1. QSEN Aligned Informatics Teaching Strategies Across the Nursing Continuum BSN, MSN, DNP Marisa L Wilson DNSc MHSc RN-BC CPHIMS Associate Professor The University of Alabama at Birmingham School of Nursing QSEN 5/2016

2. Objectives Define Informatics as an Advanced Nursing Specialty Contrast Informatics as an Expected Competency for all nurses Elaborate on QSEN Informatics Competencies Discuss Configurations within Plans of Study Review Topical Areas to Engage Learners Present “Lessons Learned”

3. Define Nursing Informatics as an Advanced Nursing Specialty NI is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. NI facilitates the integration of data, information and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. ANA, Nursing Informatics Scope and Standards of Practice, 2014

4. What makes Informatics a Specialty? Differentiated practice Defined research priorities Representation in professional organizations Formal education programs A credentialing process for specialists An accreditation process* for programs

5. Why is this important? These Informatics Nurse Specialists are: –Out there with a solid theoretical background and real world experience. –Many will consult on or guest lecture for course development. –Many want to teach at all levels –They produce a body of evidence. –They are available in most clinical sites for consult.

6. Support for Inclusion Institute of Medicine (IOM) –Crossing the Quality Chasm, 2001 –Health Professions Education: A Bridge to Quality, 2003 Healthcare professionals need to be taught: –Patient centered care –How to work in teams –Use of evidence based practice –Application of QI strategies –Proficient use of informatics and information technology

7. Support for Inclusion Technology Informatics Guiding Education Reform (TIGER) –Brought together experts –Developed a vision and strategy to improve nursing education (now interprofessional) –Formed collaborative teams to create a workforce capable of using IT –http://thetigerinitiative.orghttp://thetigerinitiative.org

8. Support for Inclusion AHRQ and Robert Wood Johnson joined forces –Formed the Quality and Safety Education for Nurses (QSEN) –Competency 5 urges the utilization of informatics to ensure safety and enhance quality care –http://qsen.org/competencies/it/http://qsen.org/competencies/it/

9. QSEN Informatics KSAs Use information and technology to communicate, manage knowledge, mitigate error, and support decision making. Prelicensure http://qsen.org/competencies/pre-licensure- ksas/#informatics Graduate http://qsen.org/competencies/graduate- ksas/#informatics

10. Support for Inclusion Affordable Care Act – 2014 –Thirty million patients will gain access and demand care. –Over 3 million nurses are expected to provide better quality and safer care. – A proficient and deeper use of technology is expected through Meaningful Use.

11. Support for Inclusion In response, the American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) incorporated informatics competencies. –AACN Essentials of Baccalaureate Education element IV –NLN released the Position Statement Preparing the Next Generation of Nurses to Practice in a Technology-rich Environment: An Informatics Agenda

12. Plan for Configuration of Courses Standalone course –One dedicated informatics course that every student takes – BSN, MSN, DNP –Varies based on expected leveled competency –Could be face to face or on line –Would be separate from use of academic or clinical electronic health record in simulation –Would not be a computer science course

13. Plan for Configuration Dedicated and specified module in each course –One module embedded in each class to cover informatics topics of interest Fundamentals, Adult Health, Mothers and Newborn, EBP, Leadership, Role of the Nurse for BSN students Policy, EBP, Leadership, Organizational Systems, Role of the Advanced Nurse for Masters student and DNP Informatics should also be highlighted in clinical and simulation

14. Plan for Configuration Informatics material threaded within and throughout course materials –Content threaded throughout appropriate material Fundamentals - Managing electronic documentation, information management Adult Health - Bar coding for safety, clinical decision support Childbearing Family – Social networking and mobile apps Community – Reporting, Interoperability Leadership – Analytics, dashboards, quality monitoring

15. Topical Areas What is informatics? –What is nursing informatics? –Who are the informaticians? –Examine the organizational culture and technology –Discuss information sharing and technology –Relate informatics innovations to nursing practice Data to information to knowledge to wisdom –Define these concepts and the relationships –Describe how we manage this with information technology –Discuss relationship with EBP

16. Topical Areas Theories and Models –Shannon Weaver Communications Theory –Rogers Diffusion of Innovation Innovation communicated through channels Innovators, Early Adopters, Early Majority, Late Majority, Laggards –Change theories and the role of the nurse Systems Development Lifecycle Lewin’s Theory – Driving, Restraining, Equilibrium Disruptive Innovations –Evaluation Models – LOGIC Inputs, Activities, Outputs, Outcomes

17. Topical Areas Standardized Terminology –Sharable and Comparable Nursing Data –Trigger for Clinical Decision Support –Foundation of the development of EBP –Resources: http://www.nursing.umn.edu/icnp/center-projects/big- data/2016-nursing-knowledge-big-data-science- conference/index.htmhttp://www.nursing.umn.edu/icnp/center-projects/big- data/2016-nursing-knowledge-big-data-science- conference/index.htm

18. Topical Areas Hardware, Software, and Communications Technology –Information Systems – Clinical and Administrative –EHRs, PHRs, Portals, Secure Messaging and access –Hardware Used – PCs, Laptops, Handhelds, Mobile, RFID, BarCode Readers, Wearables, Implantables –Data Warehouse and Storage –Outputs – reports, queries, dashboards –Communication Devices – Smartphones, VOIP, text –Computer Mediated Communication – Twitter, –Usability, Ergonomics, Human Computer Interaction

19. Topical Areas Quality and Safety and Information Technology –Relationship between data and information in CIS and EBP –Health Literacy for both nurse and patient/consumer –Clinical Decision Support and EBP Alerts, Dashboards, Reports, Analytics, Ordersets, Documentation templates –Effective information search strategies –Critique accuracy and value of information on the internet –Information Overload, Alert Fatigue

20. Topical Areas Extending Health and Care with Technology –eHealth and Mobile Apps –Social Networking –Telehealth, Telenursing http://www.americantelemed.org/docs/default- document-library/fact_sheet_final.pdf?sfvrsn=2 http://www.americantelemed.org/docs/default- document-library/fact_sheet_final.pdf?sfvrsn=2 –eCare – eICU –Patient sourced data and how we manage it –Interoperability of data and Health –Robotics in clinical areas and home –Nanotechnology –Genomics

21. Topical Areas Data Security, Confidentiality, Privacy –ANA Code of Ethics –HIPAA – HHS https://www.healthit.gov/providers- professionals/ehr-privacy-security/practice-integrationhttps://www.healthit.gov/providers- professionals/ehr-privacy-security/practice-integration –Patient Access - https://www.healthit.gov/sites/default/files/consumerac cessdatabrief_9_10_14.pdf https://www.healthit.gov/sites/default/files/consumerac cessdatabrief_9_10_14.pdf –Joint Commission –CMS

22. Topical Areas Evolution of Standards and Policy –Meaningful Use – https://www.healthit.govhttps://www.healthit.gov –Access to own information - https://www.healthit.gov/patients-families https://www.healthit.gov/patients-families –Empowered and engaged patients - https://www.patientslikeme.com https://www.patientslikeme.com –Health Information Technology Standards SNOMED LOINC HL7

23. Lessons Learned Informatics is much more than teaching an EHR Nurses need to know how to lead these changes Choice of configuration has implications for workload and staff development Timing of material is very important particularly for traditional BSNs with little clinical exposure Effort must be made to connect informatics content to patient/consumer care and role of the nurse Weave use of technology with appropriate skill of learner Start information literacy and information search strategies early

24. References Carrington JM, Tiase VL, Estrada N, & Shea KD. (2014. Nursing education focus of nursing informatics research in 2013 Nurs Admin Q. De Gagne J, Bisanar WA, Makowski JT, & Neumann JL. (2011). Integrating informatics into the BSN curriculum; a review of the literature. Nurse Education Today. Hunter K, McGonigle D, & Hebda T. (2013) The integration of informatics content in baccalaureate and graduate nursing education. Nursing Educator. Miller LA, Stimely ME, Matheny PM, Pope MF, McAtee RE, & Miller KA. (2014) Novice nurse preparedness to effectively use electronic medical records. Online Journal of Nursing Informatics. Telez M. (2012) Nursing informatics education past, present, and future, CIN Plus.

25. Resources QSEN Modules http://qsen.org/tag/informatics/ http://qsen.org/courses/learning-modules/module- seven/https://www.healthit.gov/providers-professionals http://qsen.org/courses/learning-modules/module- seven/https://www.healthit.gov/providers-professionals DHHS Office of the National Coordinator https://www.healthit.gov Informatics Deep Dive http://www.nursing.umn.edu/continuing-professional- development/nnideepdive/ http://www.nursing.umn.edu/continuing-professional- development/nnideepdive/ http://www.nursing.umn.edu/prod/groups/nurs/@pub/@nurs/docume nts/content/nurs_content_500673.pdf http://www.nursing.umn.edu/prod/groups/nurs/@pub/@nurs/docume nts/content/nurs_content_500673.pdf http://docplayer.net/5877666-National-nursing-informatics-deep- dive-program.html http://docplayer.net/5877666-National-nursing-informatics-deep- dive-program.html

26. Questions? Please feel free to contact me: Marisa L. Wilson DNSc MHsc RN-BC CPHIMS The University of Alabama at Birmingham School of Nursing mwilsoa@uab.edu