Nur 6051: Nursing Informatics Essay

Workflow analysis aims to determine workflow patterns that maximize the effective use of resources and minimize activities that do not add value. There are a variety of tools that can be used to analyze the workflow of processes and clarify potential avenues for eliminating waste. Flowcharts are a basic and commonly used workflow analysis method that can help highlight areas in need of streamlining. Nur 6051: Nursing Informatics Essay Paper

In this Assignment, you select a common event that occurs regularly in your organization and create a flowchart representing the workflow. You analyze the process you have diagrammed and propose changes for improvement.

To prepare:

• Identify a common, simple event that frequently occurs in your organization that you would like to evaluate.
• Consider how you would design a flowchart to represent the current workflow.

• Consider what metrics you would use to determine the effectiveness of the current workflow and identify areas of waste.

To complete:

Write a 3- to 5-page paper which includes the following:

• Create a simple flowchart of the activity you selected. (Review the Sample Workflow of Answering a Telephone in an Office document found in this week’s Learning Resources for an example.)
• Next, in your paper: Nur 6051: Nursing Informatics Essay Paper

o   Explain the process you have diagrammed.

o   For each step or decision point in the process, identify the following:

• Who does this step? (It can be several people.)
• What technology is used?
• What policies and rules are involved in determining how, when, why, or where the step is executed?
• What information is needed for the execution of this step?

o   Describe the metric that is currently used to measure the soundness of the workflow. Is it effective?

o   Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow.

o   Summarize why it is important to be aware of the flow of an activity.

• Remember to include a cover page, introduction, and summary for your paper. APA format. Must include at least 3 course reading for references and 2 additional scholarly references. Nur 6051: Nursing Informatics Essay Paper

Course Readings

1. McGonigle, D., & Mastrian, K. G. (2012). Nursing informatics and the foundation of knowledge(Laureate Education, Inc., custom ed.). Burlington, MA: Jones and Bartlett Learning.
   • Chapter 16, “Nursing Informatics: Improving Workflow and Meaningful Use”This chapter reviews the reasons for conducting workflow analysis and design. The author explains specific workflow analysis and redesign techniques.
2. Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow engine technology to deliver basic clinical decision support functionality. BMC Medical Research Methodology,11(1), 43–61.
   Retrieved from the Walden Library databases.In this article, the authors describe an implementation of workflow engine technology to support clinical decision making. The article describes some of the pitfalls of implementation, along with successful and future elements.
3. Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs: Challenges of design, workflow, and contractual relations. Studies in Health Technology and Informatics, 157, 7–14.
   Retrieved from the Walden Library databases. Nur 6051: Nursing Informatics Essay PaperThis article points to many health information technology designs and workflow decisions that limit their value and usage. The authors also examine the structure of the conceptual relationships between HIT vendors and the clinical facilities that purchase HIT.
4. U.S. Department of Health & Human Services. (n.d.b). Workflow assessment for health IT toolkit.  Retrieved, June 18, 2012, fromhttp://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865This article supplies a toolkit on the planning, design, implementation, and use of health information technology. The sections of the website provide a definition of workflow, examples of workflow tools, related anecdotes, and research.
5. Document: Sample Workflow of Answering a Telephone in an Office (Word document)
   Note: You will use this document to complete this week’s Assignment. Nur 6051: Nursing Informatics Essay Paper

Start your paper with an introduction to the process you are going to use in your diagram. Remember to include a substantive purpose statement.

Workflow Process

Insert the Workflow Chart after you introduce the process.

Politely decline services End No Record the caller’s message, name, and contact information. Forward to intended recipient. Yes Politely ask the caller to try again at a better time. No Does the caller wish to leave a message? Transfer caller to requested recipient. Inform caller and requested recipient of impending transfer. Yes Is the caller’s requested recipient available? No Yes Is the call a sales call? Identify caller and caller inquiry. Answer phone with salutation and company identification. Start

Figure 1. Workflow of Sample Process (This should occur after the figure).

Explanation of the Workflow Process

Explain the process you have diagrammed. For each step or decision point in the process, identify the following: Explain who completes this step (It can be several people.). Describe the technology used at each step. If there is no technology used in the process, please just state there in no technology used in the workflow process. Discuss the policies and rules are that are involved in determining how, when, why, or where the step is executed. Identify what information is needed for the execution of each step.

Metric used for Workflow Evaluation

Describe the metric that is currently used to measure the soundness of the workflow. Discuss whether the current metric is effective.

Areas for Improvement

Describe any areas where improvements could occur and propose changes that could bring about these improvements in the workflow. Nur 6051: Nursing Informatics Essay Paper

Conclusion

Conclude your paper. Summarize why it is important to be aware of the flow of an activity.

References

Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, 40(3), 254-262.

Good, M. (2003). Patient simulation for training basic and advanced clinical skills. Medical Education, 3714-21.

Gordon, C., & Buckley, T. (2009). The effect of high-fidelity simulation training on medical-surgical graduate nurses’ perceived ability to respond to patient clinical emergencies. Journal of Continuing Education in Nursing, 40(11), 491-500.

Please remember that the reference page should only include references cited in the body of your paper. You need to integrate additional resources and course readings in your paper, to earn an excellent rating you need to integrate 2 or more credible additional sources and 3-4 course resources into your application assignments.

There are several important points covered in the “Guidance for Application Assignments” I wanted to highlight:

• The use of direct quotes is discouraged and should only be used when the source material uses language that is particularly striking or notable.
• The introduction should provide an overview of the topic, the purpose of the paper, and topics that will be addressed.
• Credible sources include scholarly peer-reviewed journal articles, evidence based resources, and professional (.org), educational (.edu), and government websites (.gov). Commercial websites (.com) are not considered credible sources.
• When selecting articles for course assignments, you are advised (unless you are referencing seminal information) to focus on work published within the past five years.

The quality of patient care can be increased when utilizing a computerized management system. These systems facilitate coordination among multiple providers and healthcare institutes by providing easy and quick access to clients’ information. Patient’s data is placed together which can be monitored more efficiently instead of waiting to receive information by mail or fax (labs, referrals, orders from doctors, radiology results, etc). Nur 6051: Nursing Informatics Essay Paper

According to the American Medical Association 30 percent of all patient visits are completed without access to the patient chart 30 percent of all patient visits are completed without access to the patient’s chart. With computerized records, both physicians and practice staff can access patients’ medical records instantly, increasing efficiency and improving quality of care. By reducing the amount of time spent on paperwork and improving work flow, computerized patient records enable physicians to see more patients for longer periods of time (Ross, 2005). Nur 6051: Nursing Informatics Essay Paper

Thus making the patient feel better cared for and improving patient retention rates.page

Access to real-time information also is an benefit of these systems (Thede 2003). Improved access to patient progress notes and medication information can help telephone staff provide better service to patients. Staff members no longer need to interrupt their phone calls with patients to search for paper charts. Online records also eliminate the risk of misplaced or lost files (Ross, 2005).

Active nursing involvement is essential in the planning, choice, and implementation of computerized management system because nurses will be the main user, the system needs to be user friendly, the format of the system needs to make sense to the clinician, and the system needs to compliment nurses workflow. Handheld devices can be integrated into management systems for better quality of care when used as a resource tool for nurses. Handheld devices such as personal digital assistants are helpful tools that nurses can use to look up medication information without having to return to the nurses’ station. Nur 6051: Nursing Informatics Essay Paper

Also, application such as clocks and timers can be used as a reminder for medication or treatments and other activities. In addition, handheld P. D. A. devices can be used when giving reports which information would be permanently documented versus paper reported in which some important information is omitted when giving oral shift reports. Security features are available with computerized computer systems and handheld devices. Passwords and codes are required to utilize these devices.

The standards for electronic transmission of health data enables information to be exchanged electronically (Noffsinger & Chin,2000). To safeguard the privacy and security of these devices, they are mandated. Each health plan, healthcare clearing house, and healthcare provider who maintains or transmits information maintains reasonable and appropriate administrative technical and physical safeguards to ensure the integrity and confidentiality of the information (Perlin, 2010). Security standards for all systems and devices are common. For example, 1) lock out screen / automatic account timeout are activated after excess time.

2) Database services must be firewalled. 3) All data or computer devices must be erased before the devices is transferred. 4) Audits are performed continually to track authorized users who abuse the healthcare information that is stored in the system. HIPPA was established for security standards and safeguards for the electronic transmission of health information. According to the HIPPA law, which requires that healthcare providers have a continuity plan in place and that they routinely test the backup equipment to make sure it works to protect information. Nur 6051: Nursing Informatics Essay Paper

Data storage integrity is needed to guarantee that data sent from one end of a transaction arrives unaffected at the other end. Backup is a safeguard to retrieve lost data. Backups are needed to make copies of data so that additional copies can be used to restore original data in a data lost occurrence (Ross, 2005). Healthcare cost reduction can be achieved through utilizing computerized management systems by the reduction of medical error and decision support capabilities that improve resources and length of hospital stay for patients.

Outcomes can also be tracked so the best practice can be followed to improve patient care. Decreased paper expenses, medical record staff, and transcription cost can in addition reduce healthcare cost. Benefits of utilization of computerized management systems are as followed: 1) Prescriptions are easily read to reduce errors 2) Alerts doctor, concerning medication or dosage, if inappropriate 3) Prompts doctor to select generic and formulary medication over high priced name brand and non formulary drugs. Nur 6051: Nursing Informatics Essay Paper

4) Improves communication between physician and pharmacy (Ross, 2005). Asses to patient past medical information and recent test and prescription help assist doctors in making best clinical decision. Computerized management systems give guidance for orders, alerts, and access to patient’s specific clinic information, and helps doctors to make better clinical decision that leads to improving patient safety by decreasing errors and efficiency resource usage (Perlin, 2010).

I recommend the Health Connect Electronic Health Records Systems because it allows management of medical information and it secures exchange between healthcare consumers and providers. This system improves healthcare quality prevent medical error, reduces unnecessary healthcare cost, increases administration efficiency and decreases paperwork. This system is user friendly, make sense to the clinicians, and it compliment the workflow of this hospital. Nur 6051: Nursing Informatics Essay Paper

On any known day in the hospital setting, physicians, medical residents, nurses and other health care staff will need access to a patient’s medical record. Health care workers are expected to integrate old and new data about their patients. It is also crucial that they remember the patient’s individual health status and background. Communicating pertinent data quickly to other members of the health care team is vital. Dissemination of information to the patient, other health care facilities, and providers is also a consideration. It has been a difficult task in the past for members of the health care team to meet these expectations using a paper medical record. “Not only can electronic records not be misplaced as paper records, can, but information in the record is more accurate as well as legible” (Frolick, n.d., p. 1). The benefits of using a computerized management system are numerous. Patient information is more accessible. A computerized system improves communication between the members of the health care team. Quality of care is vastly improved using the electronic medical record. Medical histories, allergies and medications, laboratory results, radiology reports, vital signs and a patient’s height and weight can all be accessed from any computer terminal in the hospital. For instance, when a CAT scan or blood test is ordered, physicians and other clinicians at the hospital can view the image or test result on a computer, instead of waiting for a report to be sent to them. No longer will staff members have to search for the patient’s chart to check on a blood test result. Nur 6051: Nursing Informatics Essay Paper

Nursing informatics can best be described “as the integration of data, information and knowledge to support patients and clinicians in decisions across roles and settings, using information structures, process, and technology” (Knight & Shea, p. 93). Nursing informatics has evolved over the last half decade from a system with only a few abilities to a worldwide technological system used in many hospital settings and physician offices in order to unify healthcare, eliminate error, and allow clinicians to spend less time charting and more time fulfilling job duties. Nur 6051: Nursing Informatics Essay Paper

In the 1960s, technology entered the nursing profession and the very first computer systems were integrated into hospitals. The early computer systems were implemented in order to process orders promptly and keep an accurate record of charges incurred by patients during their hospital stay (Murphy, 2010). Over the next few years, technology improved and started to revolutionize the nursing profession, documentation and communication throughout the hospital went from pen and paper to online databases filled with electronic patient information (Murphy, 2010). Nur 6051: Nursing Informatics Essay Paper

The introduction of NI has “prompted significant transformation in healthcare, along with increased attention to patient safety and outcome” (HIMSS Nursing Informatics Awareness Task Force, 2007, p. 38). Nursing informatics (NI) was finally recognized as a specialty in the mid-1990s (Murphy, 2010) Nursing informatics continued to evolve and the clinical setting began using electronic health records in patient care areas. Electronic health records (EHR) is like the nursing process, in which computer charting uses a hands on approach where the clinician is responsible for physically inputting the data attained into the Electronic Health Record. (McFadden, 2012). Nur 6051: Nursing Informatics Essay Paper

EHR was a huge push by President Bush in 2004, he mandated that the electronic health record be worldwide in the United States within ten years and created the Office of the National Coordinator for Health information Technology (HIMSS Nursing Informatics Awareness Task Force, 2007). The concept behind the electronic health record was to redesign the way patient care was delivered so that documentation and data gathering was integrated and automatically uploaded eliminating the room for errors and or misinformation (McFadden, 2012). Nur 6051: Nursing Informatics Essay Paper

Today nursing informatics uses technology to improve its clinical nursing practice as well as to enhance the quality of patient care (Saba, 2001). As patients change, technology in the hospital setting must change and adapt as well. In order to make sure that the Electronic Health Record is as user friendly as possible for the majority of the clinicians using the system, TIGER was formed. “TIGER which stands for Technology Informatics Guiding Specialties which is a national collaborative of nurses from various specialties” (“TIGER,” 2010, p. 11). Nurses who are on the front line taking care of patients first hand bring knowledge of how information can be supported and improved upon in the clinical process and decision-making, which ultimately improves quality and patient outcome (“TIGER,” 2010). TIGER has improved nursing informatics by intertwining technology into the nursing practice, therefore making health information technology the stethoscope for the 21st century (“TIGER,” 2010). Along with the continuing development of technology CPOE (Computerized Provider Order Entry) was developed freeing nurses from having to transcribe physicians hand writing and eliminating the need for order clarification made via phone calls improving quality control and patient outcomes. (Thede, 2012). Nur 6051: Nursing Informatics Essay Paper

Lab results are readily available through Point Of Care seconds after a test is completed in order for nurses and physicians to have information to review and determine further course of treatment the moment the results become available (Thede, 2012). Nursing informatics has a direct impact on nurses. Nurses spend roughly 50% of their time documenting and as little as 15% at the patient bedside (HIMSS Nursing Informatics Awareness Task Force, 2007). Our role as a nurse is being redefined by computers allowing more time to actually nurse patients to health and less time documenting our measures used to return them to health. As stated by HIMSS Nursing Informatics Task Force (2007) “this movement toward evidence based clinical practice is designed by a clinical information system which serves as the integrator that supports clinical judgment and client values” (p. 31). Nursing informatics will continue to improve and will become able to process data more quickly than it does now (Saba, 2001). Nur 6051: Nursing Informatics Essay Paper

In the 21st century, nursing informatics is part of our everyday professional activity. The majority of healthcare professionals are computer literate as utilizing a computer and accessing patient records has become a part of our everyday duties as nurses. (Saba, 2001). As we continue to move toward a more IT world, nursing informaticists will continue to work with nurses to ensure that our practice is further enhanced by new technology (HIMSS Nursing Informatics Awareness Task Force, 2007). As clinicians is our duty to be prepared and properly trained with the most recent technological advances so we can spend less time finding where to document information or inputting information and more time fulfilling other nursing duties.

In summary, according to Murphy (2010) “nursing informatics has evolved to an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care” (p. 207). It is time for nurses to leave the past ways of paper charting and embrace what the future has for us in the ever evolving technological world. Our profession is being transformed to meet the needs of patients and allowing clinicians to keep accurate records but doing so in a timely and safe manner. Nursing informatics is a tool which is in place to make it easier to keep accurate records, spend more time interacting and caring for patients, and have one place to look for information regarding patient care. Nur 6051: Nursing Informatics Essay Paper

Nursing informatics can best be described “as the integration of data, information and knowledge to support patients and clinicians in decisions across roles and settings, using information structures, process, and technology” (Knight & Shea, p. 93). Nursing informatics has evolved over the last half decade from a system with only a few abilities to a worldwide technological system used in many hospital settings and physician offices in order to unify healthcare, eliminate error, and allow clinicians to spend less time charting and more time fulfilling job duties. Nur 6051: Nursing Informatics Essay Paper

In the 1960s, technology entered the nursing profession and the very first computer systems were integrated into hospitals. The early computer systems were implemented in order to process orders promptly and keep an accurate record of charges incurred by patients during their hospital stay (Murphy, 2010). Over the next few years, technology improved and started to revolutionize the nursing profession, documentation and communication throughout the hospital went from pen and paper to online databases filled with electronic patient information (Murphy, 2010).

The introduction of NI has “prompted significant transformation in healthcare, along with increased attention to patient safety and outcome” (HIMSS Nursing Informatics Awareness Task Force, 2007, p. 38). Nursing informatics (NI) was finally recognized as a specialty in the mid-1990s (Murphy, 2010) Nursing informatics continued to evolve and the clinical setting began using electronic health records in patient care areas. Electronic health records (EHR) is like the nursing process, in which computer charting uses a hands on approach where the clinician is responsible for physically inputting the data attained into the Electronic Health Record. (McFadden, 2012).

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EHR was a huge push by President Bush in 2004, he mandated that the electronic health record be worldwide in the United States within ten years and created the Office of the National Coordinator for Health information Technology (HIMSS Nursing Informatics Awareness Task Force, 2007). The concept behind the electronic health record was to redesign the way patient care was delivered so that documentation and data gathering was integrated and automatically uploaded eliminating the room for errors and or misinformation (McFadden, 2012). Nur 6051: Nursing Informatics Essay Paper

Today nursing informatics uses technology to improve its clinical nursing practice as well as to enhance the quality of patient care (Saba, 2001). As patients change, technology in the hospital setting must change and adapt as well. In order to make sure that the Electronic Health Record is as user friendly as possible for the majority of the clinicians using the system, TIGER was formed. “TIGER which stands for Technology Informatics Guiding Specialties which is a national collaborative of nurses from various specialties” (“TIGER,” 2010, p. 11). Nurses who are on the front line taking care of patients first hand bring knowledge of how information can be supported and improved upon in the clinical process and decision-making, which ultimately improves quality and patient outcome (“TIGER,” 2010). TIGER has improved nursing informatics by intertwining technology into the nursing practice, therefore making health information technology the stethoscope for the 21st century (“TIGER,” 2010). Along with the continuing development of technology CPOE (Computerized Provider Order Entry) was developed freeing nurses from having to transcribe physicians hand writing and eliminating the need for order clarification made via phone calls improving quality control and patient outcomes. (Thede, 2012).

Lab results are readily available through Point Of Care seconds after a test is completed in order for nurses and physicians to have information to review and determine further course of treatment the moment the results become available (Thede, 2012). Nursing informatics has a direct impact on nurses. Nurses spend roughly 50% of their time documenting and as little as 15% at the patient bedside (HIMSS Nursing Informatics Awareness Task Force, 2007). Our role as a nurse is being redefined by computers allowing more time to actually nurse patients to health and less time documenting our measures used to return them to health. As stated by HIMSS Nursing Informatics Task Force (2007) “this movement toward evidence based clinical practice is designed by a clinical information system which serves as the integrator that supports clinical judgment and client values” (p. 31). Nursing informatics will continue to improve and will become able to process data more quickly than it does now (Saba, 2001). Nur 6051: Nursing Informatics Essay Paper

In the 21st century, nursing informatics is part of our everyday professional activity. The majority of healthcare professionals are computer literate as utilizing a computer and accessing patient records has become a part of our everyday duties as nurses. (Saba, 2001). As we continue to move toward a more IT world, nursing informaticists will continue to work with nurses to ensure that our practice is further enhanced by new technology (HIMSS Nursing Informatics Awareness Task Force, 2007). As clinicians is our duty to be prepared and properly trained with the most recent technological advances so we can spend less time finding where to document information or inputting information and more time fulfilling other nursing duties.

In summary, according to Murphy (2010) “nursing informatics has evolved to an integral part of health care delivery and a differentiating factor in the selection, implementation, and evaluation of health IT that supports safe, high-quality, patient-centric care” (p. 207). It is time for nurses to leave the past ways of paper charting and embrace what the future has for us in the ever evolving technological world. Our profession is being transformed to meet the needs of patients and allowing clinicians to keep accurate records but doing so in a timely and safe manner. Nursing informatics is a tool which is in place to make it easier to keep accurate records, spend more time interacting and caring for patients, and have one place to look for information regarding patient care. Nur 6051: Nursing Informatics Essay Paper

References
HIMSS Nursing Informatics Awareness Task Force. (2007, March). Informatics. Nursing Management, 38, 38-42. http://dx.doi.org/http://dx.doi.org.ezproxy.ttuhsc.edu/10.1097/01.NUMA.0000262926.85304.a6 Knight, E. P., & Shea, K. (2014). A Patient-Focused Framework Integrating Self-Management and Informatics. Journal of Nursing Scholarship, 46, 91-97. http://dx.doi.org/10.1111/jnu.12059 McFadden, R. (2012, December). Nursing informatics: A specialty on the rise. , 16, 16-17. Retrieved from http://search.ebscohost.com.ezproxy.ttuhsc.edu/login.aspx?direct=true&db=rzh&AN=2012223758&site=nrc-live Murphy, J. (2010, May-Jun). Nursing informatics: the intersection of nursing, computer, and information sciences. Nursing Economic$, 28, 204-207. Retrieved from http://search.ebscohost.com.ezproxy.ttuhsc.edu/login.aspx?direct=true&db=rzh&AN=2010699607&site=nrc-live Saba, V. K. (2001, September). Nursing informatics: yesterday, today and tomorrow. International Nursing Review, 48, 177-187. Retrieved from http://web.b.ebscohost.com.ezproxy.ttuhsc.edu/nup/detail/detail?sid=976b7ae2-
0db7-4ca2-83ce-c7fded8dd419%40sessionmgr112&vid=10&hid=119&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=rzh&AN=2001106151 Staggers, N., & Thompson, C. B. (2002). The evolution of definitions for nursing informatics: A critical analysis and revised definition. Journal of the American Medical Informatics Association. The voice of nursing informatics and the future of nursing Technology Informatics Guiding Education Reform (TIGER) (2010). ANIA-CARING Newsletter, 25(4), 11-20. Retrieved from http://web.b.ebscohost.com.ezproxy.ttuhsc.edu/nup/detail/detail?sid=2b530457-f316-4cab-99a1-51bdce7a9464%40sessionmgr115&vid=1&hid=119&bdata=JnNpdGU9bnVwLWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=rzh&AN=2010939703 Thede, L. (2008, Aug 18). The Electronic health Record: Will Nursing Be on Board When the Ship Leaves? OJIN: The Online Journal of Issues in Nursing, 13. http://dx.doi.org/10.3912/OJIN.Vol13No03InfoCol01 Thede, L. (2012, Janurary 23). “Informatics: Where is it?”. OJIN: The Online Journal of Issues in Nursing, 17(1). http://dx.doi.org/10.3912/OJIN.Vol17No1InfoCol01

History of Healthcare Informatics
It wasn’t until the 1950’s, that informatics started to take off, when Robert Ledley used computers in dental projects with the National Bureau of Standards. In the 1960’s doctors, graduate students, and computer specialists began creating diagnostic systems and other medical computer programs. In the late 1960’s, the MUMPs programming system was created to integrate medical databases and is still used today (“The History”, n.d.). Nur 6051: Nursing Informatics Essay Paper

In recent years, health informatics has exploded with president Obama’s 2009 Federal Stimulus Package, which has allocated millions of dollars for funding of health care informatics development and utilization. Nur 6051: Nursing Informatics Essay Paper

The package states a goal that by 2014, every resident will have an electronic health record (Sorgen, 2010). Given this stimulus, the U.S. Department of Labor predicts a 49% job growth and the U.S. News & World Report named Healthcare Informatics as one of the top careers today (“Health Informatics Career”, n.d.). What is Healthcare Informatics?

According to the American Health Information Management Association, healthcare Informatics was adapted from the French term for computer science (Informatique), in the 1970’s in order to capture the emerging science of information and computer technology that was used in healthcare. Health and Medical Informatics is often used interchangeably but both pertain to Healthcare Informatics. Healthcare Informatics “is the multidisciplinary scientific field concerned with the acquisition, storage, retrieval, communication and optimal use of health information for problem solving and decision making.

Health Informatics enhances the development and assessment tools used representing medical data, aiding medical decision making, defining medical language and classification systems, as well computer aided learning and healthcare IT strategy” (Health Informatics Career”, n.d.). Some of the technologies that Healthcare Informaticians manage include PDAs, telemedicine, digital imaging, digital libraries/websites, email system and clinical support systems, and electronic medical records. According to
Worldwidelearn.com, in order to succeed in Healthcare Informatics, one should possess certain skills and aptitudes.

These include but are not limited to; attention to detail, excellent verbal/written communication, problem solver, ability to work independently, intimate knowledge of computer hardware/software, good customer service skills, grace under pressure, ability to work with a wide variety of associates (doctors, nurses, programmers, managers, administrators), and a desire to help the medical community. To see if this career is the right for you; you can do research online, attend seminars, take aptitude tests and talk to working professionals in Informatics. Education and Training Requirements

There seems to be a wide variety of training and educational backgrounds for professionals currently working, in Healthcare Informatics. Many nurses working in this field have received on the job training or completed online certification programs. Many professionals currently working in this field have also received a degree in other specialty areas. According to the Healthcare Information and Management Systems Society’s 2011 survey, fifteen percent of respondents received on the job training while fifty six percent reported having Post-graduate degrees in Nursing or other specialties. Nur 6051: Nursing Informatics Essay Paper

Fifteen percent were presently taking an informatics class online or through their institution. There are online certification programs that exist for busy working healthcare professionals that already have obtained a bachelor’s degree. These programs educate people on the basic skills and knowledge needed to design, implement and monitor electronic medical data systems. Some of the coursework includes: electronic records, data standards, system analysis, and design and information literacy.

A bachelor’s degree in Healthcare Informatics, provides a sound knowledge base of electronic medical systems in order to improve disease prevention, healthcare reimbursement and resource allocation. Some of the coursework includes: medical terminology, anatomy/physiology, statistics, revenue cycle management, finance, computer systems and health records. Masters and PhD programs focus more on the design of medical information systems.

Some of the coursework includes: emerging healthcare technologies, Informatics design and usability, genomics/bioinformatics, research, change management, and database security and design (“Health Care Informatics Education”, n.d.). Many degree programs also offer opportunities to specialize in certain areas, such as: nursing informatics, dental informatics, pharmaceutical informatics, public health informatics, bioinformatics, research informatics, imaging informatics and consumer health informatics (Hersh, 2009). Companies will sometimes train employees on the job, if they take certain certification programs. However, with higher educations comes an increase in salary, benefits and job positions. Many post-graduate degrees open doors for management and executive opportunities. Certification in Nursing Informatics

Unfortunately, when it comes to working in nursing informatics, having a degree in the field is not enough. Certification can also be useful. Being certified involves passing an exam showing proficiency in the specific knowledge, skills, and abilities associated with nursing informatics. Some benefits of certification include recognition for professional achievement, higher salary, and more opportunities for promotion (Lewis, 2011). Currently, there are two ways a nurse can be certified in nursing informatics.

The most common way is through the American Nurses Association Credentialing Center (ANCC) (HIMSS, 2011). The ANCC offers an exam for eligible individuals. In order to sit for the exam, the individual must hold a current RN license, have at least two years full time experience as an RN, possess a bachelor’s degree or higher in nursing or a bachelor’s degree in a relevant field, finish 30 hours of continuing education in informatics over the past three years, and complete the appropriate number of practicum requirements. Practicum requirements include the following: at least 2,000 hours in informatics nursing over the past three years; 1,000 hours in the last three years and completed at least 12 semester hours in a graduate level nursing informatics program; or graduation from a graduate nursing informatics program where at least 200 hours of supervised practicum took place. A variety of study guides, groups, and courses are available for the individual wishing to take the ANCC Nursing Informatics Certification Exam (Lewis, 2011). Nur 6051: Nursing Informatics Essay Paper

HIMSS also offers an option for nurses to become certified in nursing informatics. According to the HIMSS website (n.d.), candidates who wish to take the CPHIMS exam must meet one of the following requirements. The individual should have a bachelor’s degree in addition to five years of experience in associated information and management systems, with three of them taking place in the healthcare field, or the candidate should have a master’s degree in addition to three years experience, with two of them in healthcare. The associated information and management systems experience could take place in administration or management, clinical information systems, information systems, e-health, or management engineering. Compensation and Benefits

Nursing informatics is a career in which its workers have seen a significant increase in salary since 2004 (HIMSS, 2011). According to the HIMSS 2011 Nursing Informatics Workforce Survey, the average salary of nursing informaticists in 2004 was $69,500, but in 2011 it had increased to $98,703. Reported salaries tended to be higher in the New England and the Pacific regions. When looking at the different settings one can work in, those employed by consulting firms had the highest average salary ($153,576) with those employed by vendor organizations achieving the second highest average salary ($108,773). Those working in academics saw an increase in salary since the 2007 survey with an average of $101,346. Certification in nursing informatics also made a difference. Nurses certified by ANCC averaged $119,644 and those certified by CPHIMS averaged $110,291. On the other hand, nurses who did not attain certification had a lower average salary of $93,787.

Many of the respondents to the HIMSS (2011) survey also reported receiving benefits in addition to their salary. Medical and dental insurance were the most common benefits followed by 401(k) or 403(b) retirement plans. Other frequently included benefits were life insurance, short- and long-term disability insurance, and tuition reimbursement. It was noted that 34 percent of respondents received a bonus. Work Environment. Nur 6051: Nursing Informatics Essay Paper

One of the advantages of becoming a nurse informaticist is the wide variety of work environments. Most work in a hospital setting, spending very little time on clinical activities. Some work at corporate offices of healthcare systems and others work in academics (HIMSS, 2011). A small number of respondents to the HIMSS (2011) survey worked for consulting firms or vendors. Nurse informaticists can also find employment at ambulatory facilities, home health agencies, managed care or insurance companies, and government or military facilities. References

American Health Information Management Association (2012). Joint AMIA/AHIMA
Summary of their Relationship and Link to the Informatics Field. Retrieved from
http:///www.ahima.org/about/informatics.aspx
Guide to College Majors in Medical Informatics. Retrieved from
http://wwwworldwidelearn.com/online-education-guide/health-medical/medical-
informatics-major.htm
Healthcare Information and Management Systems Society (n.d.). CPHIMS Become certified. Retrieved from http://www.himss.org/asp/certification_cphimsApply.asp Healthcare Information and Management Systems Society (2011). HIMSS 2011 nursing informatics workforce survey. Retrieved from http://www.himss.org/content/files/2011HIMSSNursingInformaticsWorkforceSurvey.pdf Health Care Informatics Education and Training Program Summaries. Retrieved from http://www.education-portal.com/articles/Heath_Care_Informatics_Education_and_

Training_Program_Summaries.html
Health Informatics Career and Training Profile. Retrieved from http://www.allhealthcaredegrees.com/career/informatics.htm Hersh, W. (2009). A Stimulus to Define Informatics and Health Information Technology. Retrieved from http://www.biomedcentral.com/1472-6947/9/24 Lewis, A. (2011). How to successfully pass the nursing informatics certification exam. ANIA-CARING Newsletter, 26(3), 10-12. Sorgen, C.( 2010). Medical Informatics: A Healthcare Profession Snapshot. Retrieved from

http://www.washingtonpost.com
The History of Healthcare Informatics. Retrieved from

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he United States is in the midst of a nursing shortage that is being increasingly discussed in the context of declining healthcare facilities in the nation. Over 1 in 7 hospitals (15%) report a severe RN nursing shortage with more than 20% of their nursing positions vacant and 80%-85% of hospitals report that they have a nurse shortage This shortage is predicted to intensify over the next decade or two as nurses belonging to the generation of baby boomers retire.

The Nursing Management Aging Workforce Survey released in July 2006 by the Bernard Hodes Group reveals that 55% of surveyed nurses and nurse managers reported their intention to retire between 2011 and 2020 (AACN, 2006). Nur 6051: Nursing Informatics Essay Paper

In April 2006, officials with the Health Resources and Services Administration (HRSA) released projections that the nation’s nursing shortage would grow to more than one million nurses by the year 2020 (HRSA, 2003). Nursing colleges and universities are struggling to expand enrollment levels.

In the report titled “What is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses? ” analysts show that all 50 states will experience a shortage of nurses to varying degrees by the year 2015 (AACN, 2006). Factors driving the growth in demand for nurses include: an 18 % increase in the population; a larger proportion of elderly persons requiring proportionally higher levels of medical care; advances in medical technology that heighten the need for nurses; an increase in the number of work settings for nurses and demographic changes in an increasing U. S. population (HRSA, 2003).

Factors that are causing a decrease in the supply of nurses are: the declining number of nursing school enrollees, graduates and faculty; the aging of the registered nurse workforce; work environment issues leading to job burnout and dissatisfaction; high nurse turnover and vacancy rates; and declines in relative earnings (HRSA, 2003). Due to this critical imbalance between the supply and demand of nurses, the United States is today facing a nursing shortage crisis.

Nursing shortage in rural settings: Research shows that nursing shortage as defined by the federal government exists mainly in rural areas of the country that are far away from metropolitan areas. These areas suffer more from nursing shortage than urban areas due to lack of economic resources to compete with urban based employers, inadequate training for nurses to practice in rural settings and dependence on non-hospital care settings in the rural areas. Nur 6051: Nursing Informatics Essay Paper

According to a paper published by the National Clearinghouse for Frontier Communities, “Impacts and Innovations in Frontier America” (December 2004), nurse shortages in frontier and rural communities derive not only from the current national shortage of nurses but also a long-standing trend favoring rural-to-urban migration of the educated, skilled workforce. There is also the issue of money. When examined by rurality, LPNs in rural settings ($21,941) report an income 23% lower than that reported by LPNs in urban settings ($28,408) (NCSBN, 2006).

A large number of rural communities are losing existing employment and education opportunities and the paper suggests that the community context of a nurse shortage can be addressed only through community-based development approaches as well as the crafting of healthy rural policies. The Robert Wood Johnson Foundation published a report titled “The American Nursing Shortage” with the help of its researchers Bobbi Kimball and Edward O’Neil.

According to this report, even when some people feel a calling for the professions such as nursing, they are deterred by certain dimensions of the lifestyle, such as low pay, compulsory mobility and the need for service in rural areas. Available data and literature suggest that the impact of the nursing shortage on rural and frontier communities varies greatly from community to community. IN some rural places, there is no difficulty in filling vacancies but there may be just a few good paying jobs. However, in most rural areas, recruiting for openings is estimated to take about 60 percent longer to fill than in urban areas (Long 2000). Nur 6051: Nursing Informatics Essay Paper

Nurse employers receive many applications but often find applicants do not meet desired qualifications and then, they often have to accept lower qualifications to fill positions. Differences in education between frontier and non-frontier nurses exist both in their basic nursing education and the highest degree earned (FEC, 2003). Fully half of frontier nurses had qualified as RNs through associate degree (ADN) programs, in comparison with 40% of the non-frontier nurses; in contrast, non-frontier nurses were more likely to have attended diploma or BSN programs.

Differences remain when looking at highest degree received; 44% of frontier nurses’ highest degree is the ADN, in contrast with 34% of the non-frontier nurses. And, while the percentage of nurses who have earned a bachelors degree is slightly lower among frontier nurses (30% frontier, 33% non-frontier), the percentage who has earned masters degrees is also lower among frontier (7% frontier compared with 10% non-frontier) (FEC, 2003). At Prairie Vista Nursing Home in Holyoke, Colorado, a town of about 1,900 people about 130 miles northeast of Denver, administrators reportedly had to work double shifts to cover shifts after a nurse retired.

Recruiting nurses to work in rural areas is difficult to begin with; and, when urban-trained nurses enter rural practice, they often find they are ill-prepared for the demands of the job, contributing to job dissatisfaction and turnover. Once there, they typically find it difficult to access continuing education opportunities that fit their needs. “When educators bring their knowledge to us, they often do not realize that we practice differently than urban centers do” (rural nurse, quoted in Molinari 2001). In the rural setting, nurses typically fill multiple roles.

There is a need for a broad range of skills and cross training in multiple jobs. “Rural nursing requires a high level of generalist skills and critical thinking” (Fahs, Findholt et al. 2003). Another issue is that the ethnic composition of the rural nurse workforce does not correspond with the population it serves. The ANA Rural Nursing module identifies five factors that affect rural nursing practice: threats to anonymity and confidentiality; traditional gender roles; geographic isolation; professional isolation; and scarce resources (Bushy 2004). Nur 6051: Nursing Informatics Essay Paper

Patient safety for nursing shortage in rural settings: Surveys and studies published recently confirm that the shortage of registered nurses is impacting the delivery of health care in the U. S. and negatively affecting patient outcomes. Research now shows that how well patients are cared for by nurses affects their health, and sometimes can be a matter of life or death. These studies have found that (HRSA, 2003):

• A total of 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors (Harvard School of Public Health, 2002,); A higher proportion of nursing care and a greater number of hours of care by nurses per day are associated with better outcomes for hospitalized patients (Needleman et al. , 2002); • Nursing actions, such as ongoing monitoring of patient’s health status, are directly related to better health outcomes (Kahn et al. , 1990) ; • 126,000 nurses are needed immediately to fill vacancies at our Nation’s hospitals. Today, 75% of all hospital vacancies are for nurses (American Organization of Nurse Executives, 2002); Low nurse staffing levels have contributed to 24% of unanticipated events in hospitals that resulted in death, injury or permanent loss of function (Joint Commission of Accreditation of Healthcare Organizations, 2002);
• Patients who have common surgeries in hospitals with low nurse-to-patient ratios have an up to 31% increased chance of dying. Every additional patient in an average hospital nurse’s workload increased the risk of death in surgical patients by 7% (Aiken et. al. , 2002); Low nursing staff levels were a contributing factor in 24% of hospitals’ reports of patient deaths and injuries since 1996 (Joint Commission of Accreditation of Healthcare Organizations, 2002);
• Less nursing time provided to patients is associated with higher rates of infection, gastrointestinal bleeding, pneumonia, cardiac arrest, and death from these and other causes (Needleman et al. , 2002); and • Nurse executives surveyed indicated that staffing shortages are contributing to emergency department overcrowding and the need to close beds (American Organization of Nurse Executives, 2002).

The Joint Commission on Accreditation of Healthcare Organizations, 2002 has issued a warning that failure to address the problem of nursing shortage in rural areas will result in increased deaths, complications, lengths-of-stay and other undesirable patient outcomes. JCAHO examined 1,609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases (Joint Commission on Accreditation of Healthcare Organizations, 2002). New research indicates that a shortage of registered nurses prepared at the baccalaureate and higher degree level is endangering patients. Nur 6051: Nursing Informatics Essay Paper

In an article in the September 24, 2003 issue of the Journal of the American Medical Association, Dr. Linda Aiken and her colleagues at the University of Pennsylvania found that patients experience significantly lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provide direct patient care. At least 1,700 preventable deaths could have been realized in Pennsylvania hospitals alone if baccalaureate-prepared nurses had comprised 60% of the nursing staff and the nurse-to-patient ratios had been set at 1 to 4.

Unfortunately, only 11% of PA hospitals have more than 50% of the nursing staff prepared at the baccalaureate level ( Institute of Medicine, 2003). A survey titled “Views of Practicing Physicians and the Public on Medical Errors”, conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation reported in the December 12, 2002 issue of the New England Journal of Medicine found that 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors.

Overall, 42% of the public and more than a third of U. S. octors reported that they or their family members have experienced medical errors in the course of receiving medical care (AACN, 2006). Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with high nurse-to-patient ratios have an up to 31% increased chance of dying. Funded by the National Institute for Nursing Research, the study found that every additional patient in an average hospital nurse’s workload increased the risk of death in surgical patients by 7% (AACN, 2006).

According to an extensive study by Dr. Jack Needleman and Peter Buerhas, published in the New England Journal of Medicine in May 2002, a higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients (AACN, 2006). Conclusion: Available data and literature suggest that the issue of nurse shortage is a national one. Yet, the impact of nurse shortage is better seen in the rural areas where nurses are not well paid, existing nurses are not well qualified and patients are dependent on local medical facilities.

Because most frontier and rural communities are distant from hospitals, residents may rely on non-hospital based care settings for a greater proportion of their care than their urban counterparts. Due to these reasons, nurse shortage in rural areas has endangered patient safety. Nurses are the primary source of care and support in the health care sector and hence, a sufficient supply of nurses is critical in providing the national and especially the rural population with quality health care. Nurses are expected to play an even larger role in the future.

Summary of Admission History and Progress Notes: 67-year-old male has a history of non-ischemic cardiomyopathy with ejection factor of 24%, chronic left ventricle thrombus on anticoagulant, hypertension, metastasis of prostate cancer, chronic kidney disease stage 3. Patient was admitted to UCSD emergency department on 08/20 after falling down stairs. Patient presented confused but conscious. Upon presentation in the ED he had left face, left arm, and left leg weakness. After MRI and cerebral angiogram, findings were conclusive to a right-sided embolic CVA. Echocardiogram revealed apical ventricular thrombus. Nur 6051: Nursing Informatics Essay Paper

Patient presented to ED on Coumadin therapy with INR at 3.1.

Patient was not a candidate for thrombolytic therapy. He continued on Coumadin and aspirin 81 milligrams was added. Left-sided weakness resolved within one to two days. Cardiologist at UCSD recommends Cardiac Thrombectomy to prevent further strokes. Neurologist recommends endovascular intervention to prevent future embolic strokes though not during an acute episode. Patient was held at UCSD ED for permissive hypertension during acute stroke. Patient complained of cough with green phlegm over the past few days; chest x-ray findings of no local infiltrate.

Pathophysiology:
Embolic cerebral vascular accident (CVA); stroke  Etiology/Risk factors: Risk factors include a history of transient ischemic attack, hypertension, elevated serum cholesterol, diabetes mellitus, smoking, cardiac valve diseases, anticoagulant therapy, oral contraceptive use, methamphetamine use, aneurysm, or previous stroke (Swearinger, 2012).

Pathophysiology: A stroke is caused by disruption of oxygen supply to the brain by either thrombotic occlusion, embolic occlusion or cerebral hemorrhage. Most thrombotic strokes are the result of atherosclerosis. Plaque formation builds to the point of blockage in the large blood vessels that deliver blood to the brain. Most embolic strokes are caused by a cardiac emboli resulting from cardiac valve disease or atrial fibrillation. The carotid artery feeds the main blood vessels of the brain, therefore cardiogenic emboli have a direct path to the brain (Swearinger, 2012). Nur 6051: Nursing Informatics Essay Paper

S&S: Signs and symptoms vary depending on severity and side of brain affected. Symptoms may improve within 2 to 3 days as cerebral edema decreases. Patient may appear apathetic, irritable, disoriented, drowsy or comatose; incontinence may occur; unilateral weakness or paralysis may occur; headache, neck stiffness or rigidity may be present. The patient may have difficulty chewing or swallowing and may present with unequal or fixated pupils (Swearinger, 2012).

Diagnostics: Time is critical in diagnosing the type of stroke a patient has experienced. A patient is no longer eligible for rTPA if the critical window of 3 hours from last seen normal has expired. CBC, electrolytes, blood glucose and clotting factors should be drawn immediately in order to determine eligibility for rTPA. An MRI will reveal the site of infarction and other brain structure abnormalities related to cause and effect of the CVA. An MRI may take as long as an hour to complete. While a CT scan is generally a diagnostic tool of choice in many emergency situations due to the rapid process, ischemic areas will not show in the CT imaging until they start to necrose 24 – 48 hours after the CVA (Swearinger, 2012).

Complications: Complications include recurrence of CVA, paralysis, aspiration, depression, falls, and coma.

Chronic left ventricle thrombus on anticoagulant: Anticoagulant therapy is prescribed to prevent increased formation of existing thrombi. Outside of the hospital environment, the anticoagulant of choice is usually warfarin because it may be taken PO. When the therapeutic range of warfarin is achieved patient’s INR will be 2.5-3.5. Cardiogenic trombi are the result of the heart’s inability to effectively ejecting blood after managed daily living, therefore the blood becomes stagnant and begins to clot (Deglin , Sanoski , & Vallerand, 2013). Nur 6051: Nursing Informatics Essay Paper

Chronic kidney disease (CKD) stage 3 is marked by a GFR 30-59 mL per minute (Bladh, et. al., 2013). CKD is a progressive and irreversible disorder. Aggressive management of Hypertension and Diabetes Mellitus, both of which are common contributing risk factors, may slow progression. Eventually CKD can progress to end-stage renal failure (ESRD). Before development of ESRD, a person with CKD can still manage normal daily living through diet and medication (Swearinger, 2012).

Diagnostic Tests, Results and Rationales:
Diagnostic Tests
Results
Rationales
MRI
Several areas of restricted diffusion within right MCA region; consistent with acute embolic infarcts MRI images differentiate between acute and chronic lesions. Ischemic strokes can be identified early. Site of infection, hematoma, and cerebral edema can be viewed through MRI
(Swearinger, 2012) Cerebral angiogram