“Health Information Technology (HIT) can't change healthcare, but it has to be part of healthcare change.”1 According to John Loonsk, the Director of the Office of Interoperability and Standards at the Office of the National Coordinator for Health Information Technology in the Department of Health and Human Services, there are current critical healthcare needs that can be facilitated by the use of HIT. These include the avoidance of medical error, improvement of resource utilization, acceleration of knowledge diffusion, reduction of variability in healthcare delivery and access, empowerment of consumers, strengthening of data privacy and protection, and promotion of public health.
Given the importance of understanding the potential benefits of optimizing HIT to improve health care, how can the leaders in the field insure that the nursing profession gains and maintains adequate competencies in this arena? Keys to understanding and implementing strategies to achieve competencies include the following:
•Knowing what competencies have been developed and how to access them
•Determining what competencies are needed in contexts, such as education, administration, and practice
•Recognizing that as technology evolves at an ever-increasing rate, competencies will need to be continually reviewed and updated to match.
Toffler stated, “The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.”2
Most available competencies related to nursing informatics can be found on the TIGER (Technology Informatics Guiding Educational Reform) web site.3 The TIGER Initiative has been discussed earlier,4 and the TIGER site houses a comprehensive listing of current and past competencies that relate to nurses. Among others, the TIGER website allows access to:
•Nurse executives competencies developed by American Organization of Nurse Executives in 2005 related to that role5, 6 •Informatics competencies for public health professionals7 •Information literacy competency standards
•Self-assessment of informatics competencies
•University of Minnesota Library and Informatics Competencies for Nurse Practitioner Students
•Computer literacy and informatics skills using Benner's novice to expert model8 In October 2007, the TIGER Informatics Competency Collaborative (TICC), co-chaired by Brian Gugerty and Connie Delaney recommended a framework of knowledge, skills, and attitudes for organizing existing and future competencies. Draft recommendations from this group are posted on the TIGER website. The informatics competencies are organized in 4 main areas:
1.Basic computer competencies
2.Information literacy competencies
3.Information management and informatics competencies
4.Attitude and awareness competencies
Another “treasure trove” is the Quality and Safety Education for Nurses (QSEN) site,9 developed as part of a Robert Woods Johnson-funded project designed to facilitate the execution of reform in nursing education in the areas of quality and safety.10 This site defines informatics competency as (the ability to) use information and technology to communicate, manage knowledge, mitigate error, and support decision-making. The QSEN site also has other helpful information, exercises for teaching data mining and web site evaluation, and a current, annotated bibliography of informatics publications. The American Medical Informatics Association (AMIA) has initiated a “10 × 10” project to develop informatics-associated competencies.11 In addition, the American Nurses Association recently revised the Scope and Standards of Nursing Informatics.12 This publication includes earlier versions of the Scope and Standards and clearly shows how nursing informatics has changed over time.
Whether in education or in service, it is important to understand how the application of relevant competencies will impact roles in a given domain. Each of us needs to become engaged in the competency development process. We can do this as learners, teachers, nurse executives, role models, or contributors. Active participation may include reviewing draft competencies, which are posted for comment, and insuring that they are comprehensive, appropriate, and meet our needs. Educators, in addition to meeting national credentialing body recommendations relative to HIT, have the responsibility to insure that their students have the knowledge, skills, and attitudes in this area that will position them for fully engaging technology in their future practice. Administrators and service leaders must serve as role models for effectively leveraging existing and developing technology. They must assess and evaluate staff competencies, offer continuing education in core competencies, and continuously advocate for improvement in HIT.
As an old man, Michelangelo was believed to have inscribed “ancora imparo” (Yet I am learning) next to an allegorical image of Father Time.13 Today, in order for nursing to continue to be informed and contributing healthcare providers in the area of HIT, we must understand, accept, and embrace the rapidly exponential changes that are occurring in the area of technology. Once, the ability to format a 5-1/4″ disk was considered an “informatics competency.” Those disks are now history and that competency is no longer relevant or sufficient. Information technology competencies now need to be based on a strategy of continuous learning.
FULL TEXT
