Informaticians: How They May Benefit Your Healthcare Organization

Social challenges when implementing information systems in everyday work in a nursing context

Implementation of information systems in healthcare has become a lengthy process where healthcare staff (eg, nurses) are expected to put information into systems without getting the overall picture of the potential usefulness for their own work. The aim of this study was to explore social challenges when implementing information systems in everyday work in a nursing context. Moreover, this study aimed at putting perceived social challenges in a theoretical framework to address them more constructively when implementing information systems in healthcare. Influenced by institutional ethnography, the findings are based on interviews, observations, and written reflections. Power (changing the existing hierarchy, alienation), professional identity (calling on hold, expert becomes novice, changed routines), and encounter (ignorant introductions, preconceived notions) were categories (subcategories) presented in the findings. Social Cognitive Theory, Diffusion of Innovations, organizational culture, and dramaturgical analysis are proposed to set up a theoretical framework. If social challenges are not considered and addressed in the implementation process, it will be affected by nurses' solidarity to existing power structures and their own professional identity. Thus, implementation of information systems affects more aspects in the organization than might have been intended. These aspects need to be taken in to account in the implementation process.

Nursing domain of CI governance: recommendations for health IT adoption and optimization

CONTEXT

There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation.

OBJECTIVES

To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders.

DESIGN, SETTING, PARTICIPANTS

We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects.

RESULTS

We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders.

CONCLUSION

Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians.