Health IT and Nursing-Sensitive Indicators: Improving Patient Outcomes

Introduction

Health information technology (HIT) is capable of transforming care quality and establishing connections between patient outcomes and nursing care. This paper examines the application of health IT and nursing-sensitive indicators (NSIs) for improving care quality and forging those connections. NSIs refer to measures reflecting nursing care process, structure, and outcomes. NSIs of outcome denote caregiver or patient measurement approaches that are sensitive to nursing care.

While a number of advocates deliberate over the perceived advantages of health IT, an honest consideration of practical experiences with real HIT systems — together with the drawbacks and obstacles associated with poorly constructed systems — is often not addressed. Ultimately, the aim must be improvements to quality, added convenience, and growth of efficiency, rather than the mere creation of wired health facilities.

Nursing informatics as a practice specialty is having a major impact on the way care is planned and delivered in the current healthcare environment. Nursing informatics refers to that component of informatics designed for and relevant to nurses; it includes information management, knowledge from sciences other than nursing, and the importance of informatics within all areas of nursing management. This paper illustrates HIT's role in managing better patient outcomes and nursing care by concentrating on two mechanisms: (1) HIT interventions, and (2) eMeasurement, both of which directly target nursing-sensitive measures.

Background

Longstanding evidence exists of nursing care's relationship with better patient outcomes. Florence Nightingale, a pioneer of nursing, employed quality improvement data to support a handwashing effort aimed at preventing the deaths of Crimean War soldiers from hospital-acquired infections. In the last ten years, the Interdisciplinary Nursing Quality Research Initiative (INQRI) of the Robert Wood Johnson Foundation demonstrated nursing care's impact on patient-sensitive care outcomes such as delirium prevention, fall prevention, and pain management (Balas et al., 2012).

Despite scientific advances occurring since the middle of the 19th century, U.S. patient care quality remains suboptimal. A collection of reports by the Institute of Medicine (IOM), issued over the last decade, indicates that care quality across the nation is variable and that rates of error are high. Even where evidence exists, it is not applied consistently in practice. Another concern is mounting healthcare expenditure, which presently accounts for 18% of gross domestic product (GDP). If this trend persists, healthcare expenses for 2040 could be as high as 34% of GDP (Council of Economic Advisors, 2009; Dykes & Collins, 2013). Variable care quality and unsustainable expenses are fueling changes to healthcare practice and policy, and HIT adoption has long been recommended as an approach that will facilitate safe, economical, and superior-quality patient care.

Review of Literature

Healthcare information technology contributes to evidence-based care through the standardization of terminologies and structure in documentation. The use of digital information, the standards allowing for data exchange between heterogeneous entities, the ability to capture data relevant to actual care provided, and practitioner competency in using that data all contribute to evidence-based care. IOM reports support the use of healthcare information technology to improve practices and promote patient safety. Informatics is a core competency for all healthcare professionals and is regarded as an important force in improving healthcare management.

For some time, technology's role has been considered by nurses when processing extensive datasets required to validate nursing-sensitive outcomes and when grouping those outcomes. The American Nurses Association (ANA) has backed attempts to define such measures using the National Database of Nursing Quality Indicators (NDNQI) and the Nursing Care Report Card for Acute Care. Currently, the National Quality Forum (NQF) is leading an effort to create e-measures that ensure data used for clinical documentation is reused for measuring patient health outcomes as a byproduct of care management. The NQF's Quality Positioning System (QPS) is a web tool that aims to improve access to all NQF-approved measures. QPS includes a number of NSIs, such as patient fall frequency and patient falls causing injury.

Quality measurement using NSIs is a complex process, since the information required for populating the indicators stems from various sources, several of which are non-electronic. HITs integrated into clinical workflow — and which produce structured, coded information as a byproduct of patient care and administrative processes — are required for populating eMeasures and supporting nursing workflow and management. Large-scale eMeasure application will help ensure that measures employed across different HIT systems are comparable and accurate.

HIT's significance in connecting nursing care to patient outcome improvements has been examined in the literature. Through the leveraging of eMeasures, effectively designed HIT interventions can target care delivery processes and forge linkages between patient outcomes and nursing care. Though the literature indicates that HIT may be used to improve patient outcomes in terms of treatment safety and care quality, few studies have investigated the link between NSIs and HIT use. A 2009 Cochrane Review assessed the impacts of nursing documentation systems on patient outcomes and nursing practice. Study authors identified only nine research works performed with adequate rigor to meet inclusion criteria. Of these, only four assessed computerized nursing documentation systems, while the rest assessed paper-based manual systems. Researchers concluded that some evidence existed indicating that HITs can help improve certain issues — such as decreasing time devoted to data collection — but no evidence was found of nursing care recording and planning systems' ability to improve patient outcomes or nursing practice (Dykes & Collins, 2013).

Patient care delivery is chiefly dependent on information for effective decision-making. All nursing actions are reliant on data-based knowledge. The nursing process begins with information gathering and communication, both initially and in continuous assessment. Nursing informatics (NI) refers to the management of information, data, wisdom, and knowledge applicable to nursing. With the advent of the electronic health record (EHR) era, NI has grown to be a crucial element in nursing practice, and every nurse in practice now employs informatics skills.

Conclusion

HIT's potential as well as its obstacles, when it comes to clinical data collection and utilization, has long been recognized by nurse informaticists. This paper highlighted the complexity linked to forging connections between patient outcome improvement and nursing care, and underscored the need to adopt HIT and eMeasures for accomplishing this goal. HIT prerequisites that will form linkages between patient outcomes and nursing care include a health informatics framework in which eMeasures are available and implemented on a large scale.