Nurses Month Industry Perspectives: Nurse Informaticists Make a Difference

To impact digital health, nurse informaticists are leveraging healthcare technology innovations across all spectrums of healthcare, including the use of new technologies such as artificial intelligence (AI). The informaticist role has expanded with as organizations are addressing health equity gaps with technology. Also, the emergence of AI is transforming nursing practice across organizations to improve the quality of patient care.

We connected with four nursing informaticists, to get their perspectives on the role of informatics within their organizations and garnered their viewpoint on healthcare technology advancements throughout the last year. Here are their answers to questions focused on the revolutionary use of technologies in clinical practice, and opportunities to improve health equity and care quality using advanced technology.

Submitters

Kathleen McGrow DNP, MS, RN, PMP, CNIO, Microsoft

Jose P. Barbudo III, RN-BC, PhD(c), CPHIMS, FHIMSS, Nursing Informatics Coordinator, Hamad Medical Corporation

Anna Schoenbaum, DNP, MS, RN-BC, HIMSS, Vice President of Applications, Digital Health and Predictive Healthcare, Penn Medicine

Anonymous, Sr. Clinical Informatics Coordinator

Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, Chief Nurse, Wolters Kluwer Health

The nursing informaticist role has a wide reach within healthcare, what is your role at your organization?

Kathleen McGrow (KM): In my role as chief nursing information officer, I am responsible for driving big, bold ideas using evidence-based techniques to leverage technology to improve the quintuple aim. I am also responsible for leading and facilitation of ideation and envisioning for incubation of new ideas and opportunities that accelerate innovative solutions. I am lead for the v-team responsible for addressing the current healthcare workforce crisis and bringing about solutions to make an impact for clinicians, including implementation of AI and RPA.

Jose Barbudo (JB): Leading informatics projects that greatly impact nursing care across the organization. Engaging nursing community and collaborating with interdisciplinary teams towards a safer and more efficient delivery of care. Include training and educating nurses about new trends in healthcare technology and innovations.

 

Anna Schoenbaum (AS): My role in academic medicine is to lead the transformative integration of healthcare information technology and create practice and policy standards at a local and national level. I work to ensure new technologies accelerate research and to improve patient care outcomes, to achieve health equity and promote clinician wellness.

 

Anonymous (Anon): Nursing informatics encompasses many roles at our organization rolled into one. There is not a true nursing informatics role, so many IT roles are done by nurses, such as trainer, analyst, builder, data consultant, etc. IT nurses are looked to for advisement on new projects and service lines.

Anne Dabrow Woods (ADW): I lead the nursing strategy for Wolters Kluwer Health. I make sure we understand what’s currently happening in nursing education, practice, research and quality improvement, and the products and solutions we develop fit within workflow and overall will improve nursing practice and patient outcomes. Nurses are faced with the overwhelming challenges of information overload, inadequate competent staffing and documentation burden. It’s my responsibility to make sure our solutions adequately prepare nurses for practice, decrease documentation burden, improve clinical decision making, and facilitate quality patient care.

Within your organization, how has nursing informatics practice evolved in 2022 from past years? How does this transformation enhance the quality of care?

KM: The evolution of the practice of nursing informatics has expanded to include responsibilities of the dissemination of information obtained using technology for clinical practice and to ensure clinicians have the tools and solutions necessary to apply the scientific process to patient care. Nursing informaticists bring the assets of critical thinking, analysis and application of evidence-based standards necessary to care for patients. Nurse informaticists advocate the use of people, process and technology to translate knowledge and skills to solve health information technology problems. As more data has amassed, there is the need to leverage the data to obtain insights to drive interventions. Our skill set is essential to healthcare, as we can understand the data and disseminate the information and insights used to enhance patient quality of care. In addition, CNIOs are strategic thought leaders and key to ensuring evidence-based nursing practice and technology are utilized to measure impact and outcomes for clinical practice and patient care.

JB: Nursing informatics practice evolved as healthcare technology changed drastically over the past years. The need to stay up to date with newer and faster solutions that seemed impossible before. Adoption is faster and easier as resistance to using technology has decreased. Nursing informatics must be able to work efficiently and effectively with other healthcare teams and stakeholders. More importantly, we need to be cautious and at the same time open to the possibility of working with AI agents very soon within the healthcare environment.

AS: The COVID-19 pandemic brought unprecedented challenges to the healthcare industry and the nursing workforce. Whether at the bedside or working in informatics, we truly stepped up to care for patients. Nursing informatics found innovative solutions to combat the challenges. Post pandemic, the year of 2022, allowed organizations to achieve a new normal in care delivery, expand patient access, and tackle health equality. New care delivery models introduced virtual care (i.e., virtual intensive care unit, virtual nursing, tele-sitter and virtual visits). Initiatives to expand access to care and to improve patient experience required digital solutions to make scheduling appointments easier and more convenient for patients. Strategies to address the health disparities came to the forefront. Organizations are identifying ways to operationalize efforts aimed at addressing social determinants of health (SDOH). These efforts are transforming care delivery with an impact on quality, safety, and outcomes.

Anon: The role of the IT nurses has remained at a similar rate as in past years. The core staff is very stable, without loss of long-term staff, which allows for building projects the same as previous years. While the IT nursing staff has not gained new staff, the IT department as a whole added a large number of positions. I think the lack of additional nursing staff is due to the reporting structure of IT nurses reporting to the IT department, which has all non-clinical leadership.

ADW: Nursing informatics has become vitally important to healthcare organizations over the past 10 years and even more so post pandemic. Today nursing is at an inflexion point. We are in the middle of a bedside nursing shortage, the healthcare environments are often unhealthy and unsafe, the work of nursing is evolving due to the shortage, and documentation burden is overwhelming. Nursing informatics is analyzing data from the EHR and other databases and helping us redefine our work and demonstrate our value in healthcare. There are now active efforts to move nursing from the cost side of the ledger as part of the room and board charge, over to the revenue side. Nursing informatics can help lead the transformation of the profession and healthcare by making sure decisions are made that are informed by evidence.

Technological advancements are now leveraged in evolved practice, what are your perspectives on integrating AI with nursing care delivery and operations?

KM: Through integration of AI into nursing care delivery and operations we can enable nurses to work top of license, improve workflows and find joy in taking care of patients and facilitate quality patient care. I believe we need to educate leaders and nurses to understand AI capabilities and then investigate how to apply AI where it will add value. The value of AI is where and how it can be applied to clinical workflows and operational processes. AI adds value through automation or augmentation of how work is done. For example, automation of mundane, repetitive tasks. Augmentation will bring value by allowing humans to leverage AI as assistive and enhancing human capabilities such as cognition and decision making.

JB: AI is one of areas I'm very interested in. First, I believe NI need to educate our nurses and nursing leaders. Awareness is always the first step to change. Second, representation wherein healthcare professionals shouldn't just accept using AI agents/technologies without engagement from development to deployment. Third, we need to ensure that our policy both organization, national and practice support the use of AI in the delivery of care and operations. Fourth, training and skills should be developed for nurses to competently use and explain AI agent actions and decisions. Lastly, audit, ethics and accountability should always be considered prior to integrating AI technology in nursing practice.

AS: I am excited about the ongoing advances in digital technology, such as AI and machine learning, that will assist with care delivery and operations. The solutions brought by these advances will transform the healthcare ecosystem for patients across all settings—hospitals and clinics, as well as home and virtual care. Nurse informatics must be actively involved in understanding the relationship between the data collected and AI technologies, and engaged in the development, implementation, adoption and the monitoring of AI.

Anon: AI is necessary to keep up with the trends and to try to help offset the shortage of nurses by all the known reasons: not going to nursing school, leaving the bedside, leaving nursing in general. As AI continues to evolve and progress, it will be crucial for patient care going into the future. Sites should be integrating AI into care in any way possible, to assist with monitoring patients and predictive technology. Nursing schools will also have to incorporate AI into the curriculum, so new nurses are prepared and not scared of technology.

ADW: The use of artificial intelligence to improve healthcare is the future. Today we are experiencing healthcare professional shortages, increased complexity of patient conditions, new models of care and an increasing number of less experienced healthcare professionals at the bedside. AI should be used to improve clinical decision making, improve models of care by validating that the right nurse with the right level of education, training and experience is caring for the right patient. Having the right number of competent nurses caring for patients will ultimately improve quality patient care. The challenge will be integrating AI into healthcare workflow and making sure it will recognize the nuances of individual patients.

Healthcare organizations are now focused on promoting health equity. How can nursing informaticists use technology to advance health equity? 

KM: Nursing informaticists can use technology to advance health equity through education and use of a long-term sustainable strategy. Nursing informaticists can participate by bringing strong allyship within vulnerable communities, including those in low income and/or with accessibility needs. The nurse informaticist can reach out to and support leaders and organizations with influence in these vulnerable communities. This means empowering individuals and organizations working to overcome the inequities and re-educating those with health privilege to understand root causes and approaches towards health equity.

We need to study health equity by demonstrating real outcomes and the higher burden of disease that vulnerable communities and individuals bear. We need to understand the determinants of health and population health by incorporating vulnerability indices and equity dashboards into solutions to better guide clinical care. Nursing informaticists need access to resources that can be brought to bear on the problem, such as championing measures to decrease the digital divide.

Thorough understanding of programs such as the FCC Telehealth initiative for affordable connectivity are important to be aware of and understanding the ability within organizations to make an impact. This is essential for health equity around the growing interest and support for virtual care. Artificial Intelligence can be subject to bias, so nurse informaticists need to educate data scientists and others on the causes of potential bias, such as small and homogenous datasets that are not representative of diverse, low-income populations. Bias has explicitly made its way into our decision support tools as evidenced by the algorithms discussed in a recent NEJM article, including a tool to decide on treatment for breast cancer specifically lowers the aggressivity of treatment in black and Hispanic women. Bias can also be implicit by measuring a proxy for outcomes that is already biased towards inequity, such as cost of care. Many low-income patients seek less care, which in turn lowers costs. The covid pandemic has shone a bright light on health equity, including covid disease burden and vaccine inequity. Nurse Informaticists should promote a culture of empathy, openness and respect with diversity and inclusion.

JB: Nurse informaticists have the right platform and voice representing nursing and patients. A good example is clinical information system (CIS) implementation and optimization projects. As NIs, we advocate for advancing health equity by ensuring that systems are unbiased, fair and all inclusive. Breaking down the barriers to social injustice as we look forward, the data collected in the system will eventually be used for prescriptive and predictive analytics.

AS: Nurse informatics can play a critical role in advancing health equity for improved outcomes. In designing data collection tools, predictive models and other solutions, nurse informatics must integrate health equity principles into the electronic health record (EHR) and reports. We must consider aligning data standards (i.e, Race, ethnicity, ancestry, language, social determinants of health (SDOH), discrete collection of sexual orientation and gender identity), and preferred name in the EHR. System design must include an assessment of disparity impact (before, during and post implementation). And our tools must incorporate access to transportation and healthcare services. We must also consider the nurses and other roles in addressing health disparities and how information is shared. Nurses can take the lead in education, research and practice by partnering with community organizations.

Nurse leaders should participate in organizations, task forces, and committees at the local, state, or national level to advance standards, policies and incentives supporting the collection, use and sharing of SDOH data. Nurses can cultivate a culture that promotes the importance of SDOH among health care professionals and the integration of screening tools and visualization of SDOH data into existing workflows. Finally, nurses must collaborate with community agencies and healthcare entities to define how SDOH can be fully integrated into patient care.

Steps to Address SDOH

For clinical nurses who want to understand how SDOH data can be integrated into their healthcare organization, consider the following actions:

• Learn more about the organizational policies and procedures for SDOH.
• Explore EHR documentation to identify where SDOH data may already be collected and the best locations to review data.
• Encourage colleagues to have discussions with patients to understand their comfort levels by sharing SDOH information.
• Support and advise organizational plans to implement SDOH into nursing workflows.
• Identify opportunities to conduct a nursing inquiry for SDOH interventions.
• Establish ways to triage support based on individual responses to SDOH-related questions by involving interdisciplinary team members such as social services, nutritionists and mental health professionals.¹

Anon: Very few people, no matter their circumstances, are without a phone. Apps can help improve health equity using a mobile device. Technology can also be used to enable nurses to connect with patients to assess and monitor health conditions, any disparities or issues.

ADW: For years, the conversation has been on healthcare equality, and we’ve finally recognized that a one size solution does not work. Equitable healthcare means defining the healthcare outcome and then implementing the solution that best works for the patient to achieve that outcome. It also means all people should have access to care and the barriers of zip code, education and financial income need to be addressed. Healthcare organizations need to serve their communities, and to do that the organization needs to understand the community and recognize their needs. Nursing informaticists will lead this change because they understand the data better than anyone and they’ll be able to translate it into workable solutions.

 

References

1. HIMSS Nursing Informatics Committee and SDOH Task Force. (2022).