Nursing Informatics V2

Nursing Informatics Workshop
Ke vin Pe rciva l
Chief Nursing Information Officer
Frimley Health NHS Foundation Trust, United Kingdom
#HIMSS22APAC
DISCLAIMER: The views and opinions expressed in this presentation are solely those of the author/presenter and do not necessarily represent any policy or position of HIMSS.
Introductions
• Emergency Nurse
• Application Management
• 12+ Years in Health and Nursing

Informatics
• Project and Programme

Management
• Benefits Management
• Chief Nursing Information Officer
• A Patient, Relative and Advocate

2
The Main Issues in Primary and Secondary Care
3
Agenda
• Introductions
• Overview of Nursing Informatics
• Maximise the use of Data and Information by Nurses through the

use of Standards and Terminology
• The role of Clinical Decision Support to ensure the delivery of

Evidence Based Nursing Practice
4
Agenda
• Nursing Engagement and participation to maximise the use of
Data and Technology to support the delivery of professional
Nursing Practice
• The Role and Development of the Nursing Informatics within the

Nursing Workforce
• Question and Answer with reflections from the day
5
Overview of Nursing Informatics including key

concepts
6
What is Nursing Informatics?
Nursing informatics "is the specialty that integrates nursing science with
multiple information and analytical sciences to identify, define, manage and
communicate data, information, knowledge and wisdom in nursing practice.“
HIMSS 2019 from ANA
7
Practically what is Nursing Informatics

• A Nurse the works in Digital or IT with Digital People
• A Nurse with Digital Skills, Experience and Expertise that work

with Nurses
• Or Both and needing to do both roles with one salary
8
The Art of Voice of

Nursing the
Customer
Cultural
Informatics
Advocacy
9
The Science of
Nursing Nursing Information
Informatics Science Science
Computer
Science
10
The Roles of Nursing Informatics

• Consultant and Liaison • Advocate
• Educator and Trainer • Policy Developer
• Researcher • Clinical Analyst
• Product Developer • Entrepreneur
• Decision Support • Project Manager
• Benefits and Outcomes Manager • A Friend for all
• Translator
11
Data, Information and Knowledge
12
Wisdom
Wisdom is knowing that this patient requires a further 1000mg
Paracetamol because they have mild pain and that Paracetamol
is an analgesic (Pain Medication). They can have this medication
orally (by Mouth) as they are not nil by mouth and do not have
any nausea and vomiting and no swallowing problems. 1000mg
Paracetamol has been known to help with mild pain and has
helped this patient in the past.
13
14
Integration of People, Processes and Systems

PEOPLE PROCESSES SYSTEMS
(WORKFLOWS) (TECHNOLOGY)
• Nurses • Admission • Paper and Pen
• Doctors • Transfer • Computer
• Admin • Handover • Tablet
• Patients • Discharge • Phone
• Relatives • WHO Checklist • Health IT System
• Managers • WiFi, Internet, Mobile

Phone Network
Maximise the use of Data and Information by Nurses

using Standards and Terminology
16
The Goal of Nursing Informatics

• To improve the health of Individuals, Families and Communities
• Efficient and Effective use of Information Technology and

Communication
• Ensure timely access to necessary clinical information for patients
• Safe, Cost-effective and timely healthcare delivery
• To increase Quality and Efficiency
• To increase patient and user participation in the delivery of health

17
Definition Of Standards
• Standards can be about how care is delivered or treatments
undertaken
• Standards is the understanding of sources of data and information

that then are collected, reused and exchanged among multiple
systems and professionals; these systems and professionals have the
ability to understand and interpret the data and information as set out
in the standard.
18
Patient Deterioration Scores
19
NEWS Patient Deterioration Score

• Respiratory Rate
• Oxygen Saturation
• Systolic Blood Pressure
• Pulse Rate
• Level of Consciousness
• Level of Confusion or new Confusion
• Temperature
20
Benefits of Standards and Terminology

• Common Language and Understanding
• Provides a way to transfer information from one entity to another
• Provides a common thread throughout the entire end to end process
• Provides the ability to uphold security and confidentiality
• A Quantitative way to a Qualitative event
• Reduces subjectiveness and make observations more objective
21
What happens when we have standards
Organisation
Ward \ Team
Patient
22
Standard at Patient Level
23
NEWS2 at a Ward / Department Level

00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00
• Lorem
Ward A ipsum
0 dolor 0sit amet,2consectetur
3 adipiscing
3 elit.
0 2 0 2
Jill Smith
• Sub-head1 2 2 1 2 1 2 2 1
Ed Blogg 2 regarding
• Information 3 the subhead
2 3 3 2 1 1 1
More information
Neil Yu • 3 2 1 3 2 2 3 1 2
Kay Nue 0 0 1 1 2 3 3 3 4
Marinda Hart 2 1 2 2 1 2 3 2 3
Total 1.33 1.33 1.67 2.17 2.17 1.67 2.33 1.5 2.17
24
NEWS2 at a Ward / Department Level

00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00
• Lorem
Ward A ipsum
1.33dolor 1.33
sit amet,1.67
consectetur
2.17 adipiscing
2.17 elit.
1.67 2.33 1.5 2.17
Ward B
• Sub-head 1.67 2.11 1.67 2.11 1.67 2.11 1.67 2.11 1.67
Ward •CInformation
2.11 2.55
regarding 3.11
the subhead 2.55 2.55 3.11 2.11 3.11 2.11
More information
Ward D• 2.15 3.1 4.1 4.1 4.1 3.1 3.1 3.1 2.15
Ward E 1.16 1.16 1.33 1.66 1.33 1.33 1.33 1.33 1.33
Ward F 1.33 1.33 2.11 2.22 2.11 2.22 2.22 2.33 1.11
Total 1.63 1.93 2.33 2.47 2.32 2.26 2.13 2.25 1.76
25
Average NEWS Score Across Wards

4.5
3.5
2.5
1.5
0.5
0
0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00
Ward A Ward B Ward C Ward D Ward E Ward F
26
Average NEWS Score Across Wards

4.5
3.5
2.5
1.5
0.5
0
0:00 1:00 2:00 3:00 4:00 5:00 6:00 7:00 8:00
Ward A Ward B Ward C Ward D Ward E Ward F
27
Benefits of Standards at Department Level

• Ability to have an overview of status of all patients
• Reduce Unwarranted variation across patient groups
• Provide assurance of care and treatment provided to patients
• Improves Accountability and encourages collective leadership across Wards

and Departments.
28
Benefits of Standards at Organisational Level

• Ability to compare and support departments
• Ability to priorities interventions across departments
• Supports understanding of individual and collective risks and challenges
• Improves Productivity and Efficiency for the delivery of care
• Improve Quality and Experience of Healthcare
• Provide an understanding understand historical trends
29
Benefits of Standards across Organisations

• Improved Interoperability between healthcare providers (including patients)
• Improved benchmarking among provider Organization
• Opportunities for Process and Continuous Improvement
• Facilitate Audit and Research in Nursing
• Identify anomalies in clinical practice
• Provide additional support to staff and patients
• Support decision making for additional investigation or investment
30
The role of Clinical Decision Support to ensure the

Delivery of Evidence Based Practice
31
Definition of Clinical Decision Support

• Clinical Decision Support is the active intervention of technology to clinicians,
patients and carer that are filtered with the data and information that is known
about the patient by the system itself or through interfaces to other systems.
• Clinical Decision Support then allows for the Clinician, Patient or carer to decide
what actions they want to take.
• Clinical Decision Support is not an alternative for good clinical decision making
but rather an additional source of information.
32
Benefits of Clinical Decision Support

• Provide additional sources of information to Nurses and other clinicians
• Improves outcomes for patients
• Nurses and other clinicians feel more assured of their decisions (Confimation)
• Increased Quality of Care
• Improved Efficiency; both cost and time
• Improved Patient Experience and Confidence
• Ability to record the decision making more easily
33
Types of Clinical Decision Support

• Medication Prescribing and Administration
• Ordering of Investigations such as blood tests, xrays or any other diagnostic
• Note and Document Templates
• In-line Alerting
• Push Notifications
• Access to up-to-date information regarding conditions
34
How is Clinical Decision Support Developed?

• Commercially off the shelf
• Configuration of a Commercially off the shelf product
• Locally Developed Clinical Decision Support
• National Clinical Standards
• System Personalization
• Machine Learning and Artificial Intelligence
35
Dis-benefits of Clinical Decision Support

• Alert Fatigue
• In-appropriate CDS for some specialties and sub-specilaities
• Need a great deal of clinical time to set the rules (and exceptions to the rules)
• Can be seen as reducing autonomous decision making by Nurses and Clinicians
• Cognitive Bias and Human Factors by the member of staff
• Over promising and under delivering
36
Approaches to Clinical Decision Support

• Think of a non-digital approach first
• Start small and simple with a clearly defined use case
• Get early buy-in from Nursing Leadership
• Build on a solid foundation of Clinical Decision Support
• There is a need for a long-term strategy for Clinical Decision Support with
engagement between Clinicians, Digital and Informatics Professionals.
37
Clinical Decision Support
• John Brown can be managed on the Ward by

the Nurse.
• If the NEWS had gone to 5 or more then it

would require a response from the Medical
Team.
• Non-Digital World this would need to be a call

but still an example of Clinical Decision
Support.
38
Nursing Engagement and participation to maximise

the use of Standards and Terminology
39
The Key Areas of Focus

• Transforming the Delivery of Nursing by not digitising the paper
• Culture – Respecting the past but looking for the opportunities in the future
• Collective Leadership
• System Usability for All
• Patient Participation and Empowerment
• Technology as a feature of life and dealing with Digital Litracy
40
Nursing Models and Nursing Informatics

• Assess
• Diagnosis
• Planning
• Implementation
• Evaluation
41
Key things to consider

• Engagement is part of the implementation
• Focus on the Why rather than the what
• Who is very important especially if some groups become disaffected; these

need to be engaged with early
• Always Keeping the Patient and end user at the centre.
• This is tough so take your time when you need to but speed up where you
can
42
Assessment
• Spend time understanding the problem you trying to solve?
• Do not be system orientated but problem orientated
• The right solution will come out by following the process
• Digital is not always the solution; it is normally part of it but rarely is it the
solution.
43
As if Statements
• As a …… I want …… so that…..
• As a Nurse in the Intensive Care Unit, I want the observations to feed straight
into the EMR so that I can spend more time providing pressure areas care.
• Rationale and Benefit in one statement
44
In Groups
• Think about a real problems or issues you have within the
delivery of healthcare focusing on Nursing and produce a
• As a ….
• I want …
• So that…
• 10-15 Mins
45
Diagnosis
• Having a clearing defined problem is key to success but also selling it to wider
colleagues.
• Is there anything that has been missed?
• Is there anything similar we are trying to solve?
• Is there any opportunities for partnership with other departments or organizations?
• Review the Diagnosis with colleagues that have not been involved to make sure it
makes sense.
46
In Groups
• Take your as I.. Statements
• Discuss what this problem statement
• Is this really the problem you want to solve
• Is there any other problems you want to solve that are similar
• 10-15 Mins
47
Planning
• What is the solution?
• People
• Process
• System
• How could it and will it be implemented

• Big-Bang
• Initiatively
• How will you engage and communicate across the organization (including with
patients)?
48
Stakeholder Maps
49
Planning
• People (internal and External)
• Who is directly and in-directly impacted by the change? What is the Implications?
• People
• Process
• System
• Process
• What is the new end-to-end process?
• What are the training implications?
50
System and Supplier Partnerships

• Systems and Suppliers are there to help you with solutions to your problems
• Many suppliers will bring you solutions and make them your problems you
want to solve
• Customer\Supplier Relationships work where this is partnership

• Customers understand their business of healthcare completely
• Suppliers understand the capabilities and possibilities completely
• The hard bit is understanding how their capabilities can be maximized to your
business problems so don’t be scared to spend time discussing mutual
challenges and seeing the art of the possible.
51
Implementation
• How are you going to Communicate the Change?
• Who is impact and affected by the change?
• Any Policy or Guidelines Changes?
• Any Systems (Human and Digital) impacts?
• Does the software work out of the box or is there configuration required
• Any core change to the system needed
• Communication and Engage with partner organizations especially if there is

going to be impact to them.
52
Evaluation
• Always write up what you have done
• Highlight what went well but equally what didn’t go so well
• Celebrate Success but reflect on the things that didn’t go so well
• Share the outcomes; especially if you can get a patient of staff story
• If it doesn’t go to plan but has the same outcome, then you have succeeded
• Always look out for those extra nuggets of gold that come and document them.
• Include Patients as much as you can in the evaluation process
• Don’t forget the voice of the customer; you can have a technically perfect
solution but imperfect in the real world.
53
The Role and Development of Nursing Informatics

within the Wider Workforce
54
Engagement and Involvement Strategies

• Prior to Projects
• During Projects
• During Go-Live
• Post Implementation
55
Prior to Projects
• Requirement Workshops
• Look and Listen Sessions
• Questionnaires
• Focus Groups
• Bringing the voice of the customer
• Simulation Sessions
56
During Projects
• Design Workshops
• Proto-type testing
• Functional Testing
• Reviewing of Training Materials
• Testing (Functional and End-to-End)
57
During Go-Live
• Communication Channels
• Superusers and Floorwalkers
• Feedback events
• Recognition and Call-outs
• Feedback +++
58
Post Implementation
• Lessons Learnt events
• Focus Groups
• Optimization Events
• Benefits Realisation
• Remember the users post implementation will be the experts on how it work
including the work arounds.
59
Superuser Programmes
• Help with onboarding with new staff
• Support existing staff by either providing peer support or sign posting
• Can be the greatest advocates when you need them to continue to support
achievement of standards
• A good pipeline for substantive nursing informaticians
• Great to help bolster the clinical informatics teams with rotations of staff and big
system changes.
60
Reflections of the Day
61
What is Nursing Informatics?
Nursing informatics "is the specialty that integrates nursing science with
multiple information and analytical sciences to identify, define, manage and
communicate data, information, knowledge and wisdom in nursing practice.“
HIMSS 2019 from ANA
62
Questions and Answers
63
Thank you.
64

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Nursing Informatics Workshop

• 12+ Years in Health and Nursing

• Project and Programme

• Chief Nursing Information Officer

• A Patient, Relative and Advocate

The Main Issues in Primary and Secondary Care

• Overview of Nursing Informatics

• Maximise the use of Data and Information by Nurses through the

• The role of Clinical Decision Support to ensure the delivery of

• The Role and Development of the Nursing Informatics within the

• Question and Answer with reflections from the day

Overview of Nursing Informatics including key

What is Nursing Informatics?

Practically what is Nursing Informatics

• A Nurse with Digital Skills, Experience and Expertise that work

• Or Both and needing to do both roles with one salary

The Art of Voice of

Informatics Science Science

The Roles of Nursing Informatics

• Educator and Trainer • Policy Developer

• Researcher • Clinical Analyst

• Product Developer • Entrepreneur

• Decision Support • Project Manager

• Benefits and Outcomes Manager • A Friend for all

Data, Information and Knowledge

Integration of People, Processes and Systems

• Nurses • Admission • Paper and Pen

• Doctors • Transfer • Computer

• Admin • Handover • Tablet

• Patients • Discharge • Phone

• Relatives • WHO Checklist • Health IT System

• Managers • WiFi, Internet, Mobile

Maximise the use of Data and Information by Nurses

The Goal of Nursing Informatics

• Efficient and Effective use of Information Technology and

• Ensure timely access to necessary clinical information for patients

• Safe, Cost-effective and timely healthcare delivery

• To increase Quality and Efficiency

• To increase patient and user participation in the delivery of health

• Standards is the understanding of sources of data and information

Patient Deterioration Scores

NEWS Patient Deterioration Score

• Systolic Blood Pressure

• Level of Confusion or new Confusion

Benefits of Standards and Terminology

• Provides a way to transfer information from one entity to another

• Provides a common thread throughout the entire end to end process

• Provides the ability to uphold security and confidentiality

• A Quantitative way to a Qualitative event

• Reduces subjectiveness and make observations more objective

What happens when we have standards

Standard at Patient Level

NEWS2 at a Ward / Department Level

NEWS2 at a Ward / Department Level

Average NEWS Score Across Wards

Ward A Ward B Ward C Ward D Ward E Ward F

Average NEWS Score Across Wards

Ward A Ward B Ward C Ward D Ward E Ward F

Benefits of Standards at Department Level

• Reduce Unwarranted variation across patient groups

• Provide assurance of care and treatment provided to patients

• Improves Accountability and encourages collective leadership across Wards

Benefits of Standards at Organisational Level