How Information Management Enhances Direct Care Delivery in a Digital World
Direct Care and Information Management in Modern Healthcare
Health care is an information-rich environment. It has been said that healthcare encounters occur essentially for the exchange of information—between the patient and care provider and among care providers themselves (IOM, 2001). With the adoption of information technology (IT), healthcare information management has become increasingly complex. Inadequate resources and difficulty in accessing information at the time it is needed complicate the situation further (IOM, 2001).
The IOM report recommended that government, healthcare leaders, and vendors work collaboratively to build an information infrastructure quickly to eliminate handwritten clinical data. With the implementation of the Affordable Care Act, the HHS has made recommendations to encourage widespread implementation of electronic systems and databases to facilitate access to seamless and accessible healthcare information for everyone (US Department of Health and Human Services, 2010). Although there is still much to do, it is believed that appropriate use of these systems will decrease errors in prescribing and dosing, increase appropriate use of best practice guidelines, reduce redundancy, improve access to information for patients and providers, and improve quality of care.
The Impact of Information Systems on Direct Care Practice
The direct care practice of Advanced Practice Registered Nurses (APRNs) is directly influenced by these changes as increasing numbers of healthcare systems and clinics implement electronic health records and databases. The Essentials task force recognized the increasing importance of information systems for APRN practice and education. The Essentials require that APRNs be prepared to participate in the design, selection, and evaluation of systems used for outcomes and quality improvement (AACN, 2021).
This includes leadership in the area of legal and ethical issues related to information systems and knowledge about how to evaluate consumer sources of information available through technology. Borycki et al. (2017) outlined additional nursing informatics competencies required of multiple levels of nurses. With rapid changes in technology, it will be an ongoing challenge throughout an APRN’s career to lead in this area.
Competence in Technology: A Necessity for APRNs
There is an expectation of increasing competence in the use of technology. Wilbright et al. (2006) surveyed 454 nursing staff at all role levels in their self-reported skill in 11 key areas of computer use. Although the APRNs reported excellent to good skills at entering orders and accessing laboratory results, they rated their skills as fair or poor in 5 of 11 areas that were deemed essential to their role.
If APRNs struggle with the need for increasingly complex technology skills, it will be difficult for them to use tools and their time optimally to care for their patients. Well-functioning information systems can ease the workload of the APRN by optimizing the management of extensive data.
Challenges in Information Technology Implementation
However, meaningful IT needs more development to overcome challenges that clinicians face on a daily basis in their use of IT, such as workflow disruptions; lack of interfaces between systems; work-arounds, in which providers subvert the IT to get the job done; and inappropriate use of order entry warning alerts (Magrabi et al., 2010, 2012; Palojoki et al., 2016).
Computer technology can actually require increased staff time when used for complex order entry and clinical documentation. Healthcare institutions and private practices are rapidly implementing information systems across the country, so it is likely that APRNs will work in an environment in which a system is being implemented or upgraded.
The Role of APRNs in IT Implementation
APRNs can have an impact on how these systems function to make them user-friendly and efficient at the direct care interface. Although APRNs may feel they have neither the time, inclination, nor expertise to participate in these implementations, user input is imperative and ultimately affects direct care.
As information systems are implemented, APRNs need to be cognizant of the potential for at least a temporary increase in errors, reduced charge capture, incomplete or difficult-to-access information, and increased time for routine tasks. Implementation of these systems is a major undertaking because it takes time to re-equilibrate workflow and organizational skills, regardless of APRN experience.
Optimizing Direct Care Through Effective Information Management
When information systems are well implemented and used, the APRN will be able to use and view data in new ways to improve patient care. The expansion of technology can lead to a corresponding increase in the number of tools and amount of data that are available for use—both within and external to the healthcare setting.
Examples include email or video communication with patients rather than telephone calls or office visits, patient use of “apps” to assist healthy self-care, patient use of personal fitness devices that record activity levels and calories expended, data that can be downloaded and transmitted from mobile invasive technology to maintain life, the practice of telehealth for routine or specialty patient care, and the use of computers to assist in oncology protocol care decisions.
The Role of Data in Direct Care Decisions
One commonality throughout these examples is the need to determine when and how to use these data to make patient care decisions (Harrington, 2017). There will be a need for robust analytics to obtain meaning from these data, and APRNs must partner with informaticists and be at the table when determining strategy regarding when and how to use analytics (Harrington, 2016a).
The goal is to integrate technology with practice for value-added benefit (Harrington, 2016b). Although information systems and electronic resources can be great tools in the APRN’s repertoire, the APRN must be constantly aware that these technologies bring with them their own pitfalls by intruding on the patient relationship and creating a potential for errors (Harrington, 2014).
The Intersection of Direct Care and Technology
APRNs can play important roles in evaluating proposed technology and information management systems and the impact they have on APRN practice and patient care. The central competency of advanced practice nursing is direct care, regardless of the specific role of the CNS, NP, CRNA, or CNM.
APRNs are currently providing direct healthcare services that affect patients’ healthcare outcomes positively and that are qualitatively different from those provided by other healthcare professionals. Of importance, these services are valued by the public and are cost-effective.
Key Characteristics of Direct Care in APRN Practice
APRNs can offer this essential care through the use of the six characteristics that comprise APRN direct care: use of a holistic perspective, formation of therapeutic partnerships with patients, expert clinical performance, use of reflective practice, use of evidence as a guide to practice, and use of diverse approaches to health and illness management.
Their mastery accomplishes several goals, including differentiation of practice at an advanced level and context for the development of other competencies, such as guidance, coaching, and collaboration. Together, these characteristics form a solid foundation for providing scientifically based, person-centered, and outcome-validated healthcare.
Research and Future Directions in Direct Care and Information Management
Research supports each of these claims and hence substantiates the nursing profession’s and public’s confidence in the care provided by APRNs. As APRNs continue to expand the scope and settings of their practice, it will be imperative that these six characteristics continue to be substantiated by solid research in each of the roles.
In addition, research will be important in documenting the optimal so-called nurse dose of APRN intervention as we continue to face challenges in caring for culturally diverse, aging, and chronically ill populations.
FAQs
Q1: What is the role of information management in direct care?
A1: Information management plays a crucial role in direct care by facilitating the accurate and timely exchange of data between patients and healthcare providers. This enhances decision-making and improves patient outcomes.
Q2: How does technology impact the workload of APRNs in direct care?
A2: While technology can optimize data management and ease the workload of APRNs, it also presents challenges such as workflow disruptions and the need for ongoing competence in complex systems.
Q3: What are the key characteristics of direct care provided by APRNs?
A3: The six key characteristics of direct care in APRN practice include the use of a holistic perspective, formation of therapeutic partnerships, expert clinical performance, reflective practice, evidence-based practice, and diverse approaches to health and illness management.
Q4: Why is APRN input important in the implementation of information systems?
A4: APRN input is vital in ensuring that information systems are user-friendly and effective at the direct care interface, ultimately improving the quality of patient care.
Q5: What challenges do APRNs face with the adoption of IT in healthcare?
A5: APRNs face challenges such as increased complexity in technology use, potential workflow disruptions, and the need for ongoing training to stay competent in using advanced information management systems.