Health information technology can and will transform nursing education

A vision for change 

Nursing education is challenged to prepare graduates with 21st century knowledge and skills for practice in a complex, emerging technologically sophisticated, consumer-centric, global environment. Competencies required include the ability to work in teams, apply multifaceted critical thinking, decision-making and communication skills, use a variety of technologies and software, focus on quality indicators and outcomes, and employ a patient-centered approach. While the preparation of a workforce trained in the principles of evidence-based practice and skilled in the use of contemporary information technologies is a necessary precursor for the future of the professions, it will not be without challenges. Even though healthcare environments are becoming more automated, today, most health professionals are not prepared for a world in which using informatics is a core competency all healthcare professionals possess. This is compounded by the fact that most nursing faculty do not have the skills needed to integrate information technology (IT) into their teaching and learning strategies. In addition, most nursing schools do not have ready access to the necessary health information systems to integrate the technologies throughout and across curricula.

Forces of change 

In 2000, the Institute of Medicine (IOM) released its landmark report, To Err is Human,1 which served as a catalyst to call for a transformation of healthcare practices. The report became a driving force and precipitated a subsequent series of reports on patient safety, quality, efficiency, and the use of information technologies.2, 3 The IOM report issued in 2003, Health Professional Education: A Bridge to Quality, called for a major overhaul of the education of all healthcare professionals.4 This report emphasized that academic institutions educating health professional students need to be responsive to the rapidly changing healthcare environments, and it strongly recommended that these institutions focus on the core competencies mentioned above as they educate future clinicians. Central to these core competencies is the use of health information technologies because, without a basic emphasis on informatics competencies, health professionals are limited in their ability to make effective use of communication and information technology skills in their practice.

Following these reports, in 2004 the federal government began to promote the use of electronic health records and created the office of the National Coordinator of Health Information Technology in order to push this agenda and promote a vision for a consumer-centric and information-rich health care environment with an e-health record for all by the year 2014. Although the nursing profession has provided continuous support for the field of nursing informatics, nursing was not on the radar screen when the plan for the “Decade of Health Information Technology” was released in July 2004.5 This caught the attention of several nurse leaders who immediately took the initiative to form the TIGER Team (Technology Informatics Guiding Education Reform). After 2 years of planning, a TIGER Summit was held in Bethesda, MD, in November 2006. This invitational Summit joined 120 nursing practice, education, and informatics nursing leaders and represented over 40 national and specialty nursing organizations united under one voice to reform nursing education and practice to support quality and safety in patient-centered care through the use of information and other technologies. A report including a 10-year vision and a 3-year strategic plan resulting from this Summit will be widely disseminated in the near future.

National initiatives 

The Nursing education community is responding to the challenges and recommendations set forth by the various Institute of Medicine (IOM) reports identifying the need to incorporate healthcare informatics into education and practice. The American Association of Colleges in Nursing (AACN) has initiated 2 new programs that incorporate informatics competencies in a foundational way—the Clinical Nurse Leader (http://www.aacn.nche.edu/CNL/index.htm) and the Doctor of Nursing Practice (http://www.aacn.nche.edu/DNP/index.htm). The National League for Nursing has established the Task Group on Informatics Competencies charged with surveying the informatics competencies taught in all levels of nursing education curricula (http://www.nln.org/aboutnln/AdvisoryCouncils_TaskGroups/informatics.htm). At the completion of this survey and analysis, a white paper will be developed with recommendations for implementation of these competencies into nursing school curricula.

There are also private initiatives focusing on developing informatics competencies. The most recent is a project called Quality and Safety Education for Nurses (QSEN) conducted by Linda Cronenwett, PhD, RN, FAAN and her team (article to be published in Nursing Outlook in 2007). Using the recommendations from the IOM report on educating health professionals, the project has not only identified informatics competencies for the undergraduate nursing student, but also competencies for patient-centered care, quality improvements, multidisciplinary team membership, communication, evidence-based practice, and patient safety.4 This team is now working on educational tools that will be made available to the nursing education community for implementing these competencies in their curricula and competencies for the graduate nursing student.

An exemplar of teaching informatics competencies 

In 2001, the University of Kansas School of Nursing began a partnership with Cerner Corporation to develop a program to use an electronic health record (EHR) in the classroom (http://www2.kumc.edu/healthinformatics/video.html). The Simulated E-Health Delivery System (SEEDS) was designed to provide teaching and learning tools to assist health professional students to develop competencies to harness the power of information technology, thus improving the quality, efficiency and effectiveness of healthcare. The program director, Judith J. Warren, PhD, RN, BC, FAAN, FACMI, adapted the EHR software to become a major educational strategy in engaging students to learn about informatics skills and patient information management. Faculty participated in the EHR adaptation by selecting learning activities, such as patient assessment, documentation of skills, care planning, drug information management, and problem list maintenance for implementation in SEEDS. The program has become so successful that 3 other schools of nursing have now adopted the educational product and have formed the Academic Education Solution Consortium to continue the evolution of this innovative teaching/learning strategy. Members of the Consortium are University of Kansas, University of Missouri at Kansas City, University of Utah, William Jewel College, and Cerner Corporation. As a result of this program, Dr. Warren believes that “Learning to use an EHR is more than documenting care of a patient. It is learning to collect and analyze information about a patient and then passing that information on to the next clinician who cares for the patient. Only with quality patient information at the point-of-care can clinicians provide safe, effective care.”

Outcomes of SEEDS 

The SEEDS project is transforming teaching and learning. Clearly, it changes the way the faculty teaches and the students learn. The faculty members become facilitators of learning and the students are actively engaged in the process of learning through the case scenarios and the interactive documentation forms. The integrated system embedded in the curriculum brings data, information, and knowledge to the student at point-of-learning. It assists them to better conceptualize documentation practices and the nursing process by providing them a visual frame of reference. Structuring learning concepts and providing information at point-of-learning with reference text to support data-driven care and evidence-based practices helps students to better organize learning and understand relationships between and among concepts. This approach encourages students to build upon prior knowledge and mentally organize their thoughts before new concepts are introduced. As one student said, “It definitely has helped me with critical thinking skills, even before I knew that is what it was doing … All of a sudden the pieces came together so I could make competent clinical decisions” (Jason Gray). Faculty also believe the enhanced curriculum provides an information-rich learning environment that—through the process of actively conceptualizing, applying, analyzing, synthesizing and evaluating information—supports critical thinking behaviors. This is where the rubber hits the road and students begin to understand the power of the clinical information system as an enabler of their practice.

Employers are seeing the value added when they hire graduates who have participated in the SEEDS curriculum. They find the graduates are technically savvy, possess the necessary competencies and readily adapt to the use of any EHR. This, in turn, makes them more efficient and effective knowledge-workers. Employers, too, see the enhanced critical thinking and problem-solving abilities of this new generation of graduates.

The outcomes of this integrated technology curriculum give us hope for transforming nursing education and graduating a workforce with the competencies and leadership for improving quality and safety in patient care. Collaboration will be the key to successful implementation across curriculum.