The Future of Nursing and the Informatics Agenda

THE LONG-AWAITED INSTITUTE OF MEDICINE (IOM) Report on the Future of Nursing: Leading Change, Advancing Health was introduced on October 5. If you were busy and did not attend the IOM briefing, you can view the broadcast at www.iom.edu/Activities/Workforce/Nursing/2010-OCT-05.aspx. The report, well over 500 pages, emphasizes the essential role of nurses in the transformation of health care and the facilitation of objectives established in the Affordable Care Act (www.healthcare.gov/law/introduction/ index.html). Four key messages that structure its recommendations are as follows (IOM, 2010): * Nurses should practice to the full extent of their education and training. * Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. * Nurse should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. * Effective workforce planning and policy making require better data collection and an improved information infrastructure. Of course, as an informatics professor, I immediately observed that informatics knowledge, skills, and attitudes are integral to these key messages. Note the strong emphasis on removing barriers for advanced practice nurses. With the growing emphasis on patient-centered care, the medical/health home concept, and consumer engagement, it is imperative that APNs understand personal health records, e-health, and m-health (mobile health) tools. Nurses at all levels will need to become informatics literate to function within the health care delivery system. I particularly liked this quote in the chapter on practice transformation: "There is perhaps no greater opportunity to transform practice than through technology" In the chapter on the transformation of nursing practice, the report speaks to the American Recovery and Reinvestment Act (ARRA) (Public Law 111-5), which includes the HITECH Act (Health Information Technology for Economic and Clinical Health). This act authorizes the Centers for Medicare & Medicaid Services (CMS) to provide a reimbursement incentive for eligible hospitals and providers who are successful in becoming meaningful users of an electronic health record (EHR). Incentive payments begin in 2011 and phase down gradually. Starting in 2015, providers are expected to have adopted and be actively utilizing an EHR in compliance with the meaningful use definition, or they will be subject to financial penalties under Medicare. (More about the concept of meaningful use is online at http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov_ meaningful_use_announcement/2996) So, the stage has been set for assuring that health care institutions not only adopt EHRs, but that they must also demonstrate that providers are meaningful users of the technology. As Blumenthal and Tavenner (2010) state, "HITECH's goal is not adoption alone but 'meaningful use' of EHRs --that is, their use by providers to achieve significant improvements in care" (p. 1). The Future of Nursing report clearly states that "HIT (Health Information Technology) will fundamentally change the ways in which RNs plan, deliver, document, and review clinical care" It aptly states that "care and its documentation will less frequently be 'free-hand" indicating a need for nursing education to address the value and use of nursing terminologies and classification systems to codify nursing data (Murphy, 2010). To learn more about nurses' role in meaningful use, I recommend that you access the testimony of Joyce Sensmeier, co-chair of the Alliance of Nursing Informatics (www.himss.org/ASP/ContentRedirector .asp?ContentID=72211&type=HIMSSNewsItem&src=twt). A second message from the report is critical for nurse educators in all educational programs. Nurses are "expected to use a variety of technological tools and complex information management systems that require skills in analysis and synthesis to improve the quality and effectiveness of care. …