Description

In the Discussion for this module, you considered the interaction of nurse informaticists with other specialists to ensure successful care. How is that success determined? Patient outcomes and the fulfillment of care goals is one of the major ways that healthcare success is measured. Measuring patient outcomes results in the generation of data that can be used to improve results. Nursing informatics can have a significant part in this process and can help to improve outcomes by improving processes, identifying at-risk patients, and enhancing efficiency. To Prepare: Review the concepts of technology application as presented in the Resources. Reflect on how emerging technologies such as artificial intelligence may help fortify nursing informatics as a specialty by leading to increased impact on patient outcomes or patient care efficiencies. The Assignment: (4-5 pages not including the title and reference page) In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following: Describe the project you propose. Identify the stakeholders impacted by this project. Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples. Identify the technologies required to implement this project and explain why. Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team. Use APA format and include a title page and reference page. Use the Safe Assign Drafts to check your match percentage before submitting your work.

JONA
Volume 49, Number 11, pp 543-548
Copyright © 2019Wolters Kluwer Health, Inc. All rights reserved.
T H E J O U R N A L O F N U R S I N G A D M I N I S T R A T ION
A Systems-Level Method for Developing
Nursing Informatics Solutions
The Role of Executive Leadership
Sammie Mosier, DHA, MA, BSN, NE-BC, CMSRN, BC
Wm. Dan Roberts, PhD, RN, ACNP
Jane Englebright, PhD, RN, CENP, FAAN
Nursing leadership can play an essential role in the development
of nursing informatics solutions by virtue of
their broad understanding and oversight of nursing
care. We describe a systems-level method for creating
nursing informatics solutions with clearly defined structure
and leadership fromnursing executives. Based on
the guiding principles of clear lines of responsibility,
respect for expertise, and commitment to project
aims, this allows nursing executive leadership to organize,
set up, and own the development of nursing informatics
solutions.
Data about nursing care have become a critical component
of operational and patient care decisions.
These data can potentially affect the productivity, efficiency,
performance, effectiveness, cost, and value
of nursing care when properly collected and used.
The management and processing of data into knowledge
for use in nursing practice have become an important
specialty within the last decade.1
Nurse executives are dependent on data for effective
decision making. The American Organization of
Nurse Leaders has identified essential competencies
in informatics that are necessary for effective leadership
of this technology and data-informed environment.
2 In the age of big data, nurse executives are
responsible for creation of the framework that allows
for nurses and other experts to apply their knowledge,
such as through the creation of a data culture, the development
of data competencies, and the establishment
of data infrastructure.3
Together, nurse executives and nurse informaticists
are forging new solutions to improve nursing processes
and patient care. The challenge is in determining how
best to coordinate the efforts of subject matter experts
from nursing, informatics, and information technology
to design, develop, and deploy solutions to very
complex problems. Nursing leadership is well poised
to influence these processes by virtue of their broad
understanding and oversight of nursing care. While
not usually engaged in the development of nursing informatics
solutions,we propose that executive leadership
is necessary to this process.
Here we discuss our development of a systems-level
method, with clearly defined structure and leadership
fromnursing executives, to create nursing informatics
solutions that enhance patient care. This article will
describe the method and provide case examples of
2 successful applications.
Methods
This project was conducted within a large network of
hospitals with affiliated facilities across the United States
and United Kingdom. The goal was to develop amethod
for aligning leadership, clinical experts, informaticists,
and information technology experts to design, develop,
and deploy nursing informatics solutions.
The chief nurse executive (CNE) developed the
framework to harmonize the work efforts of disparate
groups of clinical and informatics experts that
were necessary to design, develop, and deploy nursing
informatics solutions. The framework was based on
3 guiding principles: clear lines of responsibility and
Author Affiliations: Vice President and Assistant Chief Nurse
Executive (Dr Mosier), Vice President of Care Delivery and Performance
(Dr Roberts), and Senior Vice President and Chief Nurse
Executive (Dr Englebright), HCA Healthcare, Nashville Tennessee.
The authors declare no conflicts of interest.
Correspondence: Dr Englebright, HCA Healthcare, One Park
Plaza, Nashville, TN 37203 (Jane.Englebright@hcahealthcare.com).
DOI: 10.1097/NNA.0000000000000815
JONA Vol. 49, No. 11 November 2019 543
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
authority, respect for each type of expertise necessary
to the project, and clear commitment to the aims of
the project.
Figure 1 depicts the structure. Clear lines of responsibility
consisted of dedicated leadership for each
component of the process, starting with executive sponsorship
and guidance. A steering committee of nursing
executives set the vision, objectives, scope, and
guiding principles. The steering committee served as
a resource for the other teams and an arbitrator of
disputes between conflicting priorities. Teams of content
experts and end-users were tasked with defining
good practice and ideal workflow to generate technology
requirements. Technical experts were charged
with designing the technology solutions that couldmeet
requirements, support the workflow, present content
optimally, and incorporate decision support when possible.
The clinical and technical teams work iteratively
to develop and test aspects of the proposed solution.
Subject matter experts provided critical input on
regulatory requirements, answering questions and
providing audit and review services. Project management
resources ensured the appropriate flow of decisions
and work products among the teams in the appropriate
sequence and ensured that any issues were escalated
to the steering committee expeditiously.
Respect for different types of expertise ensured
that each of the above responsible parties was able to
operate fully within their area of expertise. Technical
experts deferred to clinicians on content and workflow.
Clinical experts deferred to informatics experts on the
best way to design input and output and the use of decision
support. Regulatory experts deferred to clinical
experts on content and workflow while providing
guidance on regulatory requirements, including evaluation
of the final product.
Commitment to the vision and guiding principles
established by the steering committee was a requirement
for all colleagues participating in the project. A
clearly articulated set of guiding principles was used
in each work session to guide team members as they
designed, developed, and deployed the new solution.
Final success was measured on how well the solution
adhered to these guiding principles.
This framework was used to develop 2 distinct
nursing informatics solutions within a large hospital
system: Evidence-Based Clinical Documentation (EBCD)
and the Nursing Data Portal (NDP). These informatics
solutions were designed to meet the operational
goals of: 1) minimizing nursing documentation into
an evidence-based story of the patient; 2) creating a
more useful and usable patient-centric record that
guides and informs the provision of safe, effective,
and efficient care by the interdisciplinary team; and
3) rendering standardized and normalized data for
the purpose of performance visibility and evaluation
of nursing care of individuals and population at both
the process and outcome levels. Through adherence
to the framework, the resulting informatics solutions
constructed to contribute to the healthcare learning
environment through the continuous generation of
knowledge and feedback to clinical practice.
Figure 1. Structure.
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Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Results
Evidence-Based Clinical Documentation
In the development of EBCD, clear lines of responsibility
began with the chief nursing officer (CNO) Council
(Figure 2). The CNO Council served as the steering
committee for EBCD, overseeing the progress of the
project teams. This group served as a champion of
the organization’s nursing agenda and provided guidance
and input into decisions related to patient care,
including operational issues and prioritization of clinical
projects. The CNO Council defined the guiding
principles for the process and product, ensured adherence
to the overall vision, and acted as an arbitrator
of conflicting viewpoints.
The Content Team was led by clinical leaders and
included ad hoc committees of clinical experts organized
by specialty. Each ad hoc committee focused
on the specific tasks and questions relevant to their
area of expertise. Clinical expertswith current patient
care experience were able to define the data flow
needed to support the previously developed ideal
workflows,4 use evidence reviews to develop content,
and identify the desired decision support.
Development of the decision support, creation of
a style guide, and review of existing screen designs
were the responsibility of technical experts. Regulatory
subjectmatter experts addressed questions about
regulatory compliance, billing compliance, and risk
management and performed on-site assessment for
regulatory compliance. Throughout the entire process,
the project management team managed to timeline,
maintained communication, designed implementation
and education strategies, and assisted the collaboration
between teams to resolve issues.
With the clear lines of responsibility defined and
respect for expertise established, the development of
EBCD progressed in alignment with the vision for this
project. The overall vision for this project was to create
a patient-centric record that guides and informs
the provision of safe, effective, and efficient care by
the interdisciplinary team and produces data to valuate
care of individual and population of care (Figure 3).
To achieve this vision, guiding principles were developed
in regard to design and content.
The guiding principles of EBCD design were established
to ensure that the final product enhanced
and supported the process of patient care documentation,
such as strict adherence to the style guide for
consistency and alignment with the previously defined
ideal workflows.4 The guiding principles of EBCD
content ensured that documentation entered through
this system would be meaningful to patient care or
necessary for regulatory or billing requirements and
that the resulting documentation would support the
ethical and competent clinician.
Nursing Data Portal
In the development of the NDP, the steering committee
consisted of the CNOCouncil with representation
from CNEs and unit directors, the 2 primary endusers
for the product. Responsibility for content was
Figure 2. Evidence-based practice clinical documentation project team.
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Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
designated to corporate clinical leaders and data
owners. Technical responsibility was shared between
the nursing analytics, data science, and information
technology teams. Other defined responsibilities were
assigned to subject matter expert teams, including patient
experience, human resources, and financial and
executive leaders. Strong project management processes
facilitated the iterative flow of decisions and
tool development (Figure 4).
The focused expertise of these teams was key to
the success of this project. The steering committee identified
4 domains of performance (clinical outcomes,
patient experience, efficiency, and nursing engagement)
and provided final approval of the indicators
that would be used in the completed product. Technical
experts were the backbone of all the data needs for
the final project. They created the data visualization
plan, transformed data to usable scoring methods,
harmonized time frames from disparate data sources,
and aligned the data to other reports with the same
metrics. The various subject matter experts suggested
common metrics that were to be included in the final
product. These teams also validated all data posttransformation
prior to the creation of data visualizations.
In essence, the subject matter experts verified
the work of the technical experts before any data were
released for viewing. Project management team members
designed the implementation and education strategies
for this project and also managed communication
and issue resolution among the teams to meet the project
timeline goals.
With the clear lines of responsibility established
and experts assembled for the various project components,
the development of the NDP progressed toward
its singular unifying vision: one common platform for
sharing nursing performance data (Figure 5). Through
the careful design of source system screens and data
pathways and requirements, nursing performance
Figure 3. Flow of information for patient centric record.
Figure 4. Nursing data portal project team.
546 JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
metrics from multiple systems could be concisely
displayed on 1 page for maximum accessibility. The
vision of the NDP was achieved through adherence
to the guiding principle of easily understood data
and visualizations.
Discussion
Through the creation of a systems-level framework
that clearly defined responsibility, roles, and vision,
we successfully designed and implemented 2 largescale
nursing informatics solutions. These informatics
solutions were different from each other—1 clinically
focused and 1 focused on leadership—but were built
upon the same systems-level framework. In this method,
there was a clearly defined role and responsibility for
nursing executive leadership from the beginning of
the project to the end.
Multiple contemporaneous articles have demonstrated
the supportive role of nursing leadership and
informatics.5,6 Specific leadership roles, such as chief
nursing informatics officers and nursing informatics
executives, have emerged as central to the support of
transformation and the use of appropriate technology
solutions in clinical practice.7,8 Outside these specific
roles, there is a need for nurse leaders, including CNEs,
to have knowledge about informatics and its role in
patient care.9 Nurse leaders should be allowed opportunities
to both gain these competencies and apply
their knowledge to decision making regarding informatics
system and nursing care.9-11
Our systems-level method demonstrates the role
of specific leadership in guiding the ideation, design,
development, data mapping and visualization, and
application of the products developed during the informatics
and technology life cycle. Each of these
components is integral to the functionality, adoption,
and use of the final solution. Nursing executive leadership
must not only develop a clear structure, timeline,
and goals for the entire process but also provide
valuable insight into product development. This leadership
contributed to the effectiveness of these solutions
as part of the continuous feedback loop within
a learning healthcare environment. The knowledge and
understanding of clinical practice gained through these
solutions can be applied to subsequent applications
and efforts to refine and innovate within nursing care.
Furthermore, our method maximizes the expertise
of those most knowledgeable about individual
components. The clarity of roles ensured that critical
input was provided by the appropriate team members.
For instance, technical experts and informatics
professionals focused on the best way to design input
and output and the use of decision support while clinicians
were responsible for content and workflow.
An added benefit of this method is improved adoption
of the resulting solutions. Leadership engagement is
a key component of implementation processes.12-14 In
our method, leadership are engaged early and often in
the design process, ensuring that the solutions also met
the needs of leaders. Leadership engagement allowed
for local needs and workflow considerations to be incorporated
into the design, improving end-user uptake.
In summary, we have developed a systems-level
method that allows nursing executive leadership to
organize, set up, and own processes related to the development
nursing informatics solutions. Our organization
has used this structure for several projects with
positive results. Use and adaptation of the strategies
of this method may offer a way for nursing leadership
to guide and influence future solutions.
References
1. Murphy J. Nursing informatics: the intersection of nursing, computer,
and information sciences. Nurs Econ. 2010;28(3):204-207.
2. American Organization of Nurse Executives. AONE Nurse
Executive Competencies. Chicago, IL: AONE; 2015. https://
www.aonl.org/sites/default/files/aone/nurse-executivecompetencies.
pdf. Accessed July 25, 2019.
3. Englebright J, Caspers B. The role of the chief nurse executive in
the big data revolution. Nurse Lead. 2016;14(4):280-284.
Figure 5. Platform to share nursing performance data.
JONA Vol. 49, No. 11 November 2019 547
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
4. Mosier S, Englebright J. The first step toward reducing documentation:
defining ideal workflows. Comput Inform Nurs.
2019;37(2):57-59.
5. Remus S. The big data revolution: opportunities for chief nurse
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10. Healthcare Information and Management Systems Society
(HIMSS). Transforming Nursing Practice Through Technology
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11. Oakes M, Frisch N, Potter P, Borycki E. Readiness of nurse executives
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12. Sandström B, Borglin G, Nilsson R, Willman A. Promoting the
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Based Nurs. 2011;8(4):212-223.
13. Aarons GA, Sommerfeld DH. Leadership, innovation climate,
and attitudes toward evidence-based practice during a statewide
implementation. J Am Acad Child Adolesc Psychiatry.
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14. Gifford WA, Davies B, Edwards N, Graham ID. Leadership
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Nurs Leadersh. 2006;19:72-88.
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