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July 2017

Inside Informatics: Interoperability's Secret Weapon: Nurse Informaticists
By Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN
For The Record
Vol. 29 No. 7 P. 30

Are we in a post-EHR era? It certainly looks that way when you consider that the Office of the National Coordinator for Health Information Technology (ONC) reports that 96% of hospitals have implemented certified EHR technology as of 2015. Given that the majority of hospitals now have the basic commodity of EHRs in place, the industry can turn its attention to leveraging the technology and making it better—including improvements in design, user experience, analytics, clinical decision support, and, yes, more seamless interoperability.

The EHRs of the future will be much evolved from their current form; they will come far closer to realizing the promise of seamless data exchange and more effective care delivery that many had hoped for when they made their initial capital investments in the technology.

HIMSS' vision of interoperability incorporates the definition given by the Institute of Electrical and Electronics Engineers Standards Association, which is often quoted and/or paraphrased as follows: "The ability of two or more systems or components to exchange information and to use the information that has been exchanged." Simply put, interoperability standards allow two different EHR technologies to effectively exchange data and interpret them so that caregivers can use the data at the point of care to treat patients.

It sounds simple, but few will argue that interoperability and health information exchange in this post-EHR era are among the biggest challenges facing health care. The challenges are the result of several factors, including disagreement/ambiguity around which interoperability standards to use, incompatible technologies, and outdated legacy systems, which, in many cases, came to market before interoperability became an industry goal. In fact, some decades-old systems were designed to specifically preclude interoperability in order to protect market share, and thus required specialized software, or custom interfaces, to translate data from the legacy system to the interoperable system.

Today, the opposite is true, with the industry recognizing the importance of interoperability. In fact, there are incentives to adopt standards that enable data and information to be accessible across different systems.

For those reasons, interoperability remains a significant challenge that the industry must work collectively to address. The good news is that while much work remains to be done, the industry is taking the issue seriously.

The ONC recently published a Proposed Interoperability Standards Measurement Framework to assess the industry's progress toward implementing HIT interoperability standards and evaluating their use in measuring advancement, the goal of which is to push nationwide interoperability further to the forefront of HIT infrastructure.

Furthermore, provider organizations themselves have a secret weapon that often gets overlooked in the national interoperability conversation: nurse informaticists.

Nurse Power
Nursing informatics is the specialty that combines nursing practice with technical expertise. Specifically, it integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.

Leveraging information structures, processes, and technology, nurse informaticists support nurses, consumers, patients, interprofessional health care teams, and other stakeholders in their decision making to achieve desired outcomes. These highly educated professionals (a recent HIMSS study showed that more than one-half have a postgraduate degree) have a unique and rare skill set that combines technical orientation with a clinical focus on patient care.

In practice, most nurse informaticists work in a hospital or health system and have historically been focused on evaluating and optimizing the EHR system, as well as training staff on how to use the technology. Health systems used to rely on vendors for training support, but now it is mostly up to the provider organization to educate the workforce. Nurse informaticists are particularly well suited to this job because they are approaching the technology from a clinical perspective and are attuned to the documentation and decision support needs of the nursing workforce. Additionally, they can help anticipate and mitigate issues around quality, patient safety, and risk.

New systems have the potential to break what was in place and introduce risk. In this regard, CIOs and other IT leaders rely on nursing informaticists' clinical voice to help anticipate and prevent problems.

Changes Are Afoot
However, in this post-EHR era, the role of nursing informatics is evolving as provider needs shift from training and optimization to interoperability, data analytics, and demonstrating outcomes. While the vendor community works toward making the EHR systems themselves interoperable, problems with data exchange and access would still exist because provider organizations may use different terminologies that need to be translated by different systems. Because of the unique challenges that nursing data and information present, nurse informaticists are uniquely poised to champion the adoption of industry standards such as SNOMED-CT and LOINC codes for nursing documentation.

With 12 sets of nursing terminologies recognized by the American Nurses Association, shifting to a common set of standards, including national standards such as SNOMED-CT and LOINC, will help reduce complexity in data exchange, enable the consistent data structure needed for analysis, and facilitate more seamless care coordination.

As the industry shifts from fee-for-service to value-based payments, seamless data exchange and analysis will only become more critical. When care can be coordinated accurately, quickly, and easily across organizational boundaries, costs decrease and care outcomes improve.

In a fee-for-value world, nurse informaticists are more essential than ever to provider organizations. Nurse informaticists have the knowledge and expertise to configure systems in a structured fashion to support the analytics that will ultimately demonstrate outcomes. As a result, forward-looking organizations are increasingly giving nursing informatics leaders a seat at the table when it comes to strategy and IT purchasing decisions—especially those that impact patient care.

CNIOs to the Forefront
The number of chief nursing informatics officers (CNIOs) is on the rise nationally. Demand for these professionals is on the uptick as well. AMIA anticipates that as many as 70,000 new nursing informatics specialists may be needed in the next five years.

Recently, HIMSS published a job description that delineates a CNIO's critical responsibilities, including serving as a strategic liaison representing nursing and clinician needs in HIT efforts and developing nursing/clinical informatics strategies related to HIT procurement, implementation, maintenance, and optimization. This emerging leadership role also maintains relationships with key business partners and other senior industry leaders in order to leverage best practices, evaluate new technologies, and distribute knowledge internally to inform plans and strategies.

As the health care environment transforms into a value-based care model, the CNIO role takes on more importance in assessing patient care delivery, operations, and finances that impact the continuum of care. Nursing informatics leaders also understand the impact of public policy initiatives on HIT systems, helping to bridge new care delivery models with clinical practice. Their deep understanding of the clinical environment and keen insight into patient care are essential for advising their organizations about key strategies.

Nurse informaticists have the knowledge and expertise to implement standards of care that inform evidence-based practice, quality of care, patient safety, and clinician workflows. In addition, their clinical expertise and interprofessional approach enables them to collaborate with IT leaders and administrative and medical staff to translate clinician requirements into coordinated specifications for innovative solutions.

Following the EHR boom of the past several decades, interoperability challenges remain a reality for the health care industry, but nurse informaticists can play a critical role in unlocking the value of these multimillion-dollar capital investments. By doing so, it will benefit the financial health of their organizations and, more importantly, the health and wellness of the patients entrusted to their care.

— Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, is vice president of informatics at HIMSS.