11 Nursing Informatics and Healthcare Policy- NAVAJA

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NURSING INFORMATICS AND HEALTHCARE POLICY:

NURSING INFORMATICS AND HEALTHCARE POLICY

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To practice effectively in today’s continually changing healthcare environment, informatics professionals need to be aware of existing and proposed healthcare policy. Policy- a course of action that guides present and future decisions. Healthcare policy is established on local, state, and national levels to guide the implementation of solutions for the populations health needs.

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The number of informatics programs for nurses has significantly increased, preparing more informatics nurse specialists to practice in the field, and a number of trends and events have placed information technology (IT), information systems (IS), and informatics at a center of attention in healthcare.

Healthcare Policy and Nursing Informatics as a Specialty :

Nurses have contributed to the purchased, design, and implementation of IS since the 1970s and in 1992, the American Nurses Association( ANA) recognized NI as a specialty. To be acknowledged as a specialty within nursing, informatics had to: Demonstrate a differentiated practice base Identify the existence of educational programs in the field. Develop a research agenda. Healthcare Policy and Nursing Informatics as a Specialty

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The definition of NI: Before: NI was defined as the combination of nursing information, and computer sciences to manage and process nursing data into information and knowledge for use in nursing practice. Now: NI is described more broadly as a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice.

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NI facilitates the integration of data, information, and knowledge to support patients, nurses, and other providers in their decision-making in roles and settings thru the use of information structures, information processes and IT.

Differentiated and Interdisciplinary Practice:

NI brings an added dimension to nursing practice that focuses on knowledge and skill in information management techniques. NI practice differentiates itself from other areas of nursing practice but emphasizes its interaction with informatics disciplines such as mathematics, statistics, linguistics, engineering, computer science, and health informatics. Differentiated and Interdisciplinary Practice

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Other example of domain specific informatics practices: Medical informatics Dental informatics Consumer informatics. NI community believes it is essential to practice within an interdisciplinary team and a one good example of interdisciplinary work is the “ Vocabulary Summit” held annually at Vanderbilt University since 1999 spearheaded by Judy Ozbolt.

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NI supports national efforts, such as those outlined by the Pew Health Professions and Institute of Medicine (IOM) to increase interdisciplinary education.

Preparation for Specialty Practice:

To become a specialty, it was necessary for NI to show that educational programs are available to prepare nurses to practice in the field. The Division of Nursing (DN), Health Resources and Services Administration (HRSA) founded two Master’s NI programs and one Doctoral program in NI at the University of Maryland. In 1997 an NI specialty program open at New York University and in 1998 a specialty program was implemented at Duquesne University at Pittsburgh. Preparation for Specialty Practice

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In her discussion of specialization, Styles included for identifying a research focus as one criteria for a specialty. A final requirement for a specialty is representation by at least one organization. Within nursing, there is organizational support in the American Organization of Nurse Executives.

Healthcare Policy Impact On Nursing Informatics Practice:

Nursing Shortage and Nursing Informatics Nursing has experienced a number of shortages in recent history. An older nursing workforce A higher ratio of older associate degree graduates The availability of more attractive career opportunities for women Decreased interest in nursing as a career difficult work environments. Healthcare Policy Impact On Nursing Informatics Practice

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Unless something is done the shortage will rise from 6% in 2000 to 29% in 2020 or more than 800,000 nurses short of the number needed. The Bureau of Labor Statistics(BLS) is predicting registered nurse positions will increase more than 600,000 between 2002 and 2012. To cover these new positions and replace retiring nurses 1.1 million more nurses are needed by 2012. Although these numbers differ it is clear that without intervention the healthcare industry is headed for a major crisis in the nursing workplace.

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Schools and colleges of nursing have shortened program lengths and instituted accelerated program for those who already hold a baccalaureate degree in an attempt to increase nursing workforce numbers. Nursing organizations have been actively advocating for increased federal funding to expand programs and increase loans, scholarships, and incentives. In 2002 the AAN Commission on Workforce launched a multiphase project to develop IT that will help support nurses in their day to day work.

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In Phase 1, interdisciplinary, creative thinkers were assembled to determine how technology could be use to facilitate nurses’ work. Bradley(2003) indicated that technology solutions should improve existing care processes and outcomes, increase access thru the use of portable handheld devices, incorporate Internet capability to overcome distance barriers of care and improve access to knowledge acquisition. These authors also advocate for using bar-coding of medications, use of speech recognition, and fine tuning the user interface of systems to support nurses.

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As Phase 2 of the AAN technology project began, staff nurses from three hospitals in Virginia and California were asked to identify or verify the most difficult aspects of their practice and how technology would improve those tasks. As the project continues, systems will be designed, implemented, and tested to determine their effect on nurses’ work. It is up to NI specialists to help design and implement IT systems that will finally assists nurses in their practice and to validate the results thru research.

Patient Safety and Nursing Informatics:

The IOM report issued in 1999, To Err is Human: Building a Safer Health System has had a chilling and lasting effect on healthcare. Using data from two studies with large numbers of hospital admissions as a basis of analysis, the IOM determined that adverse events occurred in 2.9 and 3.7% of admissions. When these percents were applied to the number of U.S. hospital admissions it was estimated that between 44,000 and 98,000 patients die each year from medical errors. Patient Safety and Nursing Informatics

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A follow-up report, Crossing the Quality Chasm: A New Health System for the 21 st Century, strengthens the argument for using technology to improve patient safety. Surveys confirm that concern for patient safety is the biggest factor driving IT California law 1875, passed in 2003, applies pressure to hospitals to install IT to help healthcare professionals reduce error. The Leapfrog Group, comprised of Fortune 500 companies and other large healthcare purchasers list CPOE as a strategy for improved patient safety.

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The National Alliance for Healthcare Information Technology(NAHIT) is a partnership of diverse healthcare leaders who are working to influence the use of technology to improve patient safety, quality, and efficiency. During the next few years, this group plans to focus on the following: consensus based standards, multi organizational collaboration , an informed government, and best practices knowledge for system implementation.

National Informatics Initiatives and Nursing Informatics:

Executive Order for National Interoperable Information System As indicated earlier, patient safety is one of the driving forces in increased clinical automation. National events have placed IS at the forefront of health policy. The impact of the fist two IOM reports on patient safety has been discussed.. An additional IOM report Patient Safety states even more emphatically that electronic medical records, using standard data elements, are a critical tool to improve patient safety. National Informatics Initiatives and Nursing Informatics

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A 2001 report from the President’s Information Technology Advisory Committee (PITAC) highlighted key issues in IT. PITAC indicated that the United States lacks broadly disseminated and accepted national vision for IT in healthcare and recommended the appointment of a senior IT person to provide strategic leadership. On April 27, 2004, President George W. Bush issued an executive order “Incentive s for the Use of Health Information Technology Coordinator” that has the potential to impact every healthcare entity, provider, and NI professional in the United States( Executive Order 2004)

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Components of the order are: 1.) establish a national health information technology coordinator position. 2.) work to develop a nationwide interoperable health infrastructure 3.) develop, maintain , and direct implementation of a strategic plan to guide implementation of interoperable health IT in both public and private sectors. The interoperable health IT should reduce medication errors, improve quality, and produce greater value for healthcare expenditures.

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Guidelines for the infrastructure are: Inappropriate information is available at the time and placed needed for medical decisions. health quality is improved and evidence based medical care delivered. Healthcare costs are reduce More information is available to promote greater competition Health information is exchanged In June 2004, bipartisan House members formed a congressional caucus with the aim to support policies such as financial incentives to increase the acceptance of IT by healthcare providers.

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The Center for Medicare and Medicaid Services (CMS) has issued a final rule on physician self-referrals that creates exceptions for technology items or services furnished to physicians to enable their participation in a community wide health IS The American Association of Retired Persons(AARP), 35 million members strongly supports mandatory electronic prescribing rules and federal efforts to increase adoption of CPOE. Interestingly, CPOE increasingly stands for computerized practitioner order entry, language used by AARP.

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All informatics professionals will need to help healthcare workers accept IT and push for implementation of CPOE.

National Health Information Infratructure:

Another national initiative that will impact NI is the National Health Information Infrastructure(NHII). This voluntary initiative, involving a three stage process over 10 years, is intended to improve the effectiveness, efficiency, and overall quality of health and healthcare in the United States. NHII calls for comprehensive knowledge-based networks that integrate clinical, public health and personal health information to improve decision making by having information available to providers. National Health Information Infratructure

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Secretary Thompson announced that the first part of a national health IT plan would be delivered at the conference by the National Coordinator for Health IT. Conference tracks included personal health, governance, incentives, standards and architecture, confidentiality, ethics, privacy and access, measuring progress population health, and clinical research.

Health Insurance Portability and Accountability Act (HIPAA):

HIPAA was passed in 1996 and is intended to improve public and private health programs by establishing standards to facilitate the efficient transmission of electronic health information. HIPAA preempts state law and payer specific variations of data standards; mandates input from private, standard setting organizations. Health Insurance Portability and Accountability Act (HIPAA)

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HIPAA has a significant impact on informatics: IT must be designed to comply with Title II of the act. All of the requirements of HIPAA are expected to be in placed by May 23, 2008 Timetable : October 16, 2002-Electronic Healthcare Transactions and Code Sets April 14, 2003-Privacy October 16, 2003-Electronic Healthcare Transactions April 14, 2003- Privacy-small health plans July 30, 2004- Employer Identifier Standard April 21, 2005-Security Standard

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August 1. 2005- Employer Identifier Standard April 21, 2006- Security Standards-small health plans May 23, 2007- National Provider Identifier May 23, 2008- National Provider Identifier. In November 2004, under HIPAA administrative simplification, CMS expects to publish the proposed rules for a national health payer identifier and a format for standardized claims attachments. The privacy rule of HIPAA was published in December 2000 and became effective in April 14, 2001

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The privacy rule and other HIPAA regulations are having tremendous impact on health informatics, including NI. For example, under HIPAA patients must be permitted to review and amend their medical records Informatics nurses are responsible for understanding and helping to implement HIPAA regulations.

National Agenda for Nursing Informatics:

The DN, HRSA, is responsible of the nursing workforce, including preparation in the area of NI. During the 1970s, funding efforts focused on increasing awareness of the need for IS that could be used to support nursing practice and developing a nursing language that could be applied to public health settings. Funding during the 1980s and early 1990s enabled four different educational models to be develop for NI, two models focused on specialty practice in NI National Agenda for Nursing Informatics

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And two models incorporated NI skills into administration and community health programs. As a result, in 1997 the DN convened the National Nursing Informatics Group (NNIWG) to make recommendations to the National Advisory Council for Nurse Education and Practice (NACNEP) for setting the nation’s nursing informatics agenda. NNIWG members were experts in decision support, distance education, informatics education, IS, language and taxonomies and telecommunications. The experts were then ask to suggest initiatives that would offer solutions for the identified informatics needs.

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There are five assumptions considered by NACNEP to be a basis for all further discussion of NI initiatives: Learners are students, faculty and clinicians NI must be considered within an interdisciplinary context of partnership and collaboration. Efforts should target disadvantaged and underserved populations. Initiatives should be responsive to other government funding priorities Collaborations among federal agencies and between federal and private entities is neccesary .

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Five key directions for informatics in nursing education and practice were recommended to the Secretary, DHHS in the NACNEP report: Educate nursing students and practicing nurses in the core informatics content Prepare nurses with specialized skills in informatics Enhance nursing practice and education thru informatics projects Prepare nursing faculty in informatics Increase collaborative efforts in NI.

Telehealth and Nursing Informatics:

Telehealth services have been provided for about 50 years but telehealth remains an underutilized tool for nursing and NI. Telehealth- is the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Telehealth and Nursing Informatics

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Factors advancing telehealth technology innovation are: Decreasing costs of telecommunication technologies Decreasing costs of telehealth devices and applications Resolutions of interoperability issues Convergence of telehealth and telecommunications technologies, IT, and the Internet. Unfortunately telehealth provides sush specialized tools it falls outside of the influence of groups like the AMA and the Advanced Medical Technology Association.

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In addition there has been a significant disconnections bet. telehealth and informatics. This is especially true in view of the fact that both telehealth and information technologies face barriers of acceptance, reimbursement and licensure. Efforts are being made to close the gap but until recently, documentation of telehealth events has frequently been independent of or isolated from IS. In a 1997 report to Congress, the 3 major issues of reimbursement, licensure, and security were implicated in preventing widespread adoption and use of telehealth.

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On the other hand the National Council of State Boards of Nursing(NCSBN) has implemented a model recognition in which nurses obtain a state based license that is nationally recognized and locally enforced. The Balanced Budget Act passed in 1997 mandated the first reimbursement policy of telehealth services for Medicare recipients. The Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 changed some of the reimbursement policies.

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Telehealth and informatics professional groups have developed in isolation from each other. Informatics nurses need to become more involved in telehealth and inform other nurses about uses of telehealth technologies

THE END!!!!!!:

KAMSA HAMNIDA! THE END!!!!!!

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