Perspectives on the implementation of health informatics curricula frameworks.

BACKGROUND: The COVID-19 pandemic highlighted the necessity of equipping health professionals with knowledge and skills to effectively use digital technology for healthcare delivery. However, questions persist about the best approach to effectively educate future health professionals for this. A workshop at the 15th Nursing Informatics International Congress explored this issue. OBJECTIVE: To report findings from an international participatory workshop exploring pre-registration informatics implementation experiences. METHODS: A virtual workshop was held using whole and small group interactive methods aiming to 1) showcase international examples of incorporating health informatics into pre-registration education; 2) highlight essential elements and considerations for integrating health informatics into curricula; 3) identify integration models of health informatics; 4) identify core learning objectives, resources, and faculty capabilities for teaching informatics; and 5) propose curriculum evaluation strategies. The facilitators' recorded data and written notes were content analysed. RESULTS: Fourteen participants represented seven countries and a range of educational experiences. Four themes emerged: 1) Design: scaffolding digital health and technology capabilities; 2) Development: interprofessional experience of and engagement with digital health technology capabilities; 3) implementation strategies; and 4) Evaluation: multifaceted, multi-stakeholder evaluation of curricula. These themes were used to propose an implementation framework. DISCUSSION: Workshop findings emphasise global challenges in integrating health informatics into curricula. While course development approaches may appear linear, the learner-centred implementation framework based on workshop findings, advocates for a more cyclical approach. Iterative evaluation involving stakeholders, such as health services, will ensure that health professional education is progressive and innovative. CONCLUSIONS: The proposed implementation framework serves as a roadmap for successful health informatics implementation into health professional curricula. Prioritising engagement with health services and digital health industry is essential to ensure the relevance of implemented informatics curricula for the future workforce, acknowledging the variability in placement experiences and their influence on informatics exposure, experience, and learning.

Creating Case Studies for Digital Health and Technology Competency in Nursing.

BACKGROUND: Nursing programs and their faculty must ensure that graduates have the informatics, digital health, and health care technologies competencies needed by health systems. PROBLEM: A gap exists in nursing faculty knowledge, skills, and abilities for incorporating informatics, digital health, and technologies across curricula because of low focus on this area in faculty development initiatives and rapid adoption and evolution of technologies in health care systems. APPROACH: The Nursing Knowledge Big Data Science initiative Education Subgroup used a process to create case studies for including informatics, digital health, and the concomitant clinical reasoning/critical thinking competencies across curricula. OUTCOMES: Three case study examples were created using the process. CONCLUSIONS: The process for creating case studies that incorporate required informatics, digital health, and health care technologies can be used by nursing educators for teaching across their curricula and to assess student competency.

Electronic Health Record Maturity Matters! Texas Nurses Speak Out in Their Second Statewide Study.

With the passage of the Health Information Technology for Economic and Clinical Health Act in 2009, Texas nurses were faced with the rapid uptake of technology driven by this legislation. Texas Nurses Association and Texas Organization for Nursing Leadership formed a partnership to collectively track the impact on practicing nurses. The Health IT Committee was commissioned to evaluate the changing health information technology environment and associated solutions. As such, a study in 2015, entitled "Statewide Study Assessing the Experiences of Nurses with their Electronic Health Records," was conducted. The follow-up study in 2020 was conducted to compare 2015 and 2020 findings to identify improvements made on nurses' satisfaction with EHRs and identify improvement opportunities. The study design was an exploratory descriptive comparative analysis with a cross-sectional survey from a random sample of Texas nurses for the two study periods of 2015 (n = 1177) and 2020 (n = 1117). The Clinical Information Systems Implementation Evaluation Scale and a demographic survey including the Meaningful Use Maturity-Sensitive Index were the measurement instruments. Results and key covariates are discussed along with recommendations for achieving more mature EHRs and more mature organizational culture and leadership.

Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic.

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences.

Reconceptualizing the Electronic Health Record for a New Decade: A Caring Technology?

Since the 2009 publication by Petrovskaya et al on, "Dilemmas, Tetralemmas, Reimagining the Electronic Health Record," and passage of the Health Information Technology for Economic Clinical Health (HITECH) Act, 96% of hospitals and 78% of providers have implemented the electronic health record. While many positive outcomes such as guidelines-based clinical decision support and patient portals have been realized, we explore recent issues in addition to those continuing problems identified by Petrovskaya et al that threaten patient safety and integrity of the profession. To address these challenges, we integrate polarity thinking with the tetralemma model discussed by Petrovskaya et al and propose application of a virtue ethics framework focused on cultivation of technomoral wisdom.

Persons With Dementia and Their Caregivers' Perceptions About Occupational Therapy and Telehealth: A Qualitative Descriptive Study.

Occupational therapy (OT) services provided in the home to a person with dementia can decrease caregiver burden by targeting home modifications, functional performance, and safety. One method to deliver these services is through telehealth. The use of telehealth is expanding rapidly, but there is a current lack of evidence to support the use of telehealth to deliver OT services to persons with dementia. The purpose of this study was to identify the perceptions of persons with dementia and their caregivers about the use of telehealth to receive OT services. A qualitative descriptive design was used. Results provided themes in three domains: dementia journey, skills for technology use, and perceptions of OT. Each participant identified a unique journey through awareness, challenges, and adaptive strategies as they adjusted to a life with dementia. The skills for technology focused on current usage and perceptions about technology. Participants had limited knowledge of OT but did appreciate the role it has in dementia care. The themes identified in the study provide support for further exploration of the use of telehealth in OT for persons with dementia and their caregivers.

Academic success of undergraduate nursing students.

Defining students' academic success can be challenging when perceptions about the qualities that define it differ. Little is known about these perceptions when it comes to nursing students and particularly when English is a second language (ESL). Larger numbers of international and ESL students are gaining entrance into nursing education programs. The study purpose was to identify ways undergraduate nursing students and particularly ESL students self-report academic success. Study findings showed statistically significant findings for perceived student success when students had a prior degree, they were at a higher academic course level in their program, and believed they communicated adequately. Faculty roles that affect students' perceptions of their academic success are described and areas where actions can be taken are suggested.

Texas Team: Academic Progression and IOM Toolkit.

BACKGROUND: The Institute of Medicine (IOM) Future of Nursing report, identified eight recommendations for nursing to improve health care for all Americans. AIM: The Texas Team for Advancing Health Through Nursing embraced the challenge of implementing the recommendations through two diverse projects. METHOD: One group conducted a broad, online survey of leadership, practice, and academia, focusing on the IOM recommendations. The other focused specifically on academic progression through the use of CABNET (Consortium for Advancing Baccalaureate Nursing Education in Texas) articulation agreements. RESULTS: The survey revealed a lack of knowledge and understanding of the IOM recommendations, prompting development of an online IOM toolkit. The articulation agreements provide a clear pathway for students to the RN-to-BSN degree students. CONCLUSION: The toolkit and articulation agreements provide rich resources for implementation of the IOM recommendations.

Statewide Study to Assess Nurses' Experiences With Meaningful Use-Based Electronic Health Records.

Nursing professionals are at the frontline of the health information technology revolution. The Texas Nurses Association and Texas Organization of Nurse Executives partnered to evaluate the changing health technology environment in Texas, in particular the nurses' satisfaction with the use of clinical information systems. A descriptive exploratory study using the Clinical Information System Implementation Evaluation Scale and a newly developed Demographic Survey and the Meaningful Use Maturity-Sensitive Index, with a narrative component, was conducted in 2014 and 2015. Nurses across Texas received an electronic invitation to participate in the survey, resulting in 1177 respondents. Exploratory factor analysis revealed that variables of the Meaningful Use Maturity-Sensitive Index and Clinical Information System Implementation Evaluation Scale show strong interrater reliability, with Cronbach's α scores of .889 and .881, respectively, and thereby inform the survey analysis, indicating and explaining variations in regional and institutional trends with respect to satisfaction. For example, the maturity of a clinical information system within an organization and age of the nurse significantly influence the probability of nurse satisfaction (P < .05). Qualitative analysis of nurses' narratives further explained the nurses' experiences. Recommendations for future research and educational were identified.

VTE Prevention: Development of an Institutional Protocol and the Nurse's Role.

Venous thromboembolism (VTE), including the combined diseases of deep vein thrombosis and pulmonary embolism, is a significant health problem that affects mortality, morbidity, and resource expenditure. Multiple guidelines have been formulated to address this condition, but broad implementation in health care is lacking. Nurses have a pivotal role in VTE prevention through increased knowledge, patient advocacy, and implementation/development of institutional VTE protocols.

Early term birth: the impact of practice patterns on rates and outcomes.

The American College of Obstetricians and Gynecologists guidelines discourage elective deliveries before 39 weeks gestation, but clinicians continue to schedule elective inductions and cesareans resulting in births at 37 0/7 to 38 6/7 weeks gestation. These "early term" (ET) infants incur more morbidity and mortality than their 39-to-41-week counterparts. Using the Quality Health Outcomes Model, four hypotheses were tested: Among hospitals in one southwestern U.S. county, there are different rates of ET births, ET births preceded by elective labor induction, ET births preceded by elective cesarean section, and Neonatal Intensive Care Unit (NICU) admissions of ET infants. Analyses of 75,625 birth certificates involved 26,199 ET and 49,426 full term births in 16 hospitals. Chi-square analyses revealed significant differences in rates among hospitals for ET births, ET births preceded by elective labor induction, and ET births preceded by elective cesarean section, but no significant differences in NICU admissions. Wide variance across hospitals demonstrated practice patterns amenable to improvements.

Developing an applied informatics course for a doctor of nursing practice program.

Rapid development of doctor of nursing practice (DNP) programs requires that nursing faculty and students become competent and proficient in the discipline of informatics. The authors describe the steps used to develop an applied informatics course in a post-master's DNP program using content organizing and pedagogical frameworks and its positive learning outcomes.

Health information technology and nursing.

OVERVIEW: Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. A federal push to implement and enhance electronic health records (EHRs) has been supported by billions of dollars earmarked in the Health Information Technology for Economic and Clinical Health Act, passed as part of the 2009 American Recovery and Reinvestment Act. The goal has been to lay the groundwork for a HIT system that enables a more reliable exchange of information among practitioners and patients and significant improvements in the way care is delivered.But what does this really mean for nurses? This article is the first in a series on HIT and nursing and will examine the federal policies behind efforts to expand the use of this technology as well as the implications for nurses. Subsequent articles will take a closer look at the use of EHRs to improve patient safety and quality of care, and the important role nurses are playing-and could play-in this system-wide initiative.

Deep vein thrombosis/pulmonary embolism: a survey of self-reported prevention practices among hospitals.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are major causes of preventable complications for hospitalized patients worldwide. The National Quality Forum (NQF) recommends that all patients be assessed for DVT/PE risk upon admission, periodically thereafter, and receive evidence-based pharmacologic prophylaxis. Objectives of this study were to capture information about hospital practices related to detection, prevention, and treatment of DVT/PE and to explore relationships between hospital characteristics and an applicable patient safety indicator (PSI) #12 postoperative DVT/PE. Two study phases were conducted in the south-central region of the United States. First, a survey tailored to gather information about the study objectives from subject matter experts was administered, and then, using the subject matter expert results, an online survey of performance improvement professionals was deployed. Using this 5-point Likert scale online survey, respondents at each hospital reflected their DVT/PE prevention practices approach and status. Results provided insight for trends in hospital-based DVT/PE prevention practice, associated hospital characteristics, relationship among domains of prevention practice, and how electronic DVT/PE order sets related to DVT/PE outcomes. Relationship of all these characteristics to hospital overall PSI #12 postoperative DVT/PE rates were compared. Future study and survey development recommendations were discussed.

Rural hospital information technology implementation for safety and quality improvement: lessons learned.

This grant involved a hospital collaborative for excellence using information technology over 3-year period. The project activities focused on the improvement of patient care safety and quality in Southern rural and small community hospitals through the use of technology and education. The technology component of the design involved the implementation of a Web-based business analytic tool that allows hospitals to view data, create reports, and analyze their safety and quality data. Through a preimplementation and postimplementation comparative design, the focus of the implementation team was twofold: to recruit participant hospitals and to implement the technology at each of the 66 hospital sites. Rural hospitals were defined as acute care hospitals located in a county with a population of less than 100 000 or a state-administered Critical Access Hospital, making the total study population target 188 hospitals. Lessons learned during the information technology implementation of these hospitals are reflective of the unique culture, financial characteristics, organizational structure, and technology architecture of rural hospitals. Specific steps such as recruitment, information technology assessment, conference calls for project planning, data file extraction and transfer, technology training, use of e-mail, use of telephones, personnel management, and engaging information technology vendors were found to vary greatly among hospitals.

A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.

OBJECTIVE: To investigate the effectiveness of a quality improvement educational program in rural hospitals. DESIGN: Hospital-randomized controlled trial. PARTICIPANTS: A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. INTERVENTION: The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. MAIN OUTCOME MEASURES: Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. RESULTS: No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. CONCLUSIONS: While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

Challenges in conducting a hospital-randomized trial of an educational quality improvement intervention in rural and small community hospitals.

The study design for this hospital-randomized controlled trial of an educational quality improvement intervention in rural and small community hospitals, following the implementation of a Web-based quality benchmarking and case review tool, specified a control group and a rapid-cycle quality improvement education group of >or= 30 hospitals each. Of the 64 hospitals initially interested in participating, 7 could not produce the required quality data and 10 refused consent to randomization. Of the 23 hospitals randomized to the educational intervention, 16 completed the educational program, 1 attended the didactic sessions but did not complete the required quality improvement project, 3 enrolled in "make-up" sessions, and 3 were unable to attend. Of the 42 individuals who attended educational sessions, 5 (12%) have left their positions. Quality improvement interventions require several different approaches to engage participating organizations and should include plans to train new staff given the high turnover of health care quality improvement personnel.

A hospital-randomized controlled trial of an educational quality improvement intervention in rural and small community hospitals in Texas following implementation of information technology.

Rural and small community hospitals typically have few resources and little experience with quality improvement (QI) and, on average, demonstrate poorer quality of care than larger facilities. Formalized QI education shows promise in improving quality, but little is known about its effect in rural and small community hospitals. The authors describe a randomized controlled trial assigning 47 rural and small community Texas hospitals to such a program (n = 23) or to the control group (n = 24), following provision of a Web-based quality benchmarking and case review tool. Centers for Medicare and Medicaid Services Core Measures composite scores for congestive heart failure (CHF) and community-acquired pneumonia (CAP), using Texas Medical Foundation data collected via the QualityNet Exchange system, are compared for the groups, for 2 years postintervention. Given the estimated baseline rates for the CHF (68%) and CAP (66%) composites, the cohort enables the detection of 14% and 11% differences (alpha = .05; power = 0.8), respectively.