Nursing Informatics Trends and Credentials Mark D. Sugrue, RN-BC December 20, 2010
Agenda Healthcare & Nursing Today Nursing Informatics and 21 st Century Practice NI Credentialing PMP CPHIMS ANCC References 2
Healthcare & Nursing Today
US Healthcare Reform/Meaningful Use Post 9/11 security and bio-defense The War on Terror returning soldiers EHR 2014 WikiLeaks Genetic Revolution Genome Project Nanotechnology Demographic Changes (Boomers) Growth of Chronic Disease Consumerism (Internet Health Seeking) Workforce challenges Education/Curriculum/Competencies Challenges Standardization of terminologies The Trends
Nursing in the eye of the storm!!! ARRA RWJF IOM Nursing PPACA ICD10 5
Healthcare Today By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care. President George W. Bush, State of the Union Address, January 20, 2004 6
ARRA American Recovery and Reinvestment Act (H.R.1) $787B/$19B for HIT Signed: 2/17/2009 Final Rules Published: 7/13/2010 Fed Reg: 7/28/2010 CMS Incentive Payment Meaningful Use (MU) ONC Certification Standards 7
Meaningful Use Stages These goals can be achieved only through the effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth. Stage 1 Data Capture and Sharing Stage 2 Advanced Clinical Processes Stage 3 Improved Outcomes Meaningful Use Over Time From: The Markel Foundation: Connecting for Health, Achieving the Health IT Objectives of the American Recovery and Reinvestment Act April 2009 8
Meaningful Use: EHR Technology Core Hospital Functionality Enter Rx Order e-rx (EP) Rx Interaction checks Enter Active Rx List Enter Active Rx Allergies Enter Vital Signs (Ht, Wt, BP) Display BMI/Growth Charts Enter Smoking Status Decision Support Problem List Enter Pt Requests Provide e-results Provide D/C Instructions Provide Clinical Summary (EP) Exchange Health Info Conduct HIPAA Security Assessment CPOE Clinical Documentation Core HIS Medication Management Emergency Department
Stage 1 Meaningful Use Objectives For a complete list of Meaningful Use measures please see Meaningful Use Final Rule Table 2 p. 44370-44375 Meaningful Use measures for Stage 2 and Stage 3 are yet to be determined 10
Stage 1 Meaningful Use Objectives For a complete list of Meaningful Use measures please see Meaningful Use Final Rule Table 2 p. 44370-44375 Meaningful Use measures for Stage 2 and Stage 3 are yet to be determined 11
Hospitals 15 Measures ED Stroke VTE Existing National Standards - NQF All with e-specifications Stage 1 - Attestation Clinical Quality Measures: 2011 & 2012 Payment Years Eligible Professionals 6 Measures 3 Core Measures BP Smoking Adult Weight Screening OR 3 Alternative Core + 3 others from menu of 38 Existing National Standards - NQF/PQRI All with e-specifications Stage 1 - Attestation 12
OUR World Over the Next Few Years? January 13, 2010 NPRM Meaningful Use IFR Standards/Certification Late Spring, 2010 Final Rule Meaningful Use 2010 October 2010 Start Hospitals January, 2011 Start EP s 2011 2012 2013 October 2013 ICD 10 Live PY 1 Any 90 Days PY 2 Full Year PY 3 Full Year PY 4 Test Stage 1 Stage 2 ICD 10 Stage 3 13 13
.but where was Nursing? Health IT Policy Committee Health IT Standards Committee 24 Members 9 MD s including Chair and Vice Chair all male 6 Females 1 Vendor (Epic) 1 RN 30 Members 10 MD s including Chair and Vice Chair one female 12 Females 1 Vendor (Cerner) 3 RN s 2.4 Million Registered Nurses represent the largest segment of the healthcare workforce.. 14
Top 5 Reasons Providers Not Ready for Meaningful Use EHR users surveyed (n=4,000) indicated the following as the top five reasons they are losing implementation traction: 1. A lack of substantive support from their EHR vendor (93 percent); 2. Delayed implementation due to the cost of additional support from EHR vendor/consultants (89 percent); 3. A hurried selection of an EHR vendor has resulted in negative consequences (82 percent); 4. Lack available and/or trained staff to properly implement an EHR (77 percent); and 5. They are unprepared and underfunded to rectify difficult system interfaces (69 percent). Source: 2011 Black Book Rankings Electronic Health Record User Survey 15
Health Reform Patient Protection and Affordable Care Act (PPACA) Signed: March 23, 2010 Phase 1 Now 2014 Phase 2 2014 (Exchanges, Tax for those w/o insurance, etc) 2019 All insured $938B over 10 years Payment Reform, Pilot Studies, ACO s, Medical Home models, P4P Kaiser Summary - http://healthreform.kff.org/the-animation.aspx 16
PPACA and Health IT 17
International Classification of Disease 10 th Revision ICD 10 compliance mandated October 1, 2013 68% of US hospitals surveyed are not prepared (1) Impact is expected to include: Coding Medical Records Health Information Management Registration/Scheduling Encounter Forms/Charge Tickets Clinical Documentation Information Systems; including EHR s the entire Revenue Cycle Every ICD-9 diagnosis code and every ICD-9 procedure code will be impacted and every system, form, Department, etc where these codes are in use will be impacted as well (1) From Health Data Management Survey September, 2010 18 18
ICD-10 One Example!! 125 Codes Specificity = Location, depth and stage L89.131 Pressure ulcer of right lower back, stage I L89.132 Pressure ulcer of right lower back, stage II L89.133 Pressure ulcer of right lower back, stage III L89.134 Pressure ulcer of right lower back, stage IV Pressure Ulcer 9 Codes 707.00 707.09 Specificity = Location L89.139 L89.141 L89.142 L89.143 Pressure ulcer of right lower back, unspecified stage Pressure ulcer of left lower back, stage I Pressure ulcer of left lower back, stage II Pressure ulcer of left lower back, stage III L89.144 Pressure ulcer of left lower back, stage IV L89.149 Pressure ulcer of left lower back, unspecified stage L89.151 Pressure ulcer of sacral region, stage I L89.152 Pressure ulcer of sacral region, stage II. and 113 More!! Official CMS Industry Resources for the ICD-10 Transition www.cms.gov/icd10 19 19
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The Future of Nursing: Leading Change, Advancing Health Released October 5, 2010 Type Topics Activity Board Consensus Report Health Care Workforce, Quality and Patient Safety, Health Services, Coverage, and Access Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine Studies under the IOM Executive Office http://www.iom.edu/reports/2010/the-future-of-nursing-leading-change-advancing-health.aspx 21
Highlights - Key Messages 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and an improved information infrastructure. 22
8 Key Recommendations # Recommendation 1 Remove scope-of-practice barriers 2 Expand opportunities for nurses to lead and diffuse collaborative improvement efforts 3 Implement nurse residency programs 4 Increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020 5 Double the number of nurses with a doctorate by 2020 6 Ensure that nurses engage in lifelong learning 7 Prepare and enable nurses to lead change to advance health 8 Build an infrastructure for the collection and analysis of interprofessional health care workforce data 23
Scope of Practice Barriers 24
Emerging Technologies Artificial Intelligence Bar Coding Biometrics RFID Robotics Nanotechnology Faster Networks Telehealth Wireless Microsoft Future of Healthcare
Emerging Technologies to Improve Nursing Practice 26
Emerging Technology Boston Globe 12/1/2010 In command of the ICU High-tech monitoring system could save lives and money, study finds 27
Nursing Informatics Putting It All Together!!
Nursing Informatics: An Evolving Definition 1989 Graves & Corcoran A combination of nursing science, information science and computer science, to manage and process nursing data, information and knowledge to support the practice of nursing and the delivery of nursing care 29
Nursing Informatics: An Evolving Definition 1998 IMIA Nursing Informatics Special Interest Group the discipline designed to integrate nursing, its information and information management with information processing and communication technology, to support the health of people world wide. 2008 ANA Scope of Practice Nursing informatics is a specialty that integrates nursing science, computer science and information science to manage and communicate data, information, knowledge and wisdom in nursing practice. NI supports patients, nurses and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information technology and information structures, which organize data, information and acknowledge for processing by computers. 30
Nursing Informatics Practice Nursing informatics is not about the computer! the core of the science of informatics is the commodities that computers process (data, information, knowledge) and not the computer itself. (Graves & Corcoran, 1989) The computer is the tool!
Nursing Practice From: Hendrich, Ann et al, A 36 Hospital Time Motion Study: How Do Medical Surgical Nurses Spend Their Time?, The Permanente Journal, 2008, Vol. 12, No. 3 32
Nursing Practice From: Hendrich, Ann et al, A 36 Hospital Time Motion Study: How Do Medical Surgical Nurses Spend Their Time?, The Permanente Journal, 2008, Vol. 12, No. 3 33
Study Conclusion Changes in technology, work processes, and unit organization and design may allow for substantial improvements in the use of nurses time and the safe delivery of care. From: Hendrich, Ann et al, A 36 Hospital Time Motion Study: How Do Medical Surgical Nurses Spend Their Time?, The Permanente Journal, 2008, Vol. 12, No. 3 34
Roles: Today s Informatics Nurse Indicate the roles that Informatics Nurses play in IT: User Education 93% System Optimization 62% System Implementation 89% System Selection 62% User Support 86% Database Mgmnt/Reporting 53% Workflow Analysis 84% Data Integration 48% Gaining Buy-in 80% Outcomes Management 47% System Design 79% Medical Device Integration 46% Selection and Device Placement 70% Hardware/Device Support 43% Quality Initiatives 69% P4P Reimbursement/Support 13% From: HIMSS 2009 Informatics Nurse Impact Survey 35
Nursing Informatics Nelson s: Data to Wisdom Continuum Increasing Complexity Data Naming collecting organizing Information Organizing, Interpreting Knowledge Interpreting, Integrating Understanding Wisdom Understanding, applying, Applying with Compassion Increasing Interactions and Interrelationships 36
ANA Scope of Practice Nurses decisions are guided by critical thinking using data, information, and knowledge Properly designed and implemented IT should facilitate and support critical thinking! American Nurses Association, Scope and Standards, Nursing Informatics, 2008 37
Nursing Informatics HIMSS 2007 Survey Quote from Respondent Nursing informatics is the leading edge solution that can positively impact the delivery of state of the art health care, lower its cost and dramatically improve patient safety across the entire industry. HIMSS 2009 Informatics Nurse Impact Survey..these findings suggest the informatics nurse is a driver of quality of care and enhanced patient safety within their organization. 38
TO CERTIFY OR NOT TO CERTIFY?.THAT IS THE QUESTION 39
Why Certify? Distinguish yourself from your peers Expand your career opportunities; Gain leverage for performance reviews and salary adjustments Validate your knowledge, competency and credibility; Provide yourself with skills and tools to help you make a difference in your career, your organization, and your community; Demonstrate your commitment to continuing professional development; Enjoy the pride of recognition of knowing that you are among the elite in a critical field of healthcare; and Hold a premier credential based on a sound assessment to distinguish yourself in an increasingly competitive marketplace. 40
Nursing Certification A standard of excellence where specialized nurses demonstrate advanced knowledge and skills to improve the delivery of care and outcomes. The American Board of Nursing Specialties (ABNS, 2009) 41
Nursing Informatics Certifications I. PMI Project Management Institute II. HIMSS Health Information Management Systems Society III. ANCC American Nurse Credentialing Center/ANA 42
PMI PMI - the world s leading organization for the project management profession Industry agnostic Project Management skills and behaviors 350,000 certified world wide (all PMI credentials) WWW.PMI.ORG 43
PMP 6 Domain Areas 1) Project Initiation (11%) 2) Planning (23%) 3) Executing (27%) 4) Monitoring and Controlling (21%) 5) Closing (9%) 6) Professional and Social Responsibility (9%) 44
PMP Eligibility Non-BS 5 years experience + 7500 hours leading projects + 35 hrs CE BS 3 years + 4500 hours leading + 35 hrs CE Format 200 Multiple Choice Question Test (online and paper) 175 scored 4 Hours Passing Pass/Fail with Proficiency by Domain Recertification Cost 60 PDU s Professional Development Units (1 CEU = 10 PDU s) over 3 years. $555(Discounted for PMI Members) paper based test less expensive 45
CPHIMS CPHIMS is a professional certification program for healthcare information and management systems professionals. Administered by HIMSS Health Information Management Systems Society Healthcare and Information Technology focused 1219 Certified as of March 2010 WWW.CPHIMS.ORG 46
CPHIMS 9 Domain Areas General (29%) Healthcare Environment Technology Environment Systems (36%) Analysis Design Selection, Implementation, Support, and Maintenance Testing and Evaluation Privacy and Security Administration (35%) Leadership Management http://www.himss.org/content/files/cphims_content_outline.pdf 47
CPHIMS Eligibility BS + 5 Years (3 in Healthcare) or Graduate Degree + 3 Years (2 in Healthcare) Format 115 Multiple Choice Question Test (online and paper) 100 scored 2 Hours Passing Self Assessment Exam and Study Guide Pass/Fail (77% of those who take exam pass) Can retake Recertification 3 Years 45 Contact hours or retake exam Cost $300 (Members), $375 (Non-Members) 48
ANCC The American Nurses Credentialing Center is the largest and most prestigious nurse credentialing organization in the United States. ANCC is a subsidiary of the American Nurses Association (ANA) Awards many Nursing credentials and Magnet Estimated that 727 Nursing professionals hold NI certification (2009) www.nursecredentialing.org 49
ANCC Domain Areas I. System Life Cycle (27%) A. System Planning B. System Analysis C. System Design D. System Implementation and Testing E. System Evaluation, Maintenance and Support II. Human Factors (7%) A. Ergonomics B. Software and User Interface III. Information Technology (20%) A. Hardware B. Software C. Communications D. Data Representation E. Security Continued 50
ANCC Domain Areas IV. Information Management & Knowledge Generation (18%) A. Data B. Information C. Knowledge V. Professional Practice Trends and Issues (10%) A. Roles B. Trends and Issues C. Ethics VI. Models and Theories (8%) A. Foundations of Nursing Informatics B. Nursing and Healthcare Data Sets, Classification Systems and Data Sets C. Related Theories and Sciences VII. Management and Leadership (10%) 51
ANCC Eligibility RN (2 Year Full Time Equivalent) - AND BSN or BS in related field + 30 Contact Hour in Informatics last 3 yrs AND Practice Requirement: 2000 Hrs (3 yrs), or 1000 + 12 Semester hrs or Grad program in NI with 200 hrs supervised practicum. Format 175 Multiple Choice Question Test (online and paper) 150 scored 4 Hours Passing 70% - scaled Recertification Cost 5 Years Complex, Professional Development, practice hours, and/or re-testing $340-390(Discount for ANI!!) 52
Nursing Informatics Certifications 53
Get Certified!!! WE NEED YOU!! Make a Commitment to GET Certified TODAY RIGHT NOW!! 54
Health Informatics Who we are to society and health care and our patients, families, and communities is more than anything a function of what we know, how we use what we know, and how fast we can know something new adapted from Blur, 1998 55
Our Guide to the Future To envision the future, we must look to the past, validate the present and move to the future Florence Nightingale 56
Future Nursing Informatics Programs HIMSS 2011 NENIC 2011 ANIA/Caring Rutgers College of Nursing SINI NI Congress February 19 24 Orlando, FL April 29 Waltham, MA May 12 14 Las Vegas, NV June 24 16 Boston, MA July 18-23 Baltimore, MD 2012 Montreal, Canada 57
Thank You and Questions!! Mark Sugrue, RN-BC Msugrue@blumshapiro.com 58
References ANCC - www.nursecredentialing.org CPHIMS www.cphims.org CPHIMS Self Exam http://www.himss.org/asp/certification_cphimsselfexam.asp Hendrich, A. Time and Motion Study - http://xnet.kp.org/permanentejournal/sum08/time-study.pdf HIMSS 2007 Survey sponsored by McKesson - http://www.himss.org/content/files/surveyresults/2007nursinginfor matics.pdf HIMSS 2009 Informatics Nurse Impact Survey - http://www.himss.org/content/files/himss2009informaticsnurseim pactsurvey.pdf PMI www.pmi.org 59
Conferences HIMSS www.himss.org NENIC www.nenic.org ANIA/CARING - www.ania-caring.org Rutgers TBD SINI - http://nursing.umaryland.edu/sini/ NI Congress - www.ni2012.org 60