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(BQ) Part 1 book “Nursing informatics and the foundation of knowledge” hass contents: Nursing science and the foundation of knowledge; introduction to information, information science, and information systems; ethical applications of informatics; history and evolution of nursing informatics,… and other contents.
NURSING INFORMATICS and the Foundation of Knowledge FOURTH EDITION Dee McGonigle, PhD, RN, CNE, FAAN, ANEF Director, Virtual Learning Experiences (VLE) and Professor Graduate Program, Chamberlain College of Nursing Member, Informatics and Technology Expert Panel (ITEP) for the American Academy of Nursing Kathleen Mastrian, PhD, RN Associate Professor and Program Coordinator for Nursing Pennsylvania State University, Shenango Sr Managing Editor, Online Journal of Nursing Informatics (OJNI) JONES & BARTLETT LEARNING World Headquarters Jones & Bartlett Learning 5 Wall Street Burlington MA 01803 978-443-5000 info@jblearning.com www.jblearning.com Jones & Bartlett Learning books and products are available through most bookstores and online booksellers To contact Jones & Bartlett Learning directly, call 800-832-0034, fax 978-443-8000, or visit our website, www.jblearning.com Substantial discounts on bulk quantities of Jones & Bartlett Learning publications are available to corporations, professional associations, and other qualified organizations For details and specific discount information, contact the special sales department at Jones & Bartlett Learning via the above contact information or send an email to specialsales@jblearning.com Copyright © 2018 by Jones & Bartlett Learning, LLC, an Ascend Learning Company All rights reserved No part of the material protected by this copyright may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner The content, statements, views, and opinions herein are the sole expression of the respective authors and not that of Jones & Bartlett Learning, LLC Reference herein to any specific commercial product, process, or service by trade name, trademark, manufacturer, or otherwise does not constitute or imply its endorsement or recommendation by Jones & Bartlett Learning, LLC and such reference shall not be used for advertising or product endorsement purposes All trademarks displayed are the trademarks of the parties noted herein Nursing Informatics and the Foundation of Knowledge, Fourth Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or service marks referenced in this product There may be images in this book that feature models; these models do not necessarily endorse, represent, or participate in the activities represented in the images Any screenshots in this product are for educational and instructive purposes only Any individuals and scenarios featured in the case studies throughout this product may be real or fictitious, but are used for instructional purposes only The authors, editor, and publisher have made every effort to provide accurate information However, they are not responsible for errors, omissions, or for any outcomes related to the use of the contents of this book and take no responsibility for the use of the products and procedures described Treatments and side effects described in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect that is not described herein Drugs and medical devices are discussed that may have limited availability controlled by the Food and Drug Administration (FDA) for use only in a research study or clinical trial Research, clinical practice, and government regulations often change the accepted standard in this field When consideration is being given to use of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations on dose, precautions, and contraindications, and determining the appropriate usage for the product This is especially important in the case of drugs that are new or seldom used 12268-8 Production Credits VP, Executive Publisher: David D Cella Executive Editor: Amanda Martin Editorial Assistant: Christina Freitas Production Manager: Carolyn Rogers Pershouse Senior Marketing Manager: Jennifer Scherzay Product Fulfillment Manager: Wendy Kilborn Composition: S4Carlisle Publishing Services Cover and Text Design: Michael O’Donnell Rights & Media Specialist: Wes DeShano Media Development Editor: Shannon Sheehan Cover Image (Title Page, Part Opener, Chapter Opener): © fotomak/Shutterstock Printing and Binding: LSC Communications Cover Printing: LSC Communications Library of Congress Cataloging-in-Publication Data Names: McGonigle, Dee, editor | Mastrian, Kathleen Garver, editor Title: Nursing informatics and the foundation of knowledge/[edited by] Dee McGonigle, Kathleen Mastrian Description: Fourth edition | Burlington, MA: Jones & Bartlett Learning, [2018] | Includes bibliographical references and index Identifiers: LCCN 2016043838 | ISBN 9781284121247 (pbk.) Subjects: | MESH: Nursing Informatics | Knowledge Classification: LCC RT50.5 | NLM WY 26.5 | DDC 651.5/04261 dc23 LC record available at https://lccn.loc.gov/2016043838 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 The Pedagogy Nursing Informatics and the Foundation of Knowledge, Fourth Edition drives comprehension through a variety of strategies geared toward meeting the learning needs of students, while also generating enthusiasm about the topic This interactive approach addresses diverse learning styles, making this the ideal text to ensure mastery of key concepts The pedagogical aids that appear in most chapters include the following: resources Failure to achieve strong adoption results early on is not necessarily a failure of the methods utilized, but rather may be due to other factors not entirely within the control of the informaticist Perhaps a complete alteration in behavior is not possible, but modifications to behaviors needed to support a desired outcome can be realized This situation is analogous to the individual who stops smoking; the desire for the cigarette remains, but the behavior has been modified to no longer sustain smoking To manage change in an organization, nurses must modify behavior to produce the intended outcome Change takes hold when strong leadership support exists This support manifests itself as a visible presence to staff, clear and concise communications, an unwavering position, and an open door policy to field concerns about change Too often, leadership gives verbal endorsement of change and then fails to follow through with these actions or withdraws support when the going gets tough Inevitability, if leadership wavers, so too will staff Measuring the Results Metrics provide understanding about the performance of a process or function Typically within clinical technology projects, we identify and collect specific metrics about the performance of the technology or metrics that capture the level of participation or adoption Equally important is the need for process performance metrics Process metrics are collected at the initial stage of project or problem identification Current-state metrics are then benchmarked against internal indicators When there are no internal indicators to benchmark against, a suitable course of action is to benchmark against an external source such as a similar business practice within a different industry Consider examining the hotel room changeover strategy or the customer service approach of Walt Disney Company or Ritz Carlton hotels, for example, to determine suitable metrics for a particular project or focus area The right workflow complement will provide the organization with the data it needs to understand operational and clinical performance This area is highlighted through the need for healthcare organizations to capture MACRA measures Good metrics should tell the story of accomplishment The presence of technology alone does not guarantee an organization’s ability to capture and report on these measures without also addressing the surrounding workflow Metrics should focus on the variables of time, quality, and costs Table 13-1 provides examples of relevant metrics Table 13-1 Examples of Metrics Turnaround times Cycle times Throughput Change-over time Set-up time System availability Patient satisfaction Employee satisfaction MACRA highlights the need for healthcare organizations to collect information that represents the impact of technology on patient outcomes Furthermore, data are necessary to demonstrate how a process is performing in its current state In spite of the MACRA mandates, the need to collect data to demonstrate improvement in workflow— though it remains strong—is all too often absent in implementation or redesign efforts A team cannot demonstrate improvements to an existing process without collecting information about how the process is performing today Current-state measures also help the process team validate that the correct area for improvement was identified Once a process improvement effort is over and the new solution has been implemented, postimprovement measures should be gathered to demonstrate progress In some organizations, the informatics professional reports to the director of operations, the chief information officer, or the chief operations officer In this relationship, the need to demonstrate operational measures is even stronger Operational measures such as turnaround times, throughput, and equipment or technology availability are some of the measures captured Future Directions Workflow analysis is not an optional part of clinical implementations, but rather a necessity for safe patient care supported by technology The ultimate goal of workflow analysis is not to “pave the cow path,” but rather to create a future-state solution that maximizes the use of technology and eliminates non-value-added activities Although many tools to accomplish workflow redesign are available, the best method is the one that complements the organization and supports the work of clinicians Redesigning how people do work will evidentially create change; thus the nursing informaticist will need to apply change management principles for the new way of doing things to take hold Workflow analysis has been described in this chapter within the context of the most widely accepted tools that are fundamentally linked to the concepts of Six Sigma/Lean Other methods of workflow analysis exist and may become commonly used to assess clinical workflow An example of an alternative workflow analysis tool is the use of radio frequency badges to detect movement within a defined clinical area Clinician and patient movements may be tracked using these devices, and corresponding actions may be documented, painting a picture of the workflow for a specific area (Vankipuram, 2010) Another example of a workflow analysis tool involves the use of modeling software An application such as ProModel provides images of the clinical work area where clinician workflows can be plotted out and reconfigured to best suit the needs of a specific area Simulation applications enable decision makers to visualize realistic scenarios and draw conclusions about how to leverage resources, implement technology, and improve performance Other vendors that offer simulation applications include Maya and Autodesk Healthcare organizations need to consider how other industries have analyzed and addressed workflow to streamline business practices and improve quality outputs to glean best practices that might be incorporated into the healthcare industry’s own clinical and business approaches First, however, each healthcare organization must step outside itself and recognize that not all aspects of patient care are unique; consequently, many aspects of care can be subjected to standardization Many models of workflow redesign from manufacturing and the service sector can be extrapolated to health care The healthcare industry is facing difficult economic times and can benefit from performance improvement strategies used in other industries Although workflow analysis principles have been described within the context of acute and ambulatory care in this chapter, the need to perform process analysis on a macro level will expand as more organizations move forward with health information exchanges and medical home models A health information exchange (HIE) requires the nursing informaticist to visualize how patients move through the entire continuum of care and not just a specific patient care area Technology initiatives will become increasingly complex in the future In turn, nursing informaticists will need greater preparation in the area of process analysis and improvement techniques to meet the growing challenges that technology brings and the operational performance demands of fiscally impaired healthcare organizations Summary Meaningful use (MU) reflected the rules and regulations arising from ARRA MACRA has changed the game and how payment will be determined EHR adoptions “represent a small step rather than a giant leap forward” (Murphy, 2013, para 1) Workflows integrating technology provide the healthcare professional with the data necessary to make informed decisions This quality data must be collected and captured to meet MACRA measures Nurses must be involved in “meaningful data collection and reporting Documentation by nurses can tell what’s going on with the patient beyond physical exams, test results, and procedures” (Daley, 2013, para 5) Workflow redesign is a critical aspect of technology implementation When done well, it yields technology that is more likely to achieve the intended patient outcomes and safety benefits Nursing informatics professionals are taking on a greater role with respect to workflow design, and this aspect of practice will grow in light of MACRA-driven measures Other initiatives that impact hospital performance will also drive informatics professionals to influence how technology is used in the context of workflow to improve the bottom line for their organizations In an ideal world, nurse informaticists who are experts at workflow analysis will be core members of every technology implementation team THOUGHT-PROVOKING QUESTIONS What do you perceive as the current obstacles to redesigning workflow within your clinical setting? Thinking about your last implementation, were you able to challenge the policies and practices that constitute today’s workflow or were you able to create a workflow solution that eliminated non– value-added steps? Is the workflow surrounding technology usage providing the healthcare organization with the data it needs to make decisions and eventually meet MACRA criteria? How does the current educational preparation need to change to address the skills necessary to perform workflow analysis and redesign clinical processes? Describe the role of the nurse informaticist as the payment programs change related to MACRA References Agency for Healthcare Research and Quality (AHRQ) (n.d.) Workflow assessment for health IT toolkit Retrieved from http://healthit.ahrq.gov/health-ittools-and-resources/workflowassessment-health-it-toolkit Agency for Healthcare Research and Quality (AHRQ) (2008) Patient safety and quality: An evidence-based handbook for nurses Retrieved from http://www.ahrq.gov/qual/nurseshdbk American Association for Justice (2016) Medical errors Retrieved from https://www.justice.org/what-wedo/advocate-civil-justicesystem/issue-advocacy/medicalerrors American Nurses Association (2015) Nursing informatics: Scope and standards of practice (2nd ed.) Silver Springs, MD: Author Bucur, A., van Leeuwen, J., Christodoulou, N., Sigdel, K., Argyri, K., Koumakis, L., Stamatakos, G (2016) Workflow-driven clinical decision support for personalized oncology BMC Medical Informatics & Decision Making, 16, 151–162 doi:10.1186/s12911-016-0314-3 Campbell, E., Guappone, K., Sittig, D., Dykstra, R., & Ash, J (2009) Computerized provider order entry adoption: Implications for clinical workflow Journal of General Internal Medicine, 24(1), 21–26 Centers for Medicare & Medicaid Services (CMS) (2016a) Electronic health records (EHR) incentive programs Retrieved from https://www.cms.gov/RegulationsandGuidance/Legislation/EHRIncentivePrograms/index.h Centers for Medicare & Medicaid Services (CMS) (2016b) MACRA: Delivery system reform, Medicare payment reform Retrieved from https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/Value-BasedPrograms/MACRA-MIPS-andAPMs/MACRA-MIPS-and-APMs.html Centers for Medicare & Medicaid Services (CMS) (2016c) CMS quality measure development plan: Supporting the transition to the merit-based incentive payment system (MIPS) and alternative payment models (APMs) Retrieved from https://www.cms.gov/Medicare/QualityInitiatives-Patient-AssessmentInstruments/Value-BasedPrograms/MACRA-MIPS-andAPMs/Final-MDP.pdf Clancy, T., Delaney, C., Morrison, B., & Gunn, J (2006) The benefits of standardized nursing languages in complex adaptive systems such as hospitals Journal of Nursing Administration, 36(9), 426–434 Daley, K (2013) Making HIT meaningful for nursing and patients The American Nurse Retrieved from http://www.theamericannurse.org/index.php/2011/08/0 hit-meaningful-for-nursing-andpatients Earl, M., Sampler, J., & Sghort, J (1995) Strategies for business process reengineering: Evidence from field studies Journal of Management Information Systems, 12(1), 31–56 Gugerty, B., Maranda, M J., Beachley, M., Navarro, V B., Newbold, S., Hawk, W., Wilhelm, D (2007) Challenges and Opportunities in documentation of the nursing care of patients Baltimore, MD: Documentation Work Group, Maryland Nursing Workforce Commission Retrieved from http://mbon.maryland.gov/Documents/documentation Hagland, M (2016) CMS announces long-awaited MACRA proposed rule; Program includes MU makeover for MDs Healthcare Informatics Retrieved from http://www.healthcareinformatics.com/article/breakingnews-cms-announces-plan-replacemeaningful-use-physicians-newquality-reporting Healthcare Information Management Systems Society (HIMSS) (2010) MEPI toolkit: Process management, workflow & mapping: Tools, tips and case studies to support the understanding, optimizing and monitoring of processes Retrieved from http://www.himss.org/me-pitoolkit-change-management Healthcare Information Management Systems Society (HIMSS) (2015) Nursing informatics impact study Retrieved from http://www.himss.org/ni-impactsurvey Kotter, J P (1996) Leading change (pp 33–147) Cambridge, MA: Harvard Business Press Merriam-Webster Online Dictionary (2016) Optimization Retrieved from http://www.merriamwebster.com/dictionary/optimization Murphy, K (2013) Nursing approach to meaningful use, EHR adoption: CIO series Retrieved from https://ehrintelligence.com/news/nursing- approach-to-meaningful-use-ehradoption-cio-series Qualis Health (2011) Workflow analysis Retrieved from http://www.qualishealthmedicare.org/healthcareproviders/improvementfundamentals/workflow-analysis Stokowski, L (2013) Electronic nursing documentation: Charting new territory Medscape Retrieved from http://www.medscape.com/viewarticle/810573 Thompson, C., Kell, C., Shetty, R., & Banerjee, D (2016) Clinical workflow redesign leveraging informatics improves patient outcomes Heart & Lung, 45(4), 380–381 Vankipuram, K (2010) Toward automated workflow analysis and visualization in clinical environment Journal of Biomedical Informatics doi:10.1016/jbi.2010.05.015 Yuan, M., Finley, G., Long, J., Mills, C & Johnson, R (2013) Evaluation of user interface and workflow design of a bedside nursing clinical decision support system Interactive Journal of Medical Research, 2(1), e4 ... https://lccn.loc.gov/2 016 043838 6048 Printed in the United States of America 21 20 19 18 17 10 9 8 7 6 5 4 3 2 1 The Pedagogy Nursing Informatics and the Foundation of Knowledge, Fourth Edition drives comprehension... Summary References 26 Nursing Informatics and the Foundation of Knowledge Dee McGonigle and Kathleen Mastrian Introduction Foundation of Knowledge Revisited The Nature of Knowledge Knowledge Use in Practice... displayed are the trademarks of the parties noted herein Nursing Informatics and the Foundation of Knowledge, Fourth Edition is an independent publication and has not been authorized, sponsored, or otherwise approved by the owners of the trademarks or