Nursing Outlook
Volume 57, Issue 1 , Pages 65-67, January 2009

Participating in national standards initiatives: A call to action

Article Outline

 

Nearly 3 million nurses are practicing in this country and constitute the largest single group of healthcare workers. Increasingly, they use information and communication technology in the form of patient monitoring systems, computers, the Internet, email, cellular phones, and other devices. Such technology should enhance nurses' ability to provide high-quality care that is based on best practices/evidence-based practice, improve the education of students, and advance the research agenda. However, many nurses in front line and management positions are frustrated by a lack of coordination, integration, and standardization when they use healthcare information systems.1 They describe the silo effect, wherein one device does not communicate with another device, members of one discipline do not document clinical data in the same way as others, and one module of an information system does not integrate with other modules.

Nurses have been leaders in advancing information technology. National and global practice, education, and research achievements of nurses are recognized in the July/August 2008 issue of this journal.2 The articles describe initiatives involving standards and exchange of health information, initiatives that are prerequisites for widespread adoption of electronic health records (EHRs) by 2014. However, several questions remain. Have sufficient standards and integration efforts been developed to facilitate the integration of technology into holistic care? Who are the nurses involved in these initiatives? Are nurses adequately represented in the initiatives, specifically in the standards development process that will dramatically impact their practice? Do nurses have a unified voice?

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National standards and nurses 

The Office of the National Coordinator for Health Information Technology (ONC) was established in 2004 with two primary mandates: (1) provide counsel to the Department of Health and Human Services (HHS), and (2) develop an action plan for linking all health records through an interoperable system that protects privacy; connects recipients of care, providers, and payers; reduces errors and costs; and improves health.3 Interoperability is the ability of two or more systems or components to exchange information and to use the information that has been exchanged.4 David Brailer, MD, PhD, was appointed as the National Coordinator of Health IT and served for two years. His successor, Robert Kolodner, MD, and Alicia (Bradford) Morton, MS, RN-BC, the only nurse employed by ONC, joined their team more than two years ago.

In 2005, ONC established the American Health Information Community (AHIC) as a federally-chartered advisory committee.5 AHIC makes recommendations to HHS about creating digital and interoperable health records, encouraging market-led adoption of recommendations, and ensuring privacy and security. Lillee Gelinas, RN, MSN, FAAN, Vice President and Chief Nursing Officer of VHA, Inc., is the sole nurse on the 18-member panel. Lillee is also the Chair of the Electronic Health Records Workgroup and the Co-chair of the AHIC Successor, Inc. Transition Planning Team.

ONC awarded two contracts during 2005 that are especially relevant to nurses:

•Healthcare Information Technology Standards Panel (HITSP)6: The Panel is a public-private partnership intended to harmonize and integrate standards that will meet clinical and business needs for sharing information among organizations and systems. It is administered by the American National Standards Institute in partnership with Healthcare Information and Management Systems Society (HIMSS), Booz Allen Hamilton, and the Advanced Technology Institute. It consists of a chair and vice-chair, 17-member board, and panel members. John Halamka, MD, serves as the panel chair. One nurse, Linda Fischetti, RN, MS, Chief Health Informatics Architect, Veterans Health Administration, is on the HITSP board. Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, Vice President-Informatics, HIMSS, is the Technical Manager of the HITSP Technical Committees; she is responsible for guiding the efforts to harmonize standards and develop Interoperability Specifications for AHIC-approved Use Cases. HITSP has more than 500 individual volunteers, representing panel member organizations that participate in the technical committees and follow a lengthy process to review Use Cases, analyze standards gaps and overlaps, prepare interoperability specifications, and submit them to the Secretary of HHS for formal acceptance and recognition. Approximately 100 standards have been recognized to date. Many technical committee members are systems engineers or IT professionals or consultants, some are physicians, and a relatively small number are nurses or other clinicians.

•Certification Commission for Healthcare Information Technology (CCHIT)7: CCHIT is a certification body for EHRs and their networks. Certification of ambulatory EHRs began in 2006, inpatient EHRs in 2007, and Emergency EHRs in 2008. CCHIT was formed by the American Health Information Management Association (AHIMA) and the National Alliance for Health Information Technology as an independent, nonprofit organization to accelerate the adoption of health information technology. It consists of a seven-member Board of Trustees, a 21-member Board of Commissioners, physician and provider jurors, and work groups. One nurse, Susan Miller, RN, FACMPE, Administrator, Family Practice Associates of Lexington, KY, is on the Board of Commissioners. Six nurses serve as provider jurors. Nurses serve on six of the nine CCHIT work groups; Kathy Scanlon, RN, Healthcare IT Professional, is the co-chair of the Inpatient EHR Work Group.

In 2008, AHIC Successor, Inc. was established as a public-private partnership to replace AHIC. Before the announcement of new board members, the Alliance for Nursing Informatics (ANI) considered nurse candidates who met the selection criteria, and submitted three nominees. When the 15-member Board was announced in September, physician, provider, and business representatives were included, but no nurse was selected. ANI Co-chair, Joyce E. Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, and other ANI representatives met with AHIC Successor, Inc. leaders to discuss priorities, their shared vision, and the need to involve nurses. Together, they identified multiple opportunities for nursing involvement such as providing input on prioritization of the 2009 Value Cases and participating in committee assignments. Subsequently, Linda Fischetti, RN, MS, Veterans Health Administration, was named as the federal liaison to the AHIC Successor, Inc. board.

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Implications for nurses 

Much work remains despite nurses having made significant contributions to the development and integration of healthcare standards. It is imperative that nurses take action by becoming informed and involved as individuals, employees, and members of organizations. Select from the following list or develop your own action plan:

1.Monitor the development of standards through official websites, diverse listservs, and publications. Participate in comment periods and offer feedback from your areas of expertise and experience to guide development of Value Cases, and interoperability standards and specifications.

2.Join an HITSP technical committee or CCHIT work group. It is not necessary to be a nurse informatician to participate. Sharing your clinical and other professional expertise will be valuable; many members have little or no clinical experience.

3.Become an active member of an organization that is influencing the standards development process. In addition to ANI, professional organizations include the American Academy of Nursing, American Medical Informatics Association, American Nurses Association, National League for Nursing, and Technology Informatics Guiding Education Reform (TIGER). The Association for Common European Nursing Diagnoses and the International Medical Informatics Association are examples of international healthcare organizations. Although the American Association of Retired Persons is not a healthcare organization, it is an active participant in standards activities.

4.Contact nurses who are involved; urge them to continue their participation.

5.Contact other healthcare professionals who are involved; encourage them to support nurses' participation.

6.Contact the offices of your local, state, and national politicians to provide information and share your concerns.

7.Communicate with representatives of technology vendors and computer software companies; encourage them to participate in standards development initiatives and implement the national standards in their products. Offer the opportunity to shadow you or your staff members to observe the delivery of health care. Describe how their products increase the quality of care and ways their products could be improved to increase integration and interoperability.

The inauguration of a new president will result in committee leader and member changes and create opportunities for those who are willing to participate in standards initiatives. Only if nursing is truly involved will the profession be able to take advantage of standards activities to enhance practice and client care. A true interdisciplinary health care–public partnership is necessary if EHRs will be widely adopted by 2014, based on recognized standards, and will be relevant to nursing practice.1 The health and well-being of individuals, families, and communities depends on increased nursing preparedness and participation.

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References 

  1. Jaggi T. Nursing systems could be a platform for quality improvement (iHealthBeat). http://www.ihealthbeat.org/Perspectives/2008/Nursing-Systems-Could-Be-a-Platform-for-Quality-Improvement.aspxAccessed November 1, 2008
  2. Special Issue—Informatics: Science and practice. Nurs Outlook. 2008;56(5):195–280entire issue
  3. Department of Health and Human Services. Office of the National Coordinator (Mission statement). http://www.hhs.gov/healthit/onc/mission/Accessed November 9, 2008
  4. Beeler GW, Huff S, Rishel W. HL7: The key to interoperability. http://www.hl7.org/Library/General/GCPR-990318.pdfAccessed November 1, 2008
  5. Department of Health and Human Services. American Health Information Community. http://www.hhs.gov/healthit/community/background/Accessed November 9, 2008
  6. Healthcare Information Technology Standards Panel. Home page. http://www.hitsp.org/Accessed November 1, 2008
  7. Department of Health and Human Services. Certification Commission for Healthcare Information Technology. HIT certification: Background. http://www.hhs.gov/healthit/certification/background/Accessed November 9, 2008

 Karen S. Martin, RN, MSN, FAAN, is a Health Care Consultant, Martin Associates, Omaha, NE.

 Joyce E. Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, is Vice President, Informatics, HIMSS, Chicago, IL.

PII: S0029-6554(08)00310-2

doi:10.1016/j.outlook.2008.11.002

Nursing Outlook
Volume 57, Issue 1 , Pages 65-67, January 2009

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