- Email: [email protected]
The role of the informatics nurse specialist
Clinical Issues
DECEMBER 2009, VOL 90, NO 6
* Note: Some of the PNDS codes in this issue are updated codes; former PNDS codes will be retired when the 2010 PNDS book is released. The updated and revised PNDS codes follow the nurse’s workflow and are based on the nursing process assessment (A), implementation (Im), evaluation (E), and outcome (O). ** Child codes refer to the grouping of coded PNDS elements with respect to a parent-child relationship. The adult PNDS code dominates a concept and the associated concepts are known as the child PNDS codes. The VTE-1 criteria are met when documentation of VTE prophylactic treatment is ordered, but documentation of administration is not required. The VTE-2 criteria are met only when documentation shows prophylactic treatment was ordered and administered.3 To satisfy VTE-2 criteria, monitoring PNDS code A.220 confirms that the VTE assessment was completed and evidence-based guidelines were implemented, and monitoring PNDS code Im.220 confirms that the prophylactic treatment was ordered and administered.3 In hospitalized patients, VTE is one of the most common complications. Complications of VTE are the second most common cause of extended length of stay and the third most common cause of mortality and excess hospital charges.4 To ensure accurate reporting of SCIP measures, data must be accurate and easily retrievable. AORN SYNTEGRITY can provide a health care organization with a framework that not only guides effective care
by enabling evidence-based clinical decisions but also provides cost-efficient care with retrievable data based on a standardized perioperative nursing language. Editor’s note: AORN SYNTEGRITY Standardized Perioperative Framework is a trademark of AORN, Inc, Denver, CO. SNOMED CT is a registered trademark of US National Library of Medicine, Bethesda, MD. Current Procedural Terminology (CPT) codes are a registered trademark of the American Medical Association, Chicago, IL.
REFERENCES 1. Performance measurement initiatives. Historical version of the specifications manual for national hospital quality measures version 2.6b. The Joint Commission. http://www.jointcommission.org /PerformanceMeasurement/PerformanceMeasure ment/Current+NHQM+Manual.htm. Accessed October 5, 2009. 2. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. 3. Tools: SCIP quality measures. AZ SCIP quality measures.pdf. Quality Net. http://www.qualitynet .org/dcs/ContentServer?c=MQTools&pagename =Medqic%2FMQTools%2FToolTemplate&cid=12287 33278547&parentName=MeasureNSow. Accessed October 5, 2009. 4. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290(14):1868-1874. DENISE MAXWELL-DOWNING RN, BSN, MS, CNOR PERIOPERATIVE NURSING SPECIALIST, CLINICAL INFORMATICS AORN SYNTEGRITY™ STANDARDIZED PERIOPERATIVE FRAMEWORK
The role of the informatics nurse specialist QUESTION: I work at a medium-sized, level II trauma health care organization that had a perioperative RN working half-time doing perioperative patient care and the other half as the perioperative informatics nurse. We recently hired an informatics nurse specialist (INS). The INS is performing the same duties as our previous perioperative informatics nurse (ie, training staff on our computer system, fixing the computer when it doesn’t work). What is
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the difference between our previous perioperative informatics nurse and our new INS? ANSWER: Many nurses think of the perioperative informatics nurse as the information technology (IT) person who computerizes existing processes, fixes the computer when it is not functioning properly, and designs and quantifies the perioperative monthly reports. Or, they see the role as the perioperative clinical support
Clinical Issues
liaison for the end-user. Typically, a clinical support liaison is a unit-based individual who has been trained as a superuser on a particular information technology system and is trained to become a trainer for large information system implementation projects.1 The INS scope of practice is not limited by current technological tools (eg, the computer) and what they can process. The INS integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom into nursing practice through the use of information structures, information processes, and information technology.2 In 1992, the American Nurses Association (ANA) recognized the field of nursing informatics and deemed it an official nursing specialty. In 2004, the ANA revised the book Nursing Informatics: Scope and Standards of Practice, which includes informatics competencies and defines the difference between an RN working in informatics and an INS.2 Before that, many RNs worked on informatics initiatives and built their knowledge base and expertise from on-the-job experience.2 The boundaries between an INS and other nurses can be unclear; however, as the types and complexities of technologies increase and the mandate for electronic data management systems are imposed on the health care and perioperative environments, informatics knowledge and competency levels are being raised to a level at which a graduate informatics degree is becoming the standard educational requirement for an INS. Individuals outside of the nursing informatics specialty may consider nursing informatics synonymous with IT. Technology alone does not define nursing informatics. Information technology merely supports the development, implementation, and evaluation of various applications and technology that the INS uses to ensure the quality, effectiveness, usability, and efficiency of the various data applications and technologies used in the perioperative setting. The INS transforms clinical data into information by using informatics concepts, tools, and methods. The clinical data are then transformed into knowledge that
DECEMBER 2009, VOL 90, NO 6
supports the clinical decision-making process of not only the perioperative RN but the entire organization. Today, all nurses must be skilled in managing and communicating information and concerned with the content of that information. The focus of the INS is creating, structuring, and delivering that information to facilitate nursing practice through integration of data, information, and knowledge to support patients, nurses, and other practitioners in their decision-making roles and settings. The INS also must be knowledgeable about and fluent in HIPAA requirements and International Medical Informatics Association codes to ensure ethical use of data, as well as the integrity, security, and confidentiality of protected health information, not only at the perioperative department level, but throughout the organization.2 “The INS frequently serves as the bridge between informatics solution users and IT experts.”2(p23) The INS serves as the hub for cross-disciplinary communications during the implementation phase of an IT project and is the liaison and interpreter between software engineers and the end-user. The INS ensures that testing and necessary research is performed on a system’s application to determine whether the end-user’s needs are being met and conveys this information back to the software engineers in terms they can understand. Many early IT systems were developed without any input from nurses and were insensitive to real-life workflow issues.3 The INS spends a considerable amount of time during IT systems implementation ensuring the safe and intelligent incorporation of new technology and techniques into the health care environment to avoid “work arounds,” the introduction of errors, and technology that distracts from patient care. As health care and nursing informatics evolve, competencies that were once only part of the INS role will likely transfer to the bedside RN, and the competencies required for the INS will continue to expand. Too many nurses still think of IT as computerizing existing documentation processes and not as a means to transform nursing practice by using aornjournal.org
•
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DECEMBER 2009, VOL 90, NO 6
evidence-based data.3 The INS focuses on nursing practice by achieving information literacy, not merely computer literacy.
REFERENCES 1. Zytkowski ME. Nursing informatics: the key to unlocking contemporary nursing practice. AACN Clin Issues. 2003:14(3):271-281. 2. Nursing Informatics: Scope & Standards of Practice.
Clinical Issues
Silver Spring, MD: American Nurses Association; 2008:1, 17, 21, 23. 3. McBride AB. Nursing and the informatics revolution. Nurs Outlook. 2005;53(4):183-191.
JANIE BOWMAN-HAYES RN, BSN, MBA, MSN, INS PERIOPERATIVE NURSING INFORMATICS SPECIALIST AORN SYNTEGRITY™ STANDARDIZED PERIOPERATIVE FRAMEWORK
Editor’s note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear online at http://www.aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.
Health & Human Services Issues Rules to Strengthen HIPAA
T
he US Department of Health & Human Services (HHS) issued an interim final rule to strengthen its enforcement of the Health Insurance Portability and Accountability Act (HIPAA), according to an October 30, 2009, news release from HHS. Specifically, the revisions modify the HHS Secretary’s authority to impose civil money penalties for violations that occur after February 18, 2009; significantly increase the penalty amounts the Secretary may impose for violations of the HIPAA rules; and encourage timely corrective action. The HHS also is requesting comments on the revisions to the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009. Section 13410(d) of the HITECH Act increased the minimum penalty amounts from $100 per violation or a maximum penalty of $25,000 for all identical violations of the same provision to a maximum penalty of $1.5 million. Additionally, the revisions now prevent health care entities from avoiding financial penalties by proving that they were unaware that they were breaking HIPAA rules; instead, health care entities
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AORN JOURNAL
may only avoid fines by correcting violations they were unaware of breaking within 30 days of discovery. The strengthened penalty scheme is intended to give consumers greater confidence in health care privacy and health information technology by encouraging health care providers, health plans, and other health care entities to comply with HIPAA and ensure that their compliance programs are effective for preventing, detecting, and quickly correcting violations. These revisions were scheduled to become effective as of November 30, 2009, and HHS is considering comments through December 29, 2009. According to HHS, this is the first of many steps the department is taking to implement the HITECH Act’s enforcement provisions. The remaining provisions will be addressed in forthcoming rules. To comment on the revisions to the HITECH Act, visit http://www.regulations.gov, and to learn more about HIPAA and related rules, visit http://www.hhs.gov/ocr/privacy. HHS strengthens HIPAA enforcement. Washington, DC: US Department of Health & Human Services; October 30, 2009.
DECEMBER 2009, VOL 90, NO 6
* Note: Some of the PNDS codes in this issue are updated codes; former PNDS codes will be retired when the 2010 PNDS book is released. The updated and revised PNDS codes follow the nurse’s workflow and are based on the nursing process assessment (A), implementation (Im), evaluation (E), and outcome (O). ** Child codes refer to the grouping of coded PNDS elements with respect to a parent-child relationship. The adult PNDS code dominates a concept and the associated concepts are known as the child PNDS codes. The VTE-1 criteria are met when documentation of VTE prophylactic treatment is ordered, but documentation of administration is not required. The VTE-2 criteria are met only when documentation shows prophylactic treatment was ordered and administered.3 To satisfy VTE-2 criteria, monitoring PNDS code A.220 confirms that the VTE assessment was completed and evidence-based guidelines were implemented, and monitoring PNDS code Im.220 confirms that the prophylactic treatment was ordered and administered.3 In hospitalized patients, VTE is one of the most common complications. Complications of VTE are the second most common cause of extended length of stay and the third most common cause of mortality and excess hospital charges.4 To ensure accurate reporting of SCIP measures, data must be accurate and easily retrievable. AORN SYNTEGRITY can provide a health care organization with a framework that not only guides effective care
by enabling evidence-based clinical decisions but also provides cost-efficient care with retrievable data based on a standardized perioperative nursing language. Editor’s note: AORN SYNTEGRITY Standardized Perioperative Framework is a trademark of AORN, Inc, Denver, CO. SNOMED CT is a registered trademark of US National Library of Medicine, Bethesda, MD. Current Procedural Terminology (CPT) codes are a registered trademark of the American Medical Association, Chicago, IL.
REFERENCES 1. Performance measurement initiatives. Historical version of the specifications manual for national hospital quality measures version 2.6b. The Joint Commission. http://www.jointcommission.org /PerformanceMeasurement/PerformanceMeasure ment/Current+NHQM+Manual.htm. Accessed October 5, 2009. 2. Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism. The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S-400S. 3. Tools: SCIP quality measures. AZ SCIP quality measures.pdf. Quality Net. http://www.qualitynet .org/dcs/ContentServer?c=MQTools&pagename =Medqic%2FMQTools%2FToolTemplate&cid=12287 33278547&parentName=MeasureNSow. Accessed October 5, 2009. 4. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA. 2003;290(14):1868-1874. DENISE MAXWELL-DOWNING RN, BSN, MS, CNOR PERIOPERATIVE NURSING SPECIALIST, CLINICAL INFORMATICS AORN SYNTEGRITY™ STANDARDIZED PERIOPERATIVE FRAMEWORK
The role of the informatics nurse specialist QUESTION: I work at a medium-sized, level II trauma health care organization that had a perioperative RN working half-time doing perioperative patient care and the other half as the perioperative informatics nurse. We recently hired an informatics nurse specialist (INS). The INS is performing the same duties as our previous perioperative informatics nurse (ie, training staff on our computer system, fixing the computer when it doesn’t work). What is
922 •
AORN JOURNAL
the difference between our previous perioperative informatics nurse and our new INS? ANSWER: Many nurses think of the perioperative informatics nurse as the information technology (IT) person who computerizes existing processes, fixes the computer when it is not functioning properly, and designs and quantifies the perioperative monthly reports. Or, they see the role as the perioperative clinical support
Clinical Issues
liaison for the end-user. Typically, a clinical support liaison is a unit-based individual who has been trained as a superuser on a particular information technology system and is trained to become a trainer for large information system implementation projects.1 The INS scope of practice is not limited by current technological tools (eg, the computer) and what they can process. The INS integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom into nursing practice through the use of information structures, information processes, and information technology.2 In 1992, the American Nurses Association (ANA) recognized the field of nursing informatics and deemed it an official nursing specialty. In 2004, the ANA revised the book Nursing Informatics: Scope and Standards of Practice, which includes informatics competencies and defines the difference between an RN working in informatics and an INS.2 Before that, many RNs worked on informatics initiatives and built their knowledge base and expertise from on-the-job experience.2 The boundaries between an INS and other nurses can be unclear; however, as the types and complexities of technologies increase and the mandate for electronic data management systems are imposed on the health care and perioperative environments, informatics knowledge and competency levels are being raised to a level at which a graduate informatics degree is becoming the standard educational requirement for an INS. Individuals outside of the nursing informatics specialty may consider nursing informatics synonymous with IT. Technology alone does not define nursing informatics. Information technology merely supports the development, implementation, and evaluation of various applications and technology that the INS uses to ensure the quality, effectiveness, usability, and efficiency of the various data applications and technologies used in the perioperative setting. The INS transforms clinical data into information by using informatics concepts, tools, and methods. The clinical data are then transformed into knowledge that
DECEMBER 2009, VOL 90, NO 6
supports the clinical decision-making process of not only the perioperative RN but the entire organization. Today, all nurses must be skilled in managing and communicating information and concerned with the content of that information. The focus of the INS is creating, structuring, and delivering that information to facilitate nursing practice through integration of data, information, and knowledge to support patients, nurses, and other practitioners in their decision-making roles and settings. The INS also must be knowledgeable about and fluent in HIPAA requirements and International Medical Informatics Association codes to ensure ethical use of data, as well as the integrity, security, and confidentiality of protected health information, not only at the perioperative department level, but throughout the organization.2 “The INS frequently serves as the bridge between informatics solution users and IT experts.”2(p23) The INS serves as the hub for cross-disciplinary communications during the implementation phase of an IT project and is the liaison and interpreter between software engineers and the end-user. The INS ensures that testing and necessary research is performed on a system’s application to determine whether the end-user’s needs are being met and conveys this information back to the software engineers in terms they can understand. Many early IT systems were developed without any input from nurses and were insensitive to real-life workflow issues.3 The INS spends a considerable amount of time during IT systems implementation ensuring the safe and intelligent incorporation of new technology and techniques into the health care environment to avoid “work arounds,” the introduction of errors, and technology that distracts from patient care. As health care and nursing informatics evolve, competencies that were once only part of the INS role will likely transfer to the bedside RN, and the competencies required for the INS will continue to expand. Too many nurses still think of IT as computerizing existing documentation processes and not as a means to transform nursing practice by using aornjournal.org
•
923
DECEMBER 2009, VOL 90, NO 6
evidence-based data.3 The INS focuses on nursing practice by achieving information literacy, not merely computer literacy.
REFERENCES 1. Zytkowski ME. Nursing informatics: the key to unlocking contemporary nursing practice. AACN Clin Issues. 2003:14(3):271-281. 2. Nursing Informatics: Scope & Standards of Practice.
Clinical Issues
Silver Spring, MD: American Nurses Association; 2008:1, 17, 21, 23. 3. McBride AB. Nursing and the informatics revolution. Nurs Outlook. 2005;53(4):183-191.
JANIE BOWMAN-HAYES RN, BSN, MBA, MSN, INS PERIOPERATIVE NURSING INFORMATICS SPECIALIST AORN SYNTEGRITY™ STANDARDIZED PERIOPERATIVE FRAMEWORK
Editor’s note: At various times throughout the year, the Recommended Practices Committee seeks review and comment on proposed recommended practices from members and other interested individuals. When available, these proposed recommended practices appear online at http://www.aorn.org. Proposed recommended practice documents are available for review and comment for a 30-day period after they are posted. Interested individuals who do not have access to the Internet may obtain copies of the proposed documents by calling the Center for Nursing Practice at (800) 755-2676 x 334. A deadline for comments is indicated with each document. Please check these sources frequently to locate proposed recommended practices. All comments received are considered as the document is finalized. Thank you for your participation.
Health & Human Services Issues Rules to Strengthen HIPAA
T
he US Department of Health & Human Services (HHS) issued an interim final rule to strengthen its enforcement of the Health Insurance Portability and Accountability Act (HIPAA), according to an October 30, 2009, news release from HHS. Specifically, the revisions modify the HHS Secretary’s authority to impose civil money penalties for violations that occur after February 18, 2009; significantly increase the penalty amounts the Secretary may impose for violations of the HIPAA rules; and encourage timely corrective action. The HHS also is requesting comments on the revisions to the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the American Recovery and Reinvestment Act of 2009. Section 13410(d) of the HITECH Act increased the minimum penalty amounts from $100 per violation or a maximum penalty of $25,000 for all identical violations of the same provision to a maximum penalty of $1.5 million. Additionally, the revisions now prevent health care entities from avoiding financial penalties by proving that they were unaware that they were breaking HIPAA rules; instead, health care entities
924 •
AORN JOURNAL
may only avoid fines by correcting violations they were unaware of breaking within 30 days of discovery. The strengthened penalty scheme is intended to give consumers greater confidence in health care privacy and health information technology by encouraging health care providers, health plans, and other health care entities to comply with HIPAA and ensure that their compliance programs are effective for preventing, detecting, and quickly correcting violations. These revisions were scheduled to become effective as of November 30, 2009, and HHS is considering comments through December 29, 2009. According to HHS, this is the first of many steps the department is taking to implement the HITECH Act’s enforcement provisions. The remaining provisions will be addressed in forthcoming rules. To comment on the revisions to the HITECH Act, visit http://www.regulations.gov, and to learn more about HIPAA and related rules, visit http://www.hhs.gov/ocr/privacy. HHS strengthens HIPAA enforcement. Washington, DC: US Department of Health & Human Services; October 30, 2009.