Nursing Informatics: Efficiency, History, and Patient Outcomes

Introduction

Although some critics charge that innovations in technology are having a negative effect on humankind, virtually none of them deny the positive effect of such innovations on the delivery and quality of medical and surgical services today. In fact, the introduction and uptake of so-called informatics closely parallels the Information Revolution itself, and most authorities today agree that computer-based applications are going to have an even greater positive impact in the future. This paper examines how informatics in general and nursing informatics in particular have affected the efficiency of nursing practice and improved patient outcomes in the process. A discussion concerning the role of nursing informatics is followed by a description of the historical evolution of the use of informatics in this area. In addition, a discussion concerning the need to more fully integrate nursing informatics with other nursing specialties and an analysis in support of this position are followed by a discussion concerning the future direction of the use of nursing informatics. Finally, a summary of the research and key findings concerning the history, current applications, and future directions for nursing informatics are presented in the conclusion.

The Role of Nursing Informatics and Its Impact on Patient Outcomes

The American Nurses Association (ANA) defines nursing informatics as "a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge to support patients, nurses, and other providers in their decision-making in all roles and settings" (as cited in Forehand, 2013, p. 37). This broad-based definition underscores the utility of informatics in facilitating a wide range of nursing activities, including most especially those involving the administration of patient medical records and the management of scarce organizational resources. Indeed, there are few areas of practice in which informatics cannot improve nursing practice and clinical outcomes (Forehand, 2013). For instance, according to Bloch (2009), "Nursing informatics transcends all aspects of nursing practice, teaching, and research, including multiple aspects of health care policy" (p. 98). In reality, though, the introduction of nursing informatics is not a recent trend but rather dates back nearly a half century to the early 1970s, as discussed further below.

History of Informatics in Nursing

Introduced in 1971, the first commercial digital management information system developed specifically for use in a health care setting was implemented at El Camino Hospital in central California, following close collaboration with its practitioners concerning what computer-based technological applications were needed to facilitate practice and improve patient outcomes (Thede, 2012). A nursing supervisor who was working at El Camino Hospital when the system was first implemented describes it as "an inpatient-oriented, hospital-wide system" and suggests that the main factors contributing to its early success and acceptance by health care practitioners were "its true integration, clinician workflow support, and ease of use" (as cited in Thede, 2012, p. 7).

Other features that helped facilitate the uptake of this newly implemented hospital-wide management information system included the use of conventional English words and phrases rather than computer codes — which were commonly being used at the time — as well as the use of a light pen to help clinicians select on-screen resources and input patient data (Thede, 2012). Indeed, these types of ease-of-use attributes have characterized the evolution of nursing informatics ever since, and they have combined to provide more efficient nursing care together with improved patient outcomes. Perhaps even more importantly, the system designers were careful to collaborate with El Camino's nursing staff concerning what features were regarded as most important to them. In this regard, Thede points out that, "The collaborative culture and respect for the role of RNs was reflected in system design. MIS provided more functionality and better integration for nurses than we see in most systems today; requirements of the healthcare providers drove the technical innovations" (p. 4).

The collaboration with the nursing staff at El Camino resulted in the identification of a number of features that remain fundamental to modern nursing informatics applications. The nursing staff at El Camino was remarkably prescient in their vision of how these technologies could make them more efficient in ways that also contributed to improved clinical outcomes. Thede (2012) concludes that these nurses "envisioned such things as minimal time spent in documentation, working together with patients to document past history and care received, a lifetime healthcare record, and the use of aggregated data to improve nursing practice" (p. 4).

Conclusion

Fifty years ago, when computers were still the size of warehouses, the tricorder diagnostic tool used by Star Trek's Dr. McCoy seemed like far-fetched science fiction; yet these technologies are already being used in modern health care settings today. Looking ahead another fifty years, it is reasonable to posit that the state-of-the-art nursing informatics systems currently lauded as optimal solutions for improving nursing efficiency and patient outcomes will be regarded with the same historical distance as the iron lung — a technology that nonetheless saved countless lives that would otherwise have been lost.

Similarly, it is vitally important for nurse informaticists today to fully integrate these technologies and help their organizations realize their full potential until the "next big thing" replaces them. The history of nursing informatics, from its origins at El Camino Hospital in 1971 to the legislatively driven expansion of electronic health records today, demonstrates that progress in this field has always been driven by practitioners who were willing to collaborate, adapt, and advocate for tools that serve both nurses and patients. That imperative remains as urgent as ever.

References

Bleedorn, G. (2013, January–February). Say hello to the Millennial generation: Millennials love to spend money and use mobile banking but winning their loyalty is not easy. ABA Bank Marketing, 45(1), 24–26.

Bloch, J. R. (2009, March/April). Essentials of nursing informatics. Nursing Education Perspectives, 28(2), 98.

Forehand, J. W. (2013, February). Consider a career in nursing informatics. American Nurse Today, 8(2), 7.

Greenwood, B. (2017). Problems with nursing informatics. Chron. Retrieved from http://work.chron.com/problems-nursing-informatics-27523.html

Thede, L. (2012, January 23). Informatics: Where is it? OJIN: The Online Journal of Issues in Nursing, 17(1), 3–5.