Commentary—Nursing and the informatics revolution

Article Outline

• Copyright

Angela McBride’s article, Nursing and the Informatics Revolution, offers the reader a timely, readable, and relevant review of recent policy, research, and educational work on informatics, including key issues and prospects for nursing and other health disciplines. As such, it should be required reading by all clinical practitioners who haven’t been following what health policy leaders have been thinking about information and communications technology and its capacity to assist in the transformation of health care.

This accompanying editorial will pick up on some of the points made in the prescient article as well as offer examples of initiatives being undertaken by the American Medical Informatics Association (AMIA) to move from thought to action on key points she addresses.

McBride adds a global dimension to the 6 aims for future health care systems outlined in the Institute of Medicine (IOM) 2002 Chasm report. As she notes, a global view is particularly important with respect to standards and terminology since, if we cannot manage to create uniform standards, unnecessary confusion and inefficiencies will plague us for an extremely long time. For a nation that likes to conceive of itself as being flexible, we’ve been ridiculously backward with respect to adopting the metric system for weights, measures, and distance. If we don’t line up on standards now, it is unlikely that we’ll do so in the future.

Speaking of globalists, those of us who have experienced the way Europeans and Canadians conceive of healthcare, only Americans would list equitable as the last among the list of desirata that includes safe, efficient, effective, patient-centered, and timely. This is a mea culpa, since I sat on the committee that generated the 2002 Chasm report but, having given it further thought, if care is not equitable, that is, if you or your children are without insurance or access, the other aims hardly matter. For myself, I now wish that population care had been listed by the IOM in its list of aims as well. American healthcare remains perversely focused on individuals rather than considering them also to be members of groups whose health is often more influenced by group behavior than considered personal choice.

One of many of McBride’s sound recommendations relates to the need for more interdisciplinary education. AMIA seeks to work with educators across the health professions to create a model modular curriculum that all health professional schools can use to teach communications knowledge and skills along with information technology. The Board believes that AMIA is ideally situated to lead this educational innovation, and nursing, as well as medicine, needs to work diligently together to assure that the curriculum is put into place in such a manner that all entering students study this content collaboratively and collectively. We have “talked the talk” of interdisciplinary education far more than we have “walked the walk.” McBride’s article deserves to be on the syllabus for this crosscutting educational initiative.

Mention is made of the need to increase the informatics skills of faculty. This is equally true in medicine. AMIA is mounting a 10×10 initiative—10,000 informaticians by 2010—that responds to the call made at the 2004 NHII Summit in Washington by Charles Safran seeking a major workforce initiative. As such, the 10×10 program will offer moderately long and intensive, largely Web-based educational course offerings to address this serious need. In time, AMIA hopes to add coursework in translational bioinformatics and public health informatics as well. Nursing has been well ahead of medicine in structuring accreditation and certification in informatics, but according to nursing experts in the field, it has not stepped back, reflected on progress made to date, and laid out a clear course for going forward.

For this reason, AMIA has developed a nursing informatics initiative headed by Connie Delaney and Kathleen McCormick as part of its strategic planning exercise. The group is reviewing the writings of McBride and others in order to craft a strategic vision to guide nursing informatics practice, education and research. Once this activity is complete, the Board will blend it into a comprehensive approach for all disciplines within the house of informatics.

Clearly, there is broad agreement that informatics must see its primary mission to be transforming the health care non-system into a system that concerns itself with the health of both individuals and populations. We are indebted to the IOM and scholars such as McBride for offering such a clear path for a greatly improved health care system. Reformed systems of care will not only have patients much more actively involved but these systems will also utilize information technology to shorten the physical and emotional distance between patients and/or communities and professionals of various types.