NURS 5051/ NURS 6051 week 3 Discussion: Interaction Between Nurse Informaticists and Other Specialists

According to Glassman (2017), informatics is used by nurses to share patient information with colleagues and other staff, to store information, to abate mistakes, and to corroborate decision making. In the clinic setting, the electronic health record (EHR) is filled with an array of helpful data and directions in comparison to a paper chart.  The helpful tools range from a daily schedule to a patient summary sheet comprised of a vital signs flow chart, all diagnoses chronic and historical acute,  patient risk score, patient social history, family health history, past medical and surgical history, advance directives, allergies, current and historical medications, screenings, implantable devices, health concerns, goals, a list of all encounters, and messages.

On initiating a patient encounter, a notifications screen appears and if the patient is diabetic, has hypertension, or is of age for other screenings, an alert appears advising consideration of intervention.  Next, an area for the patient’s chief complaint is labeled; followed by health concerns, last menses, and a vital signs flow chart with a calculated BMI on entry of the height and weight.  Next on the encounter is a list of all historical diagnoses, allergies, medications, social history, and medical history.  The provider note follows with a subjective, objective, assessment, and order space.   In the order space, there are links for laboratory orders and imaging orders to be created. Included in the next aspect of the encounter is a segment for attachments to be submitted to the record.  The observations aspect of the chart comes next and is comprised of functional status and cognitive status.  Toward the end of the encounter is an attestation to diagnoses reconciliation and medication reconciliation.  Next, an option to develop a care plan/ discharge instructions is available.  The referral option is listed next, and this can be completed by a click which links to the directory, which houses all referral source and data related to telephone and fax numbers, as well as their address, and an option to send the referral from the EHR via fax.  Lastly on the encounter, the option to create a superbill to include all diagnosis codes and all procedure codes for the visit can be completed.

A very important reason for utilizing an EHR is the reports which can be generated with a guided search.  The reports include quality reporting, which comprises electronic clinical quality measures (eCQMs) used by Medicare and Medicaid for potential incentives to report using the Merit-Based Incentive Payment System (MIPS).  Next on the page is a link for clinical reporting which can generated reports on chart notes, particular diagnoses, drug interactions, e-prescriptions report, continuity of care documents, medication reports, custom patient list reports, a prescription history from pharmacies and payers, history of all clinic prescriptions, and a report of all clinic referrals made. Finally reports pertinent to the practice management can be generated.  Such reports include activity feed and audit reports, appointment reports, billing reports, payer reports, and prior authorizations.

Clearly, the clinical encounter has become very complex and better care is provided with the many alerts and safeguards in place.  Furthermore, reports can be generated within minutes that would have previously taken days.  A strategy that would improve informatics interactions in the primary clinic setting would be the option for diagnosis-specific templates to be clicked in with the option to check or circle selections or fill in as needed.  The current EHR used in the clinic where I am requires typing out the information in the chief complaint, the subjective, objective, and the plan.  The medications do appear in the plan automatically on sending the electronic prescription.   There are likely such EHRs out there, but area task to explore; as most require registration of the clinic in order to watch a demonstration video.  On registration in the past, sales personnel have called the clinic immediately and persistently.

In considering the impact of the continued emergence of new technologies might have on professional interactions, McGonigle and Mastrian (2017) advise that the EHR has a disordering effect on the patient encounter.  However, they also advise that EHR technology provides efficacy and improvements in safety (McGonigle and Mastrian, 2017).  Their suggestion is to find strategies that incorporate both the EHR and face to face care of patients (McGonigle and Mastrian, 2017).

Wang, Kung, and Byrd (2018) advise that the potential benefits of the EHR leave healthcare facilities little option in embracing the idea and moving forward to work toward strategies to combine the face to face encounter and the EHR in providing the best organizational care for patients.  They say that data from EHRs can provide care pattern analysis, offer data analysis, offer decision guidance, provide predictive capacities, and provide traceability (Wang, Kung, and Byrd, 2018).

In the clinic where I am, I have witnessed frustration with the EHR requiring focused attention, while the provider would prefer face to face flowing interactions with the patient.  A $2000 Dragon Medical Practice voice recognition tool was purchased for dictation to soon be laid aside in hopes of finding something that would work better. As the search continues for an EHR that offers a more comfortable way to provide duties of care in nursing science, such as healing conversations, providing attentive listening, providing a comforting touch and confirmation of understanding as patients seek for care to maintain, improve, or restore their mental and physical health as described by McGonigle and Mastrian (2017), providers and nurses must continue to embrace the EHR.

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References

Glassman, K. S. (2017). Using data in nursing practice. American Nurse Today, 12(11), 45–47. Retrieved from https://www.americannursetoday.com/wp-content/uploads/2017/11/ant11-Data-1030.pdf

McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 25, “The Art of Caring in Technology-Laden Environments” (pp. 525–535)

Wang, Y., Kung, L., & Byrd, T. A. (2018). Big data analytics: Understanding its capabilities and potential benefits for healthcare organizations. Technological Forecasting & Social Change, 126, 3–13. https://doi-org.ezp.waldenulibrary.org/10.1016/j.techfore.2015.12.019

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

• Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
• Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

*Note: Throughout this program, your fellow students are referred to as colleagues.

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