Health Information Systems in Nursing: EHR Practice Change
This paper examines the current state of Health Information Systems (HIS) and Electronic Health Records (EHR) in nursing practice and proposes a structured approach to practice change. It identifies key stakeholders — nurse informatics specialists, health information technology specialists, and clinicians — and outlines their roles in supporting adoption. Drawing on five peer-reviewed sources, the paper critiques evidence regarding EHR implementation barriers, including financial constraints, user resistance, and technical limitations. A best practice recommendation emphasizes clinician-vendor collaboration, while the Johns Hopkins Hospital Capacity Command Center serves as a real-world implementation model. Ethical considerations around patient data privacy and system security are also addressed.
- Overview of Health Information Systems in Nursing: Defines HIS, nursing informatics roles, and EHR concepts
- Why Current HIS Practice Requires Change: Low EHR data-sharing rates justify practice change
- Key Stakeholders and Their Roles: NI specialists, HIT specialists, and clinicians' responsibilities
- Evidence Critique and Summary: Five-source evidence table and literature findings
- Best Practice Recommendation and Practice Change Model: Clinician-vendor collaboration and Johns Hopkins model
- Barriers and Ethical Implications: Financial, resistance, and data privacy challenges
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What makes this paper effective
- Clearly defines all key terms and roles (HIS, NI specialist, HIT specialist) before applying them, giving the reader a solid conceptual foundation.
- Uses a structured, assignment-driven format that systematically moves from problem identification to stakeholder analysis, evidence critique, best practice, and ethical review — covering the full improvement cycle.
- Grounds its recommendation in a real-world example (Johns Hopkins Hospital's Capacity Command Center) with quantified outcomes, adding practical credibility to the argument.
Key academic technique demonstrated
The paper demonstrates evidence hierarchy evaluation — a core nursing research skill. Each of the five sources is assigned both a numerical strength level (1–7) and a methodology label (e.g., systematic review, expert opinion, empirical research), showing the student's ability to critically appraise literature rather than simply cite it. This technique is essential in evidence-based practice proposals.
Structure breakdown
The paper follows a scaffolded nursing practice-change format: it opens by defining HIS and nursing informatics, then builds a case for change using EHR adoption statistics. Stakeholder roles are analyzed in depth before a five-source evidence critique table and summary are presented. The paper then narrows to a single best practice recommendation, selects and justifies a technology-based practice change model, and closes by addressing implementation barriers and ethical risks around data security and patient privacy.
Overview of Health Information Systems in Nursing
Health Management Information Systems (HMISs) are among the building blocks vital to strengthening a nation's health and healthcare system. They may be defined as data collection systems targeted specifically at supporting planning, decision-making, and management within hospitals, smaller healthcare centers, and health-related agencies. Health information constitutes a central component of any operational health system. A Health Information System (HIS) offers evidence that supports program- and policy-level decision-making to improve individual and societal health outcomes, though the term lacks a universally well-defined or explicit definition.
The position of nurse informatics (NI) specialist emerged when the health sector recognized the need for interaction between healthcare professionals and IT experts to address patient care issues (Bickford, 2009). NI specialists play a pivotal role in the care delivery process and are a determining factor when selecting, implementing, and evaluating healthcare technology; their efforts foster safe, patient-focused, high-quality care (Elkind, 2009). According to the American Nurses Association (ANA, 2008), nursing informatics denotes a field that incorporates computer science and nursing science to facilitate the communication and management of information and skills within nursing practice (p. 1). Another definition holds that nursing informatics represents any use of information technology by nursing professionals to improve patient outcomes, facilitate nursing research and education, and manage healthcare centers (Bickford, 2009).
According to several authors, the nursing informatics discipline encompasses two kinds of roles: (1) the specialist responsible for creating, facilitating, testing, and implementing new IT tools, and (2) the clinician responsible for utilizing those tools. Current healthcare centers integrate mobile labs, electronic prescriptions, telehealth, and e-scheduling of physician appointments, all of which require informatics nurses who help ensure that computerized solutions interface with one another (HIMSS, 2011). To complete information-related tasks effectively, informatics nursing staff must synchronize and engage in significant technical and clinical data interchange to foster safe, efficient care and maintain efficient workflow.
Nursing documentation is a key aspect of healthcare information. Nursing information systems have been developed to ideally use documentation to expand nurses' knowledge related to care quality. Knowledge in this area has grown exponentially over the last four decades, driven by the discovery of new means of learning. The nursing profession has particularly benefited from these developments, continually identifying improved means of achieving patient care improvements. Nursing skills and expertise carry a dimension of personal history that influences the delivery of nursing care. Nursing practice standards, nursing theory, and ethical and legal obligations must be understood and applied to enhance care quality.
The Electronic Health Record (EHR) concept has grown to become a key facet of information workflow. IT adoption leads to improvements in care efficiency and quality, thereby producing better patient outcomes. Patient documentation is crucial for communicating patient condition and organizing care based on each individual patient's unique needs. The nursing profession has chiefly been guided by those needs; based on them and relevant environments, a number of theories may be applied to aid personalized care. Individual nursing practice is founded on a combination of medical, nursing, psychological, philosophical, and other theories.
Why Current HIS Practice Requires Change
According to a recent report, nearly fifty percent of medical professionals who use Electronic Health Record Systems (EHRs) fail to acquire the necessary patient information to effectively coordinate patient care. Quinn (2015) notes that a Department of Health and Human Services (DHHS)-sponsored study led by Professor Chun-Ju Hsiao found that only one-third of healthcare professionals use EHRs to electronically share patient data. While four in ten professionals do make use of EHRs, they do not use these systems to share patient data (Quinn, 2015).
The core issue concerns the Continuity of Care Document (CCD), with meaningful use being the central requirement. The CCD should remain uniform throughout the entire EHR process (Quinn, 2015). Although compatibility ought to be demonstrated across systems, this rarely occurs in practice.
Key Stakeholders and Their Roles
The key stakeholders within this practice area are: (1) Nurse Informatics (NI) specialists, (2) the specialists responsible for creating, facilitating, testing, and implementing new IT tools (HIT specialists), and (3) the clinicians responsible for utilizing these tools.
An NI specialist leads the adoption of evolving technology within the medical domain; therefore, superior communication skills are essential. In an NI work environment, the professional handles and communicates information to patients, nursing staff, and healthcare providers, serving as the link between IT personnel and nursing staff. One objective of information dissemination is enabling individuals to make more sound decisions based on more accurate information.
An HIMSS survey found that 57% of participants identified their chief responsibility as providing systems preparation, ongoing user support, and user training; additionally, 53% dedicated the majority of their efforts to systems development, involving systems customization or updating, or the creation of a new in-house system (HIMSS, 2011). A second area of NI specialist focus is quality control. Other responsibilities include project management, systems user education and training, system selection, policy writing, systems maintenance, and systems optimization. Outside of clinics, nursing homes, and hospitals, NI specialists also engage in testing, sales, customer training, and system design.
For the integration and enhancement of EHR and HIS applications within the nursing profession, NI specialists should ensure nurse practitioner (NP) participation and identify existing HIS inefficiencies. Specialists should endeavor to determine areas for improvement to make the system more practitioner-friendly.
Health Information Technology (HIT) specialists are responsible for the protection and release of protected health data in adherence to all regulatory guidelines and relevant procedures and policies. They are also responsible for the repair and maintenance of IT systems within any healthcare center, including PCs, servers, and networks.
HIT specialists manage and organize health databases and patient records. Using advanced software, they code clinical procedures for insurance billing and future analyses, and they ensure the security of sensitive health information. Most HIT specialists are employed in hospitals and physicians' offices. Based on their specific position, they may develop, support, or implement systems such as EHRs, and they are expected to understand what information is required, how it will be used, and where it will be stored.
HIT specialists have a significant impact on patient care quality. As they advance in their careers, their collaboration with other members of the patient care team increases, driving improved health outcomes, new patient care developments, and decreased costs. It is vital that they develop user-friendly systems and interfaces, since nurse practitioners are unlikely to devote significant time to mastering a complex system. The goal should be to increase efficiency in patient care and data handling rather than to increase complexity. HIT specialists must first assess a healthcare organization's needs before developing a user-friendly, efficient system for NPs.
Clinicians must be willing to work within an HIS framework. Accepting change is rarely easy. Nursing personnel required to learn a new concept or skill and incorporate it into clinical practice may resist the learning process, with many preferring the status quo.
Complex Adaptive Systems (CAS) address management practice modification and the transformation of nursing leadership's thinking, problem-solving, and behavior. CAS moves beyond prior assumptions, embracing the concepts of attractors — catalysts that facilitate the spontaneous emergence of new behaviors — and self-organization, which together support the emergence of innovation and orderliness (Penprase & Norris, 2005). By emphasizing that the soundest processes begin with personnel at the micro level of an organization, complexity science offers nursing leadership new approaches to navigate the chaotic, complex healthcare management environment. In several ways, an HIS can be viewed as a CAS that practitioners may be hesitant to incorporate into everyday practice.
References
American Nurses Association. (2008). Recognition of a nursing specialty, approval of a specialty nursing scope of practice statement, and acknowledgment of specialty nursing standards of practice. Silver Spring, MD.
Bickford, C. J. (2009). Nursing informatics: Scope and standards of practice. In Studies in Health Technology and Informatics (Vol. 146, p. 855).
Elkind, E. C. (2009). Why information systems are helpful to nursing. The Pennsylvania Nurse, 64(1), 24–25.
GE Healthcare Partners. (2018). The Johns Hopkins Hospital launches Capacity Command Center to enhance hospital operations. Retrieved February 23, 2018, from
HIMSS. (2011). HIMSS nursing informatics position statement. Retrieved February 23, 2018, from www.himss.org/files/HIMSSorg/handouts/HIMSSNIPositionStatementMonographReport.pdf
HIMSS. (2011). Nursing informatics workplace survey.
Penprase, B., & Norris, D. (2005). What nurse leaders should know about complex adaptive systems theory. Nursing Leadership Forum, 9(3), 127–132.
Quinn, R. (2015). Compatibility issues make physicians' use of electronic health records systems tougher. The Rheumatologist. Retrieved February 21, 2018, from
Shekelle, P. G., Morton, S. C., & Keeler, E. B. (2006). Costs and benefits of health information technology. Evidence Report/Technology Assessment (Full Report), (1530–4396), 1–71.
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