Nurse Informatics Directors Shape Documentation

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By Debra Wood, RN, contributor

With more and more hospitals converting to digital record keeping and a federal initiative to develop electronic portability of health information, nurses specializing in informatics influence technology decisions that affect nurses’ daily routines.

“By being on the front end, we’re trailblazers,” said Carol DiBiaggio, RN, director of medical informatics at Battle Creek Health System in Michigan. “We have the opportunity to shape the future of health care. We’re helping to design the models.”

DiBiaggio first directed a project implementing electronic medical records and computerized physician order entry. Designed to meet the needs of patients and clinicians, the system went live two years ago. Since then her role has expanded, and she now leads a department of physicians and nurses who teach clinicians how to use the system and manage recommended changes that come up as needs evolve.

Hailing from a background in critical care and management, DiBiaggio draws on her nursing skills and requires others in her department share a strong clinical background.

“I understand the workflow of nurses and, thus, am able to design and anticipate questions they may have,” DiBiaggio said. “Otherwise, you will have nurses and physicians trying to work around the electronic medical record. In most cases, that does not promote high quality of care.”

Creating screens that work for clinicians, she has put in place systems that improve patient safety and care delivery with decision support and real time test results.

Michele Kunz, MSN, RN-BC, ANP, director of nursing education/nursing informatics at Long Island College Hospital in Brooklyn, New York, agreed that clinical experience proves valuable when developing electronic workflow. As with DiBiaggio, Kunz first became involved with computer systems when her hospital began implementing an electronic medical record system. She participated in product selection and staff training.

“It’s rewarding when you can see how technology can help the hospital work and patient information stay organized,” Kunz said. “It’s a career opportunity, ... and you don’t have to lose your nursing skills.”

Elizabeth Rhodes, MS, RN, BC, department head for nursing informatics at Washington Hospital Center in Washington, D.C., believes the problem-solving skills she developed as a critical-care nurse come in handy in resolving computer-related issues.

“We’re still nurses. That’s something people forget,” Rhodes said. “We know what people on the floor, at the bedside, are going through. We’ve been there and done it for many years.”

Unlike the other nurses who learned about information systems on the job, Rhodes completed a masters program in nursing informatics at the University of Maryland School of Nursing in Baltimore.

“It was interesting and all-consuming,” said Rhodes, explaining that the program included project management, database development and nursing theory classes. That knowledge has proven beneficial as she helps various departments determine the appropriateness of applications and hardware for their needs. She then develops training programs and aids them in using the products to their full potential.

“One of the biggest rewards, I find, is when I run into someone who thinks there is no solution to a problem with a computer,” Rhodes said. “They call you. You calm them down and talk them through getting into the application and doing what they need to do.”

Patricia A. Abbott, Ph.D., RN, Rhodes’ advisor at the University of Maryland now an assistant professor at the Johns Hopkins University School of Nursing in Baltimore, maintains all nurses need a basic informatics competence. Graduate coursework helps them become bilingual in computer and nursing terminology and hones their project-management skills.

“Experienced nurses are already pretty good managers, because they are trying to manage big caseloads, resources and time,” Abbott said. “We bring them in and talk about how to apply those management skills to information systems, information technology and managing people and change related to rollout of systems.”

Technology will transform the health care workplace, and nurses who understand it and can harness its power will be incredibly valuable to their organizations.

“We’re seeing on the national scene, a wave is breaking,” said Abbott, who advises nurses to accept informatics and master it. “It’s not if; it’s when. You are either part of the future or you’re history.”

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