November 12, 2020

Episode 42: What nurse leaders need to know about informatics

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Podcast

Description

Informatics is a quickly growing field in the nursing world, and yet there is often confusion about what exactly informaticists do and how their work intersects with clinical nurses. Our guest for this episode is Tammy Kwiatkoski, director of clinical informatics for HIMSS. She’s here to dispel some of the mystery around this role, speak to why informatics is an attractive career path for nurses and what kind of skills are needed to break into the field. We also talk about how nurse leaders can partner with their colleagues in informatics to deliver better patient care. 

Tammy and Dr. Nurse Dan also speak about the impact that COVID-19 has had in her world. When the pandemic began, nurse informaticists at many health systems quickly stepped in to configure telemedicine tools, update documentation procedures, secure translators and ensure patients could receive virtual care, giving this role a new urgency literally overnight. 

Links to recommended reading: 

Podcast

Transcript

Dan:
Welcome to the show, Tammy.

Tammy:
Well, thank you for having me, Dan. I appreciate the opportunity.

Dan:
Yeah. So tell us a little bit about your background and what brought you into HIMSS?

Tammy:
I joined HIMSS about 10 years ago, and currently serve as the Director of Clinical Informatics. Overall, my responsibility here is to provide the oversight of the clinical informatics initiatives, and all of the external partnerships and collaborations within this area. My team generally manages the related membership activities within the HIMSS clinical communities, one of these being the nursing informatics community. But our work is really directed towards developing resources and education by means of webinar presentations, round table discussions, and publications. And we really accomplish this alongside our incredible volunteers from our committees and our task forces. Who share their expertise and together help us create valuable thought leadership pieces.

Dan:
Yeah, I love it. I've been to a lot of HIMSS conferences and just found extreme value with all of it. Just the content, the vendor connections, the content HIMSS put together. Just it's pretty cool. For our listeners, we have a range of frontline nurses all the way through nurse executives, healthcare leaders across the board. I think there's a lot of misconception about what informatics is. Can you give us an overview of how you define informatics?

Tammy:
When we look at informatics, we really look at the specialty of integrating the science and the analytical science along with clinical practice. So when we look at it from a nursing informatics perspective, it's really integrating clinical practice as a nurse and using that to identify, manage, and communicate data. By also using that wisdom that is gained from nursing practice.

Dan:
Yes. So it's really connecting that data side to the nursing practice side and building that evidence from all sorts of sources. It doesn't necessarily have to be the electronic medical record. Is that correct?

Tammy:
That's absolutely correct. Much that we do obtain is from the electronic medical record, of course. But there are a lot of other reporting mechanisms, communications, tools and technologies at use within a hospital setting. So certainly it's taking that plethora of opportunities and resources available to them onsite and transitioning that into all of the work that they do.

Dan:
What are some of the trends that have led to the growth of informatics? I worked for Kaiser Permanente for a long time. I think they were early into the game of having an informatics team and adopting electronic medical records. But I know the specialty itself has become a specialty. I think you can get certified in nursing informatics now. There's whole degree programs related to it. But what are some of the trends that have made that switch to grow the field of informatics?

Tammy:
If you talk history and some of the work that you've done in the past, and we look at the high tech act in 2009, which really drove the adoption of interoperable EHRs throughout the health care delivery system. And it's then when informatics projects started to receive that needed funding and the expansion in all areas of informatics. Yes, you can now receive many certifications and advanced degrees, including Masters in Nursing Informatics and Masters in many other areas of informatics. But many of the shifts that continued to grow the need for nursing informatics to really include the need for optimization. We've implemented this EMR, right? It now needs to give the clinicians the right information, at the right time, to provide that right care. There is this movement into the quality of care, risk management, and really making sure decisions made with an EMR are making a good impact down the line. But we've also seen new shifts in the technology itself.

Tammy:
More organizations are becoming very wired. And they are very complex where everything talks to one another. Technology is very sophisticated. And just the number of technologies available beyond the EMR is mind blowing. Nursing informatics is at the forefront of embracing and developing that clinical use of those technologies. And it's just ever expanding. But then there's also... Look at us as patients. There's this trend amongst patients using their personal devices, tracking their own data, their embracing of telehealth. And also taking just an interest more in their health data and using their patient portals. So as these trends continue, the need for informatics will just continue to grow and evolve. And we can expect that there will yet be another trend right behind us. It is fast moving and ever changing.

Dan:
Yeah. And one of the things that I've noticed with some of the conversations I've had with nursing technology leaders is the electronic medical record used to be the place where everything was done. And now the trend is moving away to more dashboards and integration of multiple technologies with a user layer on top of that. Instead of having everything run through just one system. What are you seeing in terms of kind of the cool, innovative technologies that are allowing that data to surface with insights that allow the informaticist to be able to make practice changes?

Tammy:
One thing that we can really point to now is telehealth. Technology is continuing to advance and there are more high-tech innovations used in hospitals. But very specifically, and currently telehealth has really taken on quite a new meaning to many of us. How that we can advance that use of telehealth and adapt that into our clinical workflow and integrating it to the systems is very much at the forefront of what many informatics nurses are doing at the current time. But there are just an unlimited amount of technologies that are coming into the hospital systems and presenting themselves. And we do have to find our way to wean through what is usable, what is necessary, and what is critical for our clinical care. So where a nurse informaticist comes in here is to find a way to partner the right technologies that will help compliment and support the need for nurses to deliver quality patient care.

Dan:
I think telehealth is definitely changing the game and it's also pushing regulation differently. Which is kind of interesting too. I know HIMSS recently released its 2020 Nursing Informatics Workforce Survey. Can you talk a little bit about some of the findings there?

Tammy:
Absolutely. Thank you. We have surveyed the nursing informatics profession every three years since 2004. And our goal was to help better understand the functions, the responsibilities, and also of course, looking at the compensation related to the role. Some notable findings from this year's survey include that graduate degrees in the field are increasing. We saw an uptick in the percentage of respondents who have a Master's Degree up from 59% to 66% in just the last three years. We've also seen that the nursing informaticist years of clinical experience is decreasing. And what we see here is that they are entering into informatics earlier from their clinical practice. Showing that perhaps informatics is more prevalent earlier in their clinical career, but that it's important to have that clinical experience behind them. What we're also seeing though, is that the role of the CNIO or a Senior Nursing Informatics Officer is continuing to rise where more respondents are reporting that the organization does have that as a formal role. But the nursing informatics specialist continues to be the key job title.

Tammy:
But what's interesting is that there's more of a significant growth in that area with director and manager levels. Which really shows that there might be an increase in larger departments and more diverse roles and not just an executive level when it comes to informatics. If I can say the one thing that was really exciting to see out of the survey, was that there was a significant change in the reporting structure. So while IT is still probably the most common department for nursing informatics to report to, they're increasingly reporting to nursing directly. Or to the administration or quality improvement departments than ever before. And this really shows that there's a shift to align priorities more directly with nursing practice basing it again on their clinical experience.

Dan:
That's an interesting trend, right? I think my experience with informatics was that transition. It started in IT. No one knew where to put the informatics nurses in IT though. They lived in all kinds of different places. And then finally they pulled them out and moved them over into the larger nursing organization. And then they became the translators between the clinical practice and the technology side. And there was a lot of value there in taking what the nursing teams needed and helping the IT and data folks understand that in a more technical fashion. I think that's a huge role for the informatics nurse.

Tammy:
You couldn't have said it better, truly. If you were to really create the true persona of an informatics nurse, you've really captured the essence of what they do. While it's certainly important for the informatics nurse to have that key connectivity to IT teams as well as to their clinical practice, it's that knowledge and that capability to speak both languages. To be able to draw from that clinical knowledge and experience that they had. And to be able to translate that into IT requirements. They speak the best of both worlds to really enhance the work that they're trying to do and really bring strength and meaning to what they're trying to accomplish for the organization. But at the end of the day, it's really all about positive quality patient care.

Dan:
Yeah. And I like the other thing that you talked about, which is nursing informatics has led the industry. I had a conversation not too long ago with some physician colleagues and we were talking about informatics education and that you can get certified in it. And many of the physicians didn't have any idea what informatics was. And I know there's CMIOs. Now there's CNIOs, but I think nursing has really led the way in this field and others are catching up. Who else has informatics roles from a clinical standpoint besides nursing and maybe physicians?

Tammy:
It can get very confusing when you just add the one initial of the I in there. We do also have pharmacy informatics. When you think about the necessary need for e-prescribing as well as using the technologies in order to do so. We also work with enterprise imaging and informatics within enterprise imaging. So that's another key area of growth that we're seeing as images come into play, the digital storage, and the transmission of patient data and that manner. So certainly this is what comprises all of clinical informatics and the specialties are there. They are working together. But certainly have each have their own disciplines that they strive to make more efficient. And really driving that to achieve very specific organizational goals.

Dan:
It's the new interprofessional team is pulling the informatics folks onto the clinical practice side and the quality side and how better decisions for a health system are being made. Let's dive into the CNIO role. So that stands for Chief Nursing Informatics Officer. And what does that person do at a high level for an organization?

Tammy:
From a high level, if I was going to say it succinctly in one sentence, I would say that their focus really is on the opportunities to improve efficiency for their clinical teams, with delivering quality outcomes for patients. And our HIMSS Nursing Informatics Committee actually recently updated a standardized job description, because of the need to have these competencies kind of laid out for this. But it's very dependent of course, on the specific job title and the organization that they represent. But really it focuses on, I'd say about five key areas. Certainly they're involved much into the strategy and the leadership of the organization, as you would expect any C-suite leader to focus on. But with their area, they're truly focusing more on the nursing informatics strategies related to their health IT procurement and working with optimizing that opportunity with other senior leaders. But they're also responsible for ensuring quality improvement efforts are consistent to support clinical and patient outcomes.

Tammy:
They are there to guarantee patient safety. To ensure that the technology and the infrastructure are emphasized in preventing medical errors or adverse events. They also understand and have to be engaged in public policy initiatives to know how to bridge new care delivery models into the clinical practice. And then finally at the bottom of what we're talking about today is really just knowing the technology, collaborating with administration or medical teams, and other informatics leaders, and the IT leaders, to be able to be those translators to know the clinician requirements and coordinate that into specifications for clinical solutions.

Dan:
And there's probably a fair amount of understanding policy as well. Meaningful use and all those things that are coming out related to health IT, and specifically electronic medical record work. That they probably need to be experts on and translate that into the organization as well.

Tammy:
Certainly, they have to have a pretty sound grasp of knowledge related to public policy. Hopefully organizations like ourselves can be of help because it is a lot to dive into. And there are a lot of requirements and there's a lot to read and to learn and to know. We also, with one of our partnerships and collaborations have the Alliance For Nursing Informatics that really does dive into these larger policy initiatives and how it impacts nursing informatics as a whole. So hopefully, as organizations we can help them become the experts that they need. Even though this is certainly an area of expertise that people have full professions and full teams working on. So hopefully we can help with that to weed through the complications. And what's coming out of the public policy environment.

Dan:
How does somebody get into the informatics field? What's the traditional pathway? Is it a formal degree program? Is it, "I'm a clinician and I dabble in technology and get interested in it and find roles that evolve over time,"? Is it a little, both? What are you seeing now in the trends of people getting into this?

Tammy:
There could be many entry points into the field. And it's of course, dependent on different work sites and your current organization's financial or operational situation. The majority of nursing informatics specialists have a primary workplace at a hospital. Although we have nursing informatics in the field that expands to the vendor environment, payers, academia, and even in that government or military space. But truthfully you really need a Bachelor's degree as a minimum requirement for many of these positions, as well as having clinical experience. So speaking for nursing informatics experience as a registered nurse. But a good starting point really would be your own self engagement. And I would encourage if they were interested to become more involved in informatics, is really just to be informed and knowledgeable of the current technologies that you're using. Ask those questions, get involved in projects, offer to be a super-user, a tester, or a trainer. And really just wanting to become more proficient in the technology that you're using or mastering your current EMR.

Tammy:
From there, you can move your career further into informatics. There's many resources available. The list is fairly endless. But one, I would suggest going through associations. Using organizations like HIMSS that could provide education and certification programs to expand your knowledge, to affirm your knowledge. Because as the field grows, this would probably be a logical way to stand out. If you're competing for positions and advancement, is to show that you've completed those certification programs and have that body of knowledge that is tested. But then there's also people. If you find a mentor or build a relationship with your own organization's informatics nurse. Talk to your IT teams as a nurse and see what's needed and have those conversations. You can certainly learn a lot from those lunchroom conversations and hallway conversations.

Tammy:
But then as we already touched on before there is also that formal education. And you might want to really take a focus and decide on what type. Or if you wanted to pursue an advanced degree, if that would best support your career goals? Obviously that's a higher of commitment to pursue something like a Master's Degree and one to consider given the amount of time and finances that would be required to achieve. So, certainly it has a lot of dependencies. And I think with that self-awareness and acknowledgement of where you fit within your knowledge base, finding a mentor and using associations, you can probably find your best path.

Dan:
That's good advice. Tailor it to what you want out of your career and what roles you're looking for. And then there's a lot of pathways to get there. Especially now there's a lot of associations like AMIA and others that can support you in that work as well. How has COVID-19 impacted nursing informatics? I mean, the thing that comes top of mind for me is it forced telehealth and remote monitoring to be a normal, which provides lots of data and new avenues for using technology to deliver care. But what else has COVID done to boost or hinder informatics?

Tammy:
Obviously none of us are going to be the same. And really, I think the changes are consistent here. And we don't know exactly where we are going to land. But when the pandemic started, informatics nurses found themselves really turning back to their clinical skills to try to look to establish those new clinical workflows, or supporting the change management. And really implementing these new processes under this constant change and fluctuating environment, and even movement of their facilities and changing of the rooms. I think what the pandemic has truly done is heightened the value of nursing informatics. As healthcare organizations really needed to change and adapt quickly. It's the informatics nurse who is by design capable of making those changes and adapting very quickly.

Tammy:
So they were there designing new HR workflows, streamlining the documentation, determining what is needed for documentation, working to report the real-time data. As you mentioned, setting up telehealth. But they've really applied their clinical knowledge to try to find those efficiencies to know what meaningful data is required to deliver the appropriate care during these extraordinary times. And really, they were truly involved in establishing telehealth. And really learning how to teach the nurses as well, how to use telehealth. And so the nurse informatics role is to ensure that the clinical workflow is integrated into the organization system and that the nurses are trained to be able to do so.

Dan:
I think it just brought the technology and data to the forefront. And nurses had to adapt quickly to take things that maybe hadn't existed before and turn them into reliable care pathways and interactions with the health systems and caregivers. So I like COVID-19 for only one reason, which is it's breaking down some of the traditions that we've held so close in the past and allowed us to do some things differently. And I think roles like the nursing informaticist are able to break through some of the resistance to change that may have been there pre-pandemic.

Tammy:
I would agree with you. And I'd say probably all clinicians and those involved in health care at this time would agree with that statement as well. I think the resulting impact is that we really need to invest in moving our preparedness for this going forward. But while it's hard to predict what that will be. And there will be that continued uncertainty, there really are more informatics driven initiatives that are required. There's more analysis and education, operational changes, and systems developed that are going to continue to shift once again with the added application of telehealth or remote patient monitoring. And even hospitals at home, there's a lot to be learned and taken from this experience for sure.

Dan:
As a nurse leader, let's say I'm a Chief Nurse Executive or a health system leader. What's the best way for me to start partnering with my nursing informatics partners in the organization? How do I find them? If I'm a day-to-day operations person, how should I be thinking about engaging with an informatics team to support that day-to-day work?

Tammy:
Our workforce survey reported was that more of the nursing informatics teams are shifting to reporting directly to their nurse executives a little bit away from IT. Which does show the need to align more closely with nursing practices. But this partnership is happening, I believe. And there's quite a recognition of each area of specialty, which is truly respected and trusted among one another. But there absolutely is such a power in a collaboration between a CNO, a CNIO and your IT leadership. What that will do is really just maximize nursing's capability to use the technology and overcome any barriers to success. So you have your IT managing project scope, your nursing informaticist, implementing these projects to ensure nursing workflow is optimized, and then you had their CNO leading that effort to ensure the organizational objectives can be achieved. And that's really powerful. I think as more information comes out about the value of informatics they will find one another most naturally.

Tammy:
And as I said earlier, within the how to get into the field, it's having the conversations, becoming super users, becoming more involved in the testing and training and really optimizing your skillset. But what I really see is that there's just that need for this powerhouse group to continue to stay in contact with one another and ensure that when there are decisions to be made, and when your strategizing projects, and what projects should be prioritized when you are planning program expansions, or new construction... And now with many mergers and acquisitions, there's a need to band together to bring that strength of the capabilities that each of them bring to that table. And to have those conversations.

Dan:
It's almost an imperative now that if you're making decisions around strategy systems care changes workforce, if you don't have a informatics team member in the room, you're probably coming ill prepared to make those decisions. And so they're an essential piece of the puzzle now. And they're part of the new interprofessional team to move us into the future of care delivery. So I think it's essential. I've seen teams remove informatics from their leadership circle. And then the remainder of the year, the conversation was, "Well, where's the data to support that thing, or where's the data to support that decision, or how do we get access to the quality data related to that?" And if they had the informatics team there, it would have been easy to be able to have those conversations. So it definitely is a detract or when they're not in the room.

Tammy:
They are the bridge, they are the bridge. They can bring everything together in a very logical perspective and use accurate data, accurate reporting and have the tools and the capability to see both sides. So it's almost we say, a translator, a mediator, or serving a bit of that bridge to be able to understand all sides and find the right solution. And again, for the nurse informaticist it's with the intention to help nurses help many patients in doing so.

Dan:
Yeah, the impact is very large. So to wrap us up, what would you like to hand off to our listeners?

Tammy:
It's a very challenging question. But if I was to wrap this up in a few statements, it's really just to know one never really knows where our journeys will take us. And as a nurse, even more specifically, because there are so many opportunities to specialize in their careers. And that includes a variety of careers in nursing informatics. While there might be many job titles within nursing informatics, one constant is that they are an essential role in the healthcare ecosystem. Because they bring their clinical knowledge, their leadership, and their skills to positively impact countless nurses who can then impact countless patients. And just with a different role. They are truly dedicated to influencing positive outcomes. For me at HIMSS in my role, it has been incredible to learn from such brilliant thought leaders. And I'm truly humbled by the passion, the commitment, and then their problem solving capacity that they have. They are also very willing to help one another and build that next generation of nurse informaticists. And it's really been my honor to find those opportunities for them, showcase their projects, and help to really amplify their messaging and their experiences to benefit others.

Dan:
What a great way to end it and show the value of the team members that are sometimes behind the scenes, but are so integral to where we're moving forward. Tammy, where can we find you and where's the best place to connect and learn about all the resources HIMSS has related to informatics and health?

Tammy:
Well, you can go to himss.org if you hit backslash NI, you'll find all the information on the nursing informatics initiatives we've talked about today. I'm happy to connect via LinkedIn and on Twitter at TKwiatkoski. And we also use the hashtag nursesforhit.

Dan:
Awesome. We'll put all those in the show notes and get those out to our listeners. Tammy, thanks so much for being on the show and sharing your expertise from the HIMSS organization and from the clinical informatics standpoint.

Tammy:
Thanks for inviting me. And if I can just end with a huge thank you to all of your nurse listeners for their dedication to their practice and their commitment to patient care. They're truly incredible. So a huge thank you.

Dan:
I ditto that. And thanks for ending with that one, Tammy.

Tammy:
Thank you.

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