctoral program in NI atUniversity of Maryland in 1988-1992.-In 1992, the American Nurses Association (ANA) officially established the role of the informatics nursespecialist, shortly after which they began offering the first credentialing exam in 1995. Although thisrecognition of NI is fairly new among the nursing specialty practices, skilled information managementhas always been a cornerstone of successful nursing practice. Nurses spend a significant portion of their time collecting and translating data for consumption by other providers, patients, and families. Ascomputers increasingly become a tool for repositing healthcare information, it’s imperative that allnurses have computer competencies, just as they would with any other healthcare instrument. TheANA’s Scope and Standards of Nursing Informatics Practice (2001) identifies three progressive levels of NI competencies: the beginning nurse, experienced nurse, and informatics nurse specialist. As thespecialty of NI has become more defined, nurses have sought out more learning opportunities andhave benefited from the emergence of more formal NI education programs. Until the last decade, therewere few formal NI programs. It’s even more recent that informatics theories and competencies havestarted being incorporated into basic nursing associate degree and baccalaureate curriculums. Notsurprisingly, many practicing nurse informaticists received their “formal” training on the job, typicallyas a necessity of their institution’s systems implementation.-in 1997, NI specialty program opened in New York University and in 1998 at Duquesne University inPittsburgh.
 
-the certification examination for NI graduates currently available is through the American NursesCredentialing Center.
-
 The American Nursing Credentialing Center (ANCC) began administering an informatics nursecertification exam in November 1995. The exam topics cover areas of basic IT, information andknowledge management, system development, human factors and NI models, theories, andprofessional practice. The ANCC details the nursing candidate’s qualifications for the informatics nursecertification exam as:
a baccalaureate or higher
an active RN license, with at least 2 years of professional practice
practice of at least 2,000 hours of NI within the last 3 years
OR
12 hours of graduate work and 1,000 hours of NI practice
OR
Completion of a graduate program in NI that included at least 200 hours of clinical practicum
Completion of 30 continuing education contact hours in specialty area within the last 3 yearsfor those who haven’t completed a graduate informatics program. Those RNs, with a baccalaureate or higher degree in the field of nursing, who successfully pass thecertification exam are recognized as “board certifiedwith the initials “RN,BC.” For RNs withbaccalaureate or higher degree in a nonnursing field, their certification is recognized as “certified” withan “RN,C.”-a final requirement for a specialty in representation by at least one organization as NI has the supportof both nursing and multidisciplinary organizations. (ex. American Medical Informatics Association(AMIA) and Health Information Management Systems Society(HIMSS))
Healthcare Policy Impact on Nursing Informatics Practice
Patient Safety
-In 2004, President G.W. Bush issued an executive order creating The Decade of Health Information Technology with a goal of establishing an electronic health record (EHR) for every American in the next10 years. One of the reasons for this order was the release of findings from the Institute of Medicine(IOM) studies concluding that information technologies hold the promise to transform health carepractice and facilitate
patient safety-
One of Centers for Medicare and Medicaid Services (CMS) most important initiatives is to assistpractitioners in making care more effective and less costly, particularly by promoting adoption of health information technology-the Technology Informatics Guiding Educational Reform (TIGER) Summit in 2006 collaborated withcolleagues from key federal agencies and healthcare organizations and articulated a vision for thefuture of nursing that enables nurses to use informatics in practice and education to provide safe,quality care.
NATIONAL INFORMATICS INITIATIVES
-The presidential initiative to provide an electronic health record to all Americans by 2014. As amember of the American Health Information Community (AHIC), associations identify actions neededto advance standards for electronic health data exchange. AHIC operates under the guidance of theDepartment of Health and Human Services.-The Nationwide Health Information Network works to build a secure, nationwide health informationinfrastructure to connect health providers, consumers and others supporting health and healthcare.AHIC workgroups establish guidance for development of the Network’s architecture. The Network aimsto:• Give consumers more control of their health information• Provide better information for clinical decision making• Promote appropriate use of healthcare information beyond direct patient care
 The Office of the National Coordinator for Health Information Technology (ONC) is at the forefront of the administration’s health IT efforts and is a resource to the entire health system to support theadoption of health information technology and the promotion of nationwide health information
 
exchange to improve health care. ONC is organizationally located within the Office of the Secretary forthe U.S. Department of Health and Human Services (HHS).ONC is the principal Federal entity charged with coordination of nationwide efforts to implement anduse the most advanced health information technology and the electronic exchange of healthinformation. The position of National Coordinator was created in 2004, through an Executive Order,and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act(HITECH Act) of 2009.
 The American Recovery and Reinvestment Act of 2009 (ARRA) provided for the creation of an HITPolicy Committee under the auspices of the Federal Advisory Committee Act (FACA). The HIT PolicyCommittee is charged with making recommendations to the National Coordinator for Health IT on apolicy framework for the development and adoption of a nationwide health information infrastructure,including standards for the exchange of patient medical information.Later that year, the HIT Policy Committee formed several workgroups to further the work of the FACACommittee. These workgroups are comprised of stakeholder representatives and subject matterexperts. The HIT Policy Committee’s workgroups are: Meaningful Use Workgroup,Certification/Adoption Workgroup, Information Exchange Workgroup, NHIN Workgroup, StrategicPlanning Workgroup, Privacy & Security Policy Workgroup, and Enrollment Workgroup.
 The American Recovery and Reinvestment Act of 2009 (ARRA) also provided for the creation of an HITStandards Committee under the auspices of the FACA. The HIT Standards Committee is charged withmaking recommendations to the National Coordinator on standards, implementation specifications,and certification criteria for the electronic exchange and use of health information. Initially, the HITStandards Committee will focus on the policies developed by the Health IT Policy Committee. The HIT Standards Committee also formed several workgroups to further the work of the FACA. Theseworkgroups are comprised of stakeholder representatives and subject matter experts. The HITStandards Committee’s workgroups are: Clinical Operations Workgroup, Clinical Quality Workgroup,Privacy & Security Workgroup, and Implementation Workgroup.
 The Federal Health Architecture Initiative (FHA) represents a unique opportunity to build partnershipsacross communities of interest throughout the nation's health care environment in the development of a truly integrated and effective health information exchange network. FHA will enable the employmentor migration of existing systems to meet citizen-centric business activities while providing clear rulesfor the development of new tools for improved performance and access to health related informationand services throughout the national health arena. Participants other than the Department of Healthand Human Services include Department of Homeland Security, Veterans Administration,Environmental Protection Agency, Department of Agriculture, Department of Defense, and Departmentof Energy.
 The NCVHS serves as the statutory [42 U.S.C. 242k(k)] public advisory body to the Secretary of theDepartment of Health and Human Services in the area of health data and statistics. In that capacity,the Committee provides advice and assistance to the Department and serves as a forum forinteraction with interested private sector groups on a variety of key health data issues. The Committee is composed of 18 individuals from the private sector who have distinguishedthemselves in the fields of health statistics, electronic interchange of healthcare information, privacyand security of electronic information, population-based public health, purchasing or financinghealthcare services, integrated computerized health information systems, health services research,consumer interests in health information, health data standards, epidemiology, and the provision of health services. Sixteen of the members are appointed by the Secretary of DHHS for terms of fouryears each, with about four new members being appointed each year. Two additional members areselected by Congress.
 The health services research arm of the U.S. Department of Health and Human Services (HHS),complementing the biomedical research mission of its sister agency, the National Institutes of Health.
Home to research centers that specialize in major areas of health care research:

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