HIM 301 Introduction to Health Informatics Wk4-D2

Chapter 25 Health Policy and Informatics

Joyce Sensmeier

Judy Murphy

By understanding current informatics-related health policy issues, the role of the professional organizations, the current federal infrastructure support for health informatics, and specific approaches for participating in the advocacy process, health informatics leaders can positively affect healthcare policy.

Objectives

At the completion of this chapter the reader will be prepared to:

1.Describe key health policy issues for informatics

2.Differentiate the Institute of Medicine recommendations in the HIT and Patient Safety and The Future of Nursing reports

3.Define the process for developing and implementing informatics concepts in health policy

4.Describe the impact of informatics on health policy

Key Terms

EHR adoption, 405

Health information technology (health IT), 397

Health policy, 398

Unintended consequences, 401

Abstract

All health practitioners should have an understanding of current health policy initiatives and advocate for efforts that leverage informatics and technology to improve patient safety and health outcomes. Health practitioners provide care in every setting and should be involved in shaping the effective use of information technology and related policies wherever they practice. This chapter describes how health practitioners can take on leadership roles and influence health policy to improve safety and efficiency, thereby bringing practice standards and evidence for decision making to the point of care and empowering patients and healthcare consumers as partners.

Introduction

Healthcare leaders are being affected on multiple fronts by a changing healthcare landscape. Healthcare reform and economic stimulus legislation is rapidly advancing regulations that incentivize the adoption and Meaningful Use of electronic health records (EHRs) to improve the health of Americans. Health practitioners understand that Meaningful Use of health information technology (health IT), when combined with best practice and evidence-based care, can improve health and healthcare for all Americans. Informatics leaders should be knowledgeable about and current in public policy initiatives in order to translate their impact into practice and care delivery.1

Health practitioners should have a voice in the selection, planning, implementation, and evaluation of EHR systems and health information exchange to achieve quality outcomes. Informatics leaders should be able to articulate their organization's vision and strategy for clinical transformation as well as actively engage in managing change and measuring success through established metrics. While informatics is highly specialized, there are foundational competencies that all practitioners and students should possess to meet the standards of providing safe, quality, and competent care.2 Among these competencies is the ability to understand current health policy initiatives and advocate for changes that leverage informatics and technology to improve patient safety and health outcomes.

Key Health Policy Issues for Informatics

EHR Adoption

A new era for EHRs began in 2004 when President George W. Bush addressed the topic in his State of the Union address: “… an electronic health record for every American by the year 2014 … by computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.”3 President Bush then established the Office of the National Coordinator for Health Information Technology (ONC) and appointed the first National Coordinator for Health Information Technology. The focus on EHRs grew when just after his inauguration in 2009 President Obama proclaimed that he wanted the federal government to invest in EHRs so that all health records would become digitized within 5 years. He vowed to continue to push for the 2014 deadline established by President Bush: “To lower health care cost, cut medical errors, and improve care, we'll computerize the nation's health records in five years, saving billions of dollars in health care costs and countless lives.”4

Support for EHRs continued with the passage into law of the American Recovery and Reinvestment Act (ARRA) and its key Health Information Technology for Economic and Clinical Health (HITECH) Act provisions in the early weeks of President Obama's administration. Backed by an allocation of $19 billion, this legislation authorized the federal government to provide reimbursement incentives for hospitals and eligible providers who take steps to become “meaningful users” of certified EHR technology to improve care quality and better manage costs.

The incentivized adoption of EHRs is at the core of reform initiatives and can help to improve care quality and better manage care costs, meeting clinical and business needs by capturing, storing, and displaying clinical information when and where it is needed to improve individual patient care and provide aggregated, cross-patient data analysis. EHRs manage healthcare data and information in ways that are patient centered and information rich. Improved information access and availability enable both the healthcare provider and the patient to better manage the patient's health by using capabilities provided by enhanced clinical decision support and customized education materials.

Today, as the United States undergoes dramatic change during healthcare delivery and payment reform, technology plays a huge role in shaping the country's future healthcare system. The terms EHR and Meaningful Use are becoming commonplace in the national lexicon and with the advent of new technological innovations, informatics leaders are in positions of great influence within their organizations. The following background information describes these changes and how informatics leaders can play an influential role.

Meaningful Use and Incentives

The majority of the HITECH Act funding is being used to incentivize and reward hospitals and eligible providers for Meaningful Use of certified EHRs with increased Medicare and Medicaid payments. The hospital program started in fiscal year 2011 (running from October 1, 2010, to September 30, 2011) and the eligible provider program started in calendar year 2011 (running from January 1, 2011, to December 31, 2011). The criteria for meeting Meaningful Use are divided into the following five initiatives adapted from the work of the National Priorities Partnership (NPP):

1.Improve quality, safety, and efficiency and reduce health disparities

2.Engage patients and families

3.Improve care coordination

4.Improve population and public health

5.Ensure adequate privacy and security protections for personal health information5

Specific objectives were defined to demonstrate that EHR use has a “meaningful” impact on one of the five initiatives. For Stage 1, hospitals must complete 14 core objectives and choose 5 of 10 objectives from the menu set of objectives. Eligible providers must complete 15 core objectives and choose 5 of 10 objectives from the menu set of objectives. Some of the objectives are the same or overlap between hospitals and eligible providers. Each objective includes corresponding measurement criteria and applicable standards. If the objectives are met during the specified year and the hospital or healthcare provider submits the appropriate measurements, the hospital or healthcare provider will receive the incentive payment. The hospital incentive amount is based on Medicare and Medicaid patient volumes; the healthcare provider incentives are fixed per provider. The incentives are paid over 5 years and the hospital or healthcare provider will need to continue to submit measurement results annually for each of the 5 years to continue to qualify for payment. The objectives mature every few years, with new Stage 2 criteria and standards published in 2014.

One Meaningful Use criterion for both hospitals and healthcare providers is to report quality measures to the Centers for Medicare & Medicaid Services (CMS) (for Medicare) or to the state (for Medicaid). Hospitals must report 15 clinical quality measures and eligible providers must report 6 clinical quality measures (3 core or alternate core measures and 3 of 38 measures from an alternate set). Quality measurement is considered one of the most important components of the incentive program under the HITECH Act since the purpose of the health IT incentives is to promote reform in the delivery, cost, and quality of healthcare in the United States. Dr. David Blumenthal, former national coordinator for health IT, emphasized this point when he said that healthcare IT is the means, but not the end. Getting healthcare IT up and running in doctors' offices is not the main objective behind the incentives provided by the federal government under the American Recovery and Reinvestment Act, according to Dr. Blumenthal—improving health is.6

Health IT Policy Committee.

The HITECH Act reenergized the ONC in 2009 with specific accountabilities and significant funding and created two new federal advisory committees under its control: the Health IT Policy Committee and the Health IT Standards Committee. These two federal advisory committees comprise individual public and private stakeholders (including physicians and nurses) tasked to provide recommendations on the health IT policy framework, standards, implementation specifications, and certification criteria for electronic exchange and use of health information. The focus here is on the Health IT Policy Committee. Additional information on the Health IT Standards Committee is provided below.

The Health IT Policy Committee is charged with making recommendations to the ONC on a policy framework for the development and adoption of a Nationwide Health Information Network (NwHIN), including standards for the exchange of patient medical information. The Committee worked closely with the ONC and CMS to develop and refine the Meaningful Use criteria used for the EHR incentive program payments. Committee workgroups address and make recommendations to the full Committee on key reform issues such as Meaningful Use of EHRs, certification and adoption of EHRs, information exchange, the strategic plan framework, privacy and security policy, and enrollment in federal and state health and human services programs.

Regional Extension Centers.

The HITECH Act–funded Health IT Extension Program consists of Regional Extension Centers (RECs) and a national Health Information Technology Research Center (HITRC). This program supports the training and consulting needs of the many healthcare providers seeking to adopt EHRs and achieve Meaningful Use by offering education, outreach, and technical assistance. RECs help healthcare providers in their geographic service areas to select, successfully implement, and meaningfully use certified EHR technology to improve the quality and value of healthcare.

There are 62 RECs located in virtually every geographic region of the United States to ensure adequate support to healthcare providers in communities across the country. The HITRC promotes communication and learning among the RECs and collaborates with them by offering technical assistance, guidance, and information on best practices to support and accelerate healthcare providers' efforts to become meaningful users of EHRs. This support is especially helpful to small healthcare provider practices with limited resources for the selection, implementation, and evaluation of EHRs.

Health Policy and Standards

With the recognition that local and regional electronic exchange of health information is essential to the successful implementation of a nationwide exchange and to the success of national healthcare reform in general, the HITECH Act authorized and funded a State Health Information Exchange Cooperative Agreement Program. This state-based grant program offers much-needed local and regional assistance and technical support to healthcare providers while enabling coordination and alignment within and among states. Ultimately this will allow information to follow patients anywhere they go within the United States healthcare system.

The Health IT Standards Committee, along with the ONC, is responsible for recommending standards to the state health information exchanges (HIEs) and for providing the standards infrastructure necessary for this transformation to occur. Rather than using rule making through a top-down process for vetting and selecting the data transport, content exchange, and vocabulary standards, they chose a consensus-based bottom-up approach through the Standards and Interoperability (S&I) Framework Initiatives.

Health IT Standards Committee.

The Health IT Standards Committee is charged with making recommendations to the ONC on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information. In harmonizing or recognizing standards and implementation specifications, the Health IT Standards Committee is also tasked with providing for all associated EHR certification testing by the National Institute of Standards and Technology (NIST). Serving the Committee are workgroups addressing clinical operations, clinical quality, data exchange, privacy and security requirements, and implementation strategies that accelerate the adoption of the proposed standards.

The Health IT Standards Committee has made considerable progress in addressing concerns over interoperability implementation through their support of the standards development work being done by the S&I Framework. One of the S&I Initiatives, the Direct Project, was launched to develop the standards and services required to enable secure health information exchange at a more local and less complex level, such as a primary care provider electronically sending a referral or care summary to a local specialist. The state HIEs have embraced this simpler standard and have added it to their implementation plans, providing options for the data exchange offered in each state. The Health IT Standards Committee has been supportive of optionality when addressing different use cases for interoperability.

ONC Standards and Interoperability Framework.

Today there is very little controversy over the importance of interoperability and the electronic exchange of standardized patient data between clinical and administrative stakeholders in healthcare. Although healthcare has a long-standing clinician- or hospital-centric view of data and has embraced hospital-centric patient records that were nontransportable to other care venues, today our healthcare model includes a continuum of care view with increased emphasis on ambulatory and home care and with the patient at the center of that care.7 In that model the need for data to move with the patient across venues of care has become clear.

Interoperability is the ability of health information systems to work together within and across organizational boundaries to advance the effective delivery of healthcare for individuals and communities by sharing data between EHRs. To achieve interoperability, standards for data transport, content exchange, and vocabulary management are needed. These standards are explained in more detail in Chapter 22. This is why standards development is so important; it enables the interoperability needed for regional and nationwide health data exchange and is essential to the development of patient-centric records.

Launched in January 2011, the ONC-sponsored S&I Framework is an investment by the country in a set of harmonized interoperability specifications to support national health outcomes and healthcare priorities, including Meaningful Use and the ongoing mission to create better care, better population health, and cost reduction through delivery improvements. The S&I Framework creates a forum in which healthcare stakeholders can focus on solving real-world interoperability challenges. Each S&I Initiative focuses on a single interoperability challenge with a set of value-creating goals and outcomes that will enhance efficiency, quality, and effectiveness of the delivery of healthcare through the development or modification of standards for data transport, content exchange, and vocabulary management.

The S&I Framework started with three initiatives but now is managing 10 initiatives, such as transitions of care, lab results, and healthcare provider directories. Each S&I Initiative has a rigorous process that includes the following:

•Development of clinically oriented user stories and robust use cases

•Harmonization of interoperability specifications and implementation guidance, including synchronization among the initiatives

•Provision of real-world experience and implementer support through new initiatives, workgroups, and pilot projects

•Mechanisms for feedback and testing of implementations, often in conjunction with ONC partners such as NIST

The work is done online through a moderated wiki with more than 1300 volunteer participants.8 The focus of the S&I Framework is on delivering guidance to the health IT community through the development of standards content and technical specifications, the development of reusable tools and services, and the effort to unite stakeholders on common healthcare challenges. This work is necessary to move forward on EHR data exchange between venues of care and to take our country to the next level in creating a patient-centric rather than facility-centric healthcare record.

Patient Safety

In 1999 the Institute of Medicine (IOM) report To Err Is Human estimated that 44,000 to 98,000 lives are lost every year due to medical errors in hospitals, which led to the widespread recognition that healthcare is not safe enough and catalyzed a revolution to improve the quality of care.9 Despite considerable effort, patient safety has not yet improved to the degree hoped for in the follow-up IOM report, Crossing the Quality Chasm.10 One strategy the nation has turned to for safer, more effective care is the widespread use of health IT. As described earlier, the federal government is investing billions of dollars toward Meaningful Use of EHRs so that all Americans can benefit.

When designed and implemented appropriately, health IT can improve healthcare providers' performance, support better communication between patients and healthcare providers, and enhance patient safety, all of which ultimately leads to better care. For example, the number of patients who receive the correct medication in hospitals increases significantly when hospitals implement computerized prescribing and use bar-coded medication administration. However, there is a concern that poorly designed and implemented health IT can actually create new hazards in the already complex delivery of healthcare. To protect patients, health IT must be designed and used in ways that maximize patient safety while minimizing harm. Information technology can better help patients if it becomes more usable, more interoperable, and easier to implement and maintain.

IOM Report on Health IT and Patient Safety

In the wake of more widespread use of health IT and to mitigate the risks posed by these safety concerns the U.S. Department of Health & Human Services (HHS) asked the IOM to evaluate health IT safety concerns and to recommend ways in which both the government and the private sector can make patient care safer using health IT. The resulting IOM report, HIT and Patient Safety, states that safe use of health IT relies on several factors, including clinicians and patients.11 Safety analyses should not look for a single cause of problems but should consider the system as a whole and consider the interplay of people, process, and technology when looking for ways to make it safer. Vendors, users, government, and the private sector all have roles to play. The IOM's recommendations include improving transparency in the reporting of health IT safety incidents and enhancing monitoring of health IT products. A summary of these recommendations follows:

•HHS should ensure that vendors support users in freely exchanging information about health IT experiences and issues, including safety

•ONC should work with the private sector to make comparative user experiences publicly available

•HHS should fund a new Health IT Safety Council within an existing standards organization to evaluate criteria for judging the safety of health IT

•HHS should establish a mechanism for vendors and users to report health IT–related deaths, serious injuries, or unsafe conditions

•HHS should recommend that Congress establish an independent federal entity, similar to the National Transportation Safety Board, to perform investigations in a transparent, nonpunitive manner.

According to the report these would be the first stages for action, to advance current understanding of the threats to patient safety. While some organizations have very good tracking databases to prioritize technical issues and human factors issues related to technology, others do little to track health IT problems and resolutions. Because of this lack of self-monitoring the IOM recommended that HHS get involved to monitor and report on health IT safety beginning in 2012. HHS could decide to direct the Food and Drug Administration to exercise authority to regulate health IT but that was not the first approach explored in the safety plan developed by the ONC in 2012.

The IOM report also examines a broad range of health information technologies, including EHRs, secure patient portals, and HIEs. It asks the Secretary of HHS to publish a plan within 12 months to minimize patient safety risks associated with health IT and report annually on the progress being made. The plan was published for public comment in late 2012 and finalized in 2013.

Unintended Consequences of Health IT Implementation

The unprecedented funding provided by the HITECH Act has spawned a flurry of EHRs and other health IT implementations. While expectations are high for achieving all of the quality, safety, and cost benefits from these implementations, experience and research shows that unplanned and unexpected consequences have resulted from major policy and technological changes.12,13 Health IT is not immune from this phenomenon. Thus it is important to consider the potential unintended consequences that may be engendered by adoption of health IT, particularly when it is accelerated.14

More research in this area of health IT began in 2004 with Agency for Healthcare Research and Quality (AHRQ) grants for planning, implementing, and testing the value of both EHRs and HIEs yet there is still much that has not been explored or proven. However, there are some things to consider during implementation. Monitoring for and tracking of the unplanned or unexpected consequence, especially when it has an undesirable outcome, is important. Enhanced communication among multiple stakeholders in different venues and disciplines will strengthen the collective ability to identify and address unintended consequences of health IT. Federal and organizational leadership can facilitate the sharing of information about technical and organizational safeguards that address unintended consequences. Further, mechanisms are needed to share findings of health IT system implementers so that data captured by individual organizations can have a broader impact.

Impact of Informatics on Health Policy

Meaningful “Meaningful Use”

So what is Meaningful Use? Simply put, it is determining how you want to leverage the EHR implementation to accomplish other strategic and clinical goals in your organization beyond just meeting the Meaningful Use criteria. It is not just doing the minimum and checking off the Meaningful Use criteria in order to attest and get the incentive payments but rather using the implementation process to create the health, healthcare, and payment changes needed to advance healthcare reform.

With regard to the implementations of health IT systems for health practitioners, the importance of planning and executing the project as a practice change that is being facilitated by technology cannot be overemphasized. The technology change should take a supportive role to the people, processes, and practice changes being enabled by the technology. Thus it is important to ensure that EHR implementation is seen as the means to an end and not as an end unto itself. It is not about the EHR implementation alone but about the way in which the clinician's practice evolves through the use of the supportive technology. Implementing in this way ensures that there is clarity around the purpose of the EHR, as demonstrated by the Meaningful Use objectives, quality outcome measures, and evidence-based practices.

Another way of looking at this is to consider how users are going to leverage the EHR to create the practice and payment changes needed for the future transformation of healthcare. Whether it is the implementation of a patient-centered medical home, value-based purchasing, bundled payments, or accountable care organizational changes, health IT is not only needed but also essential to creating the data, information, knowledge, and wisdom infrastructure necessary for these healthcare practices.

Quality Initiatives

National Priorities Partnership

As mentioned earlier in this chapter, the Stage 1 Meaningful Use objectives were organized around five quality initiatives adapted from the work of the NPP. The NPP is a collaborative effort of 51 major national organizations that brings together public and private sector stakeholder groups as partners in a forum that balances the interests of consumers, purchasers, health plans, clinicians, providers, communities, states, and suppliers in achieving the aims of better care, affordable care, and healthy people and communities.

Under contract to provide input to the Secretary of HHS on the 2012 National Quality Strategy, NPP published its report on national priorities on September 1, 2011. To provide more meaningful input on each priority the structure for this work allowed the full NPP to serve as an overarching committee, while its partners divided into three subcommittees responsible for advising on goals, measures, and strategic opportunities specific to three domains of the National Quality Strategy: healthy people and healthy communities, better care, and affordable care. This important work evolved from NPP's previous input to HHS on national priorities and goals, including a report submitted in 2010 as well as its 2008 report, Aligning Our Efforts to Transform America's Healthcare.

National Quality Strategy

In March 2011 HHS released the National Quality Strategy for health improvement, the first effort to create a national framework to help guide local, state, and national efforts to improve the quality of care in the United States.15 The National Quality Strategy recognizes health IT as critical to improving the quality of care, improving health outcomes, and ultimately reducing costs. Putting the National Quality Strategy into action, HHS subsequently launched the following two key initiatives that set specific national targets:

•Partnership for Patients, which is working with a wide variety of private and public stakeholders to make hospital care safer by reducing hospital-acquired conditions by 40% and improving care transitions upon release from the hospital so that readmissions are reduced by 20%

•Million Hearts campaign, which is a public–private initiative to prevent 1 million heart attacks and strokes between 2012 and 2016 by improving access to care and increasing adherence to basic preventive medicine

The evidence shows that health IT, along with delivery system improvements, will be a key ingredient in the success of these campaigns and other efforts around the country to improve health outcomes. One study published in The New England Journal of Medicine looked at diabetes care in Cleveland and found the following:

•51% of patients being treated by physician practices using an EHR received care that met all endorsed standards of diabetes care compared to 7% of patients treated by practices not using an EHR

•44% of patients treated by practices using an EHR met at least four of five outcome standards for diabetes compared to 16% of patients treated by paper-based practices with similar outcomes16

This study speaks volumes about the positive impact that well-implemented health IT can have on the quality of clinical practice when it supports clinician decisions. With decision support, health IT can facilitate the consistent execution of evidence-based best practices by healthcare providers, including both nursing and medicine.

Process of Developing and Implementing Informatics Policy

Ensuring That Health Practitioners Are Positioned on Key Committees and Boards

Over the past decade the informatics community, especially nursing informatics, has become more actively engaged with health policy efforts. Informatics nurses are claiming a seat at the policy table and are being sought after for key national appointments and hired for executive positions. Through this effort there has been an awakening to the importance of recognizing opportunities to communicate and collaborate with others to produce favorable outcomes.17

Another notable change is that nurses today proactively reach out to other leaders in positions of influence, including government agencies, national organizations, and committees, to share knowledge and offer expertise, and they have learned a great deal from these discussions. One key takeaway is that national leaders and groups respond positively to nursing's large population. For example, the Alliance for Nursing Informatics (ANI) and the American Nurses Association (ANA) are working closely to articulate a unified voice that more broadly represents the profession, which consists of more than 3 million nurses. Increasingly, representatives from these two groups are being invited to participate in national efforts that advance policies focused on improving patient safety and outcomes.

As one example, on September 12, 2011, ONC launched a consumer campaign to empower and educate patients, caregivers, and individuals in managing their day-to-day health and acting as partners in their health through the use of health IT.18 ANI and ANA jointly pledged to coordinate a campaign with other national nursing organizations to promote use of personal health records (PHRs) and patient portals. The ultimate goal of the ANI Pledge to Support the Consumer eHealth Program19 is to help clinicians offer a wider range of considerations and options for patients while also providing patients with resources that encourage proactive behavior, thus empowering them to be active partners in their health plan.

Providing Expert Testimony

Opportunities may also arise to offer testimony or serve as an expert witness in a public forum on a current policy topic such as evaluating the impact of an EHR on patient safety or how to standardize documentation of quality measures. For example, testimony may be requested by a national organization such as the National Quality Forum, a national committee such as the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, or a forum hosted by a professional society such as the ANA. Health practitioners should seek and embrace these opportunities since their clinical background and experience make them credible witnesses. To be successful it is important to plan ahead carefully to ensure that comments are grounded in evidence and closely aligned with any relevant organizational policy statements.

Preparation should begin by gathering background materials and reviewing current literature, white papers, articles, research and policy statements, or key legislation on the topic. The hosting organization may request that certain documents be submitted in advance, including a draft copy of the testimony, the expert's curriculum vitae and biography, and a financial disclosure statement. It is ideal to work with a knowledgeable “prep” team when developing the testimony to ensure that all predetermined questions or topics are fully and clearly addressed.

During the preparation, previous relevant testimony, position statements, and background materials from the expert's sponsoring organization should be reviewed. It is also helpful to seek out and interview individuals who are knowledgeable in the topic area, including board members and industry, organizational, and volunteer leaders. Multiple rounds of editorial and content review should take place prior to calling the testimony “final” and ready for submission. Keep in mind that the comments likely will be documented in a public record, so the testimony should be clearly stated and credible.

Next, oral comments should be prepared, keeping in mind that they likely will need to be delivered in a maximum time frame of minutes rather than hours. It is helpful to summarize the testimony into its most important points so that it can be delivered within the allotted time, after repeated practice sessions. Be mindful that a timing device such as a stop light may be used to track and enforce the time limit. Another helpful strategy is to have a team of subject matter experts drill the testifier on potential questions that might be posed. This practice session will reinforce the ability of the nurse expert to answer succinctly while still emphasizing the key points. Gather and review background materials on the hosting entity, including its leaders and committee members; their pictures, congressional districts, and political parties; and any relevant legislation they may have recently introduced or supported. Keeping these key strategies in mind will go a long way toward ensuring success and may also lead to future opportunities to advance the cause.

Responding to Requests for Comments

With the advent of the HITECH Act there are an increasing number of opportunities for organizations and individuals to submit comments on the ensuing regulations and other related federal guidance documents. Laws passed by Congress rarely contain enough specific language to fully guide their implementation.20 Regulations and the rule making process are used to clarify definitions, authority, eligibility, benefits, and standards. Their development is shaped by the monitoring, involvement, and input of professional societies, healthcare providers, third party payers, consumers, and other special interest groups.

Each organization's internal policies may offer direction as to if or when a formal written response to federal policy-makers is warranted. As an example, ANI has developed a policy that describes its process for member organizations to achieve consensus on policy issues affecting nursing informatics.19 This policy states:

ANI, as a collaboration that represents multiple nursing informatics organizations, responds as one voice to federal health policy initiatives by sharing nursing informatics perspectives for shaping health policy. Due to limited timing to respond, it is not always possible to have a full review by all members within each of the ANI member organizations. ANI will make every effort to provide notification about its intent to respond to a call for comments for healthcare reform initiatives, requirements and rulings from ONC or other government agencies and organizations, as soon as ANI decides to pursue a specific call. The length of time available to respond will determine the steps in the procedure for obtaining comments.19

To enhance the credibility of submitted comments, address any questions in the notice and take the time to offer positive feedback on points of agreement with the proposed regulation. If a template is provided, use it for the response submissions. Finally, be sure to publicize the response and use it as an opportunity to increase awareness and provide education about the public policy effort and related publications or activities.

The ANA has offered the following guidance on how individual nurses can affect federal rules and regulations:

•Learn about the federal rule-making process and how to make your voice heard.

•Become informed about the public policy and health policy issues currently under consideration at the federal level of government.

•Check out the Federal Register. It is the very best source of information about proposed rules and changes to existing rules for federal programs. It is posted every day and contains complete directions on where to send comments and deadlines for the public comment period.

•Work with your state nurses association by offering your expertise to assist in developing new regulations, modifying existing regulation, or preparing comments on proposed regulations.20

Developing Position Statements

Another mechanism for advancing health policy is through the development and publication of position statements. A position statement is an explanation or a recommendation for a course of action that reflects an organization's stance on an issue of concern. Position statements are typically developed after an internal discussion with content experts, then advanced to the broader membership for review and input, and finally submitted to the oversight governance group or board for approval. This review and approval process allows interested parties to voice their concerns and opinions on the issue at hand and enables the group to reach consensus. A recent example is the Healthcare Information and Management Systems Society (HIMSS) Nursing Informatics Position Statement titled Transforming Nursing Practice through Technology & Informatics. This HIMSS Position Statement was developed by the HIMSS Nursing Informatics Community and subsequently reviewed and approved by its board of directors. Position statements may also be created in collaboration with other groups and issued as joint statements.

Leading Policy Activities through Organizational Work and Leadership

Organizations that actively influence health informatics policy through organizational work and leadership include the American Academy of Nursing (AAN), American Health Information Management Association (AHIMA), American Medical Informatics Association (AMIA), HIMSS, and others. A brief summary of the public policy focus of selected organizations is provided in Table 25-1.

Strategies

Health practitioners require certain skills to be able to communicate effectively with policy-makers and take advantage of relevant advocacy opportunities. According to Walker, in order to advocate, informaticists must be strategists, leaders, great communicators, and they must engage stakeholders across multiple spectrums to ensure that the needs of patients and nurses are met.17 Health informaticists have a deep understanding of clinical processes, technology, and health IT systems in addition to experience as advocates for patients, groups, communities, and overall populations.

TABLE 25-1 Public Policy Focus of Selected Organizations

ORGANIZATION

PUBLIC POLICY FOCUS

Alliance for Nursing Informatics (ANI)

ANI aims to foster further development of a united voice for nursing informatics and provide a forum for its expression. Further, ANI provides a forum to respond to opportunities that support and encourage nursing informatics participation in activities such as: developing resources, guidelines, and standards for nursing informatics practice, education, scope of practice, research, certification, public policy, and workforce development. www.allianceni.org/statements.asp

American Academy of Nursing (AAN)

The Academy serves the public and the nursing profession by advancing health policy and practice through the generation, synthesis, and dissemination of nursing knowledge. www.aannet.org/about-the-academy

American Health Information Management Association (AHIMA)

AHIMA's advocacy and public policy team monitors, responds, and participates in national policy and industry initiatives that are important to the health information management profession. www.ahima.org/advocacy/default.aspx

American Medical Informatics Association (AMIA)

AMIA … works to shape public policy regarding ongoing health and health policy concerns such as ensuring access to care and protecting funding for core health IT and informatics-related training programs and services. In addition, AMIA works to respond to ongoing and emerging issues such as bio-surveillance and emergency preparedness, access to care, public health infrastructure, disease control and prevention, health disparities, and global health. www.amia.org/public-policy/policy-priorities

American Nurses Association (ANA)

Practicing nurses have first-hand experience regarding the effects of healthcare laws and regulations in providing quality care. This gives the nursing community a unique perspective on healthcare policy. ANA is in part an advocacy organization, charged with using these insights to set policy and influence healthcare legislation. www.nursingworld.org/MainMenuCategories/Policy-Advocacy

Healthcare Information and Management Systems Society (HIMSS)

HIMSS frames and leads healthcare practices and public policy through its content expertise, professional development, research initiatives, and media vehicles designed to promote information and management systems' contributions to improving the quality, safety, access, and cost-effectiveness of patient care. www.himss.org/ASP/aboutHimssHome.asp

Each year, HIMSS creates policy principles for all stakeholders to consider for inclusion as provisions in legislation proposed by the U.S. Congress or state legislatures, or for inclusion in federal and state regulations, to foster enhanced healthcare using IT. www.himss.org/ASP/ContentRedirector.asp?ContentId=76351&type=HIMSSNewsItem

Joint Public Health Informatics Taskforce (JPHIT)

The Joint Public Health Informatics Taskforce (JPHIT) is a consortium of nine public health associations committed to improving population health through coordinated informatics policy and action. www.phii.org/what-we-do/joint-public-health-informatics-taskforce-jphit/111

It seems clear from these discussions that nurses must advocate as leaders to advance an improved health system. Changes in health policy are one part of the necessary reform21 but how do nurses prepare to engage in public policy efforts? The beginner must acquire a basic knowledge of health policy and funding. An understanding of health policy principles can be gained through formal coursework, continuing education, or even self-study of the myriad resources available virtually on the Internet. Volunteering to participate in state-level advocacy activities that also prepare participants to meet with legislators offers another opportunity to learn how to influence policy.

Beyond acquiring knowledge of basic policy principles, demonstrating leadership skills and leveraging a professional network are necessary to achieve success. Professional colleagues may be willing to act as coaches to offer advice, criticism, information, encouragement, and support. Communication skills are essential to be able to craft and articulate key points that will “make the case” as well as to capture and engage the target audience. Exemplary leadership activity will move the cause forward in an actionable way toward policy improvement.21 Demonstrating such leadership requires more than showing passion for an issue. It also involves being able to connect evidence to the policy agenda and framing it in a logical context. HIMSS believes that nurses must lead and be visible, vocal, and present at the table for all significant healthcare reform initiatives.22 Collaboration and unified messaging among all stakeholders are keys to success. Getting involved with the policy efforts within one's own organization is a simple way to get started.

Discipline-Specific Policies: Nursing

This section provides an example of current influences within the specific discipline of nursing. All health disciplines are encouraged to research current policies specific to their areas. Readers in other health disciplines are encouraged to note the outline and content provided here as a model.

Use of Health IT to Advance the Future of Nursing

An important report titled The Future of Nursing: Leading Change, Advancing Health was published as the result of a partnership launched in 2008 between the Robert Wood Johnson Foundation and the IOM.23 The purpose of the report was to determine recommendations to transform the nursing profession, leading to advanced roles and leadership positions for nurses in the redesign of the healthcare system.

The Future of Nursing Report Recommendations

Many leading nursing organizations, including ANI, provided testimony to the Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing. The vision of ANI—to improve health and healthcare through nursing informatics and innovation—is closely aligned with the recommendations of the report as it envisions the future of the profession. ANI testimony emphasized that nurses are key leaders in the effective use of IT to positively affect the quality and efficiency of healthcare services. These contributions, along with others from national nursing leaders, were used by the Committee in the development of the report, which has been described by some as the “tipping point in nursing care,” calling for the nursing profession to be reengineered with a more educated workforce capacity.

The Future of Nursing report outlines several opportunities to transform nursing practice through informatics and technology. As EHRs become more refined and integrated, nurses will have the opportunity to help define additional Meaningful Use objectives. Nurses need to be in the right leadership positions in order to influence policy.

Implications for Time and Place of Care.

Care supported by interoperable digital networks will shift in the importance of time and place. It is likely that a significant subset of care delivery might be independent of physical location when health IT is fully implemented. Nurses provide care in every setting, particularly in the community; therefore nurses should be involved in shaping the effective use of health IT and related policies wherever they practice. Nurses have identified that lack of an integrated EHR is a barrier to success.22 As described earlier in this chapter, national initiatives to address EHR adoption and integration challenges are being advanced. Nurses should become increasingly more engaged in national, regional, and local policy efforts in order to drive this agenda of patient-centric, location-independent healthcare information.

In the 2011 HIMSS Nursing Informatics Workforce Survey, and for the first time in this triennial survey, almost one third of respondents mentioned lack of integration and interoperability as the top barrier to their success, followed by lack of financial resources (26%) and lack of administrative support (23%).1 The majority of the 660 nurse informaticists who participated in this research work in a hospital setting where they frequently experience the negative impact of disconnected systems on transitions of care, medication reconciliation, and their ability to achieve optimal patient outcomes. The IOM recommendations in The Future of Nursing, once implemented, will go far toward addressing these integration barriers.

Expand Opportunities for Nurses to Lead and Diffuse Collaborative Efforts.

Interoperable EHRs linked with PHRs or patient portals will influence how collaborative care teams are able to work and share clinical information. Care teams are no longer bound by physical space but rather can engage in virtual learning environments to support the care delivery of the future. The increasing use of communication tools, the proliferation of mobile devices, and the increasing availability of online health tools will multiply opportunities for healthcare providers to collaborate with each other and to engage with patients.24 Personal health information is a valuable resource to individuals, their families, and the healthcare professionals who provide treatment and deliver care in residential and community settings. Examples of personal health information management systems and tools that can be leveraged include PHRs and web-based portals linked to EHRs or clinical information systems. Well-defined policies are necessary to ensure that the security and confidentiality of protected health information is safeguarded in this rapidly evolving virtual healthcare environment. Nurses should seek opportunities to participate in efforts to define policies that affect patient care, including volunteering for policy development committees within their own organizations.

While health IT will have its greatest influence on how nurses plan and document their care, all facets of care are becoming increasingly digital. From the expanded use of remote devices and smart beds, data capture is being automated and nurses are more able to focus on complex cognitive decisions using knowledge management and decision support. Policy-makers should and do work with nurse leaders to leverage these opportunities to transform nursing practice through the use of new and existing technologies intended to support decision making and care delivery. For example, nurses can provide input as to how the proposed use of health IT may affect their workflow or offer guidance on the optimal use of these technologies to improve care delivery.

Prepare and Enable Nurses to Lead Change to Advance Health.

Other key recommendations in The Future of Nursing report emphasize the importance of preparing and enabling nurses to lead change to advance health. Public, private, and governmental healthcare decision makers should include nurses at every level. Nurses consistently rank at the top of the Annual Gallup Poll on Honesty/Ethics in Professions, doing so each year since they were first included in the poll in 1999, except in 2001 when firefighters were included on a one-time basis to recognize their heroic actions on September 11.25 Nurses are the most trusted professionals, outranking medical doctors by 15 percentage points, but frequently they do not recognize that power or leverage opportunities to influence policy or strategic direction.

The TIGER Initiative's goal of engaging more nurses in leading both the development of a national health IT infrastructure and healthcare reform is referenced in The Future of Nursing, as is its goal to accelerate adoption of smart, standards-based, interoperable technology that will make healthcare delivery safer, more efficient, timely, accessible, and patient centered while also reducing the burden on nurses.26 Through efforts such as TIGER, nurses are cultivating informatics competencies to better influence policy efforts in today's rapid EHR adoption.

The promotion of data standardization to enable knowledge sharing has played a critical role in the establishment of healthcare policy. The TIGER Standards and Interoperability Collaborative and its associated workgroups have addressed important aspects of the TIGER action plan to support nursing engagement and to enable the nursing voice to be heard throughout standards adoption processes and national health IT activities.2

The TIGER Standards and Interoperability Collaborative has published a Call to Action, which states the following:

•To ensure safe, efficient, and quality care, nurses must be advocates for patient-consented, secure, and reliable exchange of health information

•Collaboration across professional disciplines, healthcare organizations, and society is necessary to achieve our collective goal of improving care delivery through use of interoperable EHRs

•For the betterment of clinical practice and the profession, nurses must embrace collaboration and build a consensus agreement regarding standardization of nursing language

•Nurses have a professional responsibility to be engaged in standards development, harmonization and synchronization, and implementation activities, including encouraging adoption of and patient engagement in PHRs and EHRs

•Nurses should encourage collaboration to achieve interoperable health information exchange for clinical, research, and education

•Nurses should perform environmental scanning for lessons learned from use of emerging technologies in other industries such as communications, banking, and retail

•Nurses must ensure ongoing collaboration across all nursing specialties regarding adoption of standards for health information exchange2

The Future of Nursing report emphasizes that the United States has the opportunity to transform its healthcare system, and nurses can and should play a fundamental role in this transformation. However, this transformation will require that nurses embrace technology as a necessary tool to innovate the delivery of nursing care.

Center to Champion Nursing in America

Future of Nursing: Campaign for Action is an initiative to advance comprehensive healthcare change. It envisions a healthcare system in which all Americans have access to high-quality care, with nurses contributing to the full extent of their capabilities.27 The campaign is coordinated through the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation, and includes 48 state action coalitions and a wide range of healthcare providers, consumer advocates, policy-makers, and business, academic, and philanthropic leaders.

The Campaign for Action is moving forward simultaneously on national, state, and local levels through efforts to accomplish the following:

•Strengthen nurse education and training

•Enable nurses to practice to the full extent of their education and training

•Advance interprofessional collaboration among healthcare professionals to ensure coordinated and improved patient care

•Expand leadership ranks to ensure that nurses have a voice on management teams, in boardrooms, and during policy debates

•Improve healthcare workforce data collection to better assess and project workforce requirements27

State-level action coalitions are also working to advance the campaign's efforts at the local, regional, and state level. These action coalitions will capture best practices, determine research needs, track lessons learned, and identify replicable models that can be embedded in national policy efforts.

HIMSS Nursing Informatics Position Statement

To further advance recommendations in The Future of Nursing report, HIMSS published a position statement titled Transforming Nursing Practice through Technology & Informatics. This statement asserts that:

Nurses are key leaders in developing the infrastructure for effective and efficient HIT [health IT] that transforms the delivery of care. Nurse informaticists play a crucial role in advocating both for patients and fellow nurses who are often the key stakeholders and recipients of these evolving solutions. Nursing informatics professionals are the liaisons to successful interactions with technology in healthcare. As clinicians who focus on transforming information into knowledge, nurse informaticists cultivate a new time and place of care through their facilitation efforts to integrate technology with patient care. Technology will continue to be a fundamental enabler of future care delivery models and nursing informatics leaders will be essential to transforming nursing practice through technology.1

To achieve the goals of this position statement nurse leaders should be engaged at all levels in health IT policy and strategy-setting committees and initiatives. As well, they must be knowledgeable and well versed in current public policy initiatives and seek opportunities to participate in advocacy and educational efforts directed toward policy-makers.

Conclusion and Future Directions

By understanding current informatics-related health policies issues, the role of the professional organizations, the current federal infrastructure support for health informatics, and specific approaches for participating in the advocacy process, health informatics leaders can positively affect healthcare policy. As demonstrated by a variety of nursing initiatives, leadership makes a difference. Health practitioners can and must take on leadership roles and influence policy to improve safety and efficiency, thereby bringing evidence for decision making to the point of care and empowering patients and consumers as partners. Collectively, health practitioners must respond to the policy challenges outlined in this chapter to advance nursing's role in leading change and advancing health. Whatever their role, nurses must be confident that they can influence health policy at the local and organizational, regional, state, and national level.

Where are we now, more than 25 years after starting the implementation of health IT in healthcare and about 2 years into the EHR incentive program? Winston Churchill put it best when he said, “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”28(p264) We have much more hard work to do. Through strong leadership and active participation we will be able to organize and complete the hard work necessary to create the policy changes that will transform healthcare.

References

1.

Healthcare Information and Management Systems Society (HIMSS): 2011 HIMSS nursing informatics workforce survey HIMSS http://www.himss.org/content/files/2011HIMSSNursingInformaticsWorkforceSurvey.pdf, 2011.

2.

TIGER Initiative: Nursing standards and interoperability: a TIGER collaborative report TIGER Initiative http://www.thetigerinitiative.org/docs/TigerReport_StandardsAndInteroperability_001.pdf, 2008.

3.

Bush, GW: The 2004 State of the Union address http://www.washingtonpost.com/wp-srv/politics/transcripts/bushtext_012004.html, 2004.

4.

Obama, B: Remarks of President Barack Obama: weekly address WhiteHouse.gov http://www.whitehouse.gov/president-obama-delivers-your-weekly-address, January 24, 2009.

5.

National Priorities Partnership: National Priorities and Goals: Aligning Our Efforts to Transform America's Healthcare . 2008, National Quality Forum, Washington, DC.

6.

Blumenthal, D: National HIPAA Summit in Washington, D.C http://www.healthcareitnews.com/news/healthcare-it-means-not-end-says-blumenthal, 2009.

7.

Murphy, J: The center of the universe: a closer look at a patient-centric care model. J Healthc Inf Manag. 22(2), 2008, 6–7.

8.

Standards & Interoperability Framework Wiki http://wiki.siframework.org/, 2012.

9.

Institute of Medicine: To Err Is Human: Building a Safer Health System . 1999, National Academy Press, Washington, DC.

10.

Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century . 2001, National Academy Press, Washington, DC.

11.

Institute of Medicine: HIT and Patient Safety: Building Safer Systems for Better Care . 2011, The National Academies Press, Washington, DC.

12.

Ash, JS, Berg, M, Coiera, E: Some unintended consequences of information technology in health care: the nature of patient care information system-related errors. J Am Med Inform Assoc. 11(2), 2004, 104–112.

13.

Koppel, R, Metlay, JP, Cohen, A, et al.: Role of computerized physician order entry systems in facilitating medication errors. J Amer Med Assoc. 293(10), 2005, 1197–1203.

14.

Bloomrosen, M, Starren, J, Lorenzi, NM, Ash, JS, Patel, VL, Shortliffe, EH: Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting. J Am Med Inform Assoc. 18(1), 2011, 82–90.

15.

National Quality Strategy: http://www.ahrq.gov/workingforquality/nqs/, 2011.

16.

Cebul, R, Love, TE, Jain, AK, Hebert, CJ: Electronic health records and quality of diabetes care. N Engl J Med. 365(9), 2011, 825–833.

17.

Walker, A: Shaping nursing informatics through the public policy process. In Saba, V, McCormick, KA (Eds.): Essentials of Nursing Informatics. 5th ed, 2011, McGraw-Hill, New York, NY, 279–287.

18.

Office of the National Coordinator for Health Information Technology: National health IT week HealthIT.gov http://www.healthit.gov/healthitweek/, 2011.

19.

Alliance for Nursing Informatics (ANI): Alliance for Nursing Informatics pledge to support the Consumer eHealth Program ANI http://www.allianceni.org/documents/ANIPledgetoSupportONCConsumereHealthProgram_000.pdf, September 12, 2011.

20.

American Nurses Association: Agencies & regulations Nursing World http://www.nursingworld.org/Agencies-RegulatoryAffairs.aspx, 2012.

21.

Gillis, CL: Developing policy leadership in nursing: three wishes. Nurs Outlook. 59(4), 2011, 179–181.

22.

Healthcare Information and Management Systems Society (HIMSS): Position Statement on Transforming Nursing Practice through Technology and Informatics . 2011, HIMSS, Chicago, IL.

23.

Institute of Medicine: The Future of Nursing: Leading Change, Advancing Health . 2011, The National Academies Press, Washington, DC.

24.

California HealthCare Foundation (CHCF): What's ahead for EHRs: Experts weigh in CHCF http://www.chcf.org/~/media/MEDIA%20LIBRARY%20Files/PDF/W/PDF%20WhatsAheadEHRsExpertsWeighIn.pdf, 2012.

25.

Gallup Poll: http://www.gallup.com/poll/1654/honesty-ethics-professions.aspx, November, 2012.

26.

TIGER Initiative: The TIGER Initiative: collaborating to integrate evidence and informatics into nursing practice and education: an executive summary TIGER Initiative http://www.thetigerinitiative.org/docs/TIGERCollaborativeExecSummary_20090405_000.pdf, 2008.

27.

Center to Champion Nursing in America: http://championnursing.org/about-FON-CFA, 2012.

28.

Churchill, WS: The End of the Beginning . 1943, Cassel, London, England, http://www.winstonchurchill.org/component/content/article/3-speeches/987-the-end-of-the-beginning.

PAGE 408

Discussion Questions

1. Outline the basic health policy competencies for health informatics leaders.

2. Discuss three key policy issues that affect EHR adoption.

3. Describe the policy concerns regarding the use of health IT and patient safety.

4. Discuss the implications of The Future of Nursing report on the use of health IT by nursing and other health-related disciplines.

5. Outline the process for developing and implementing informatics policy.

6. Describe four strategies for leading policy activities through organizational work and leadership.

Case Study

Mr. Smith Goes to Washington is a 1939 American film starring James Stewart and Jean Arthur about one man's effect on American politics. Today, health practitioners make their own trips to our nation's capital and while the focus may be somewhat different, the experience is no less exciting. Here is a case study outlining one possible scenario.

It all started with a phone call requesting that a nurse testify at a congressional hearing on Standards for Health IT: Meaningful Use and Beyond, hosted by the House Subcommittee on Technology and Innovation. The testimony would include both written and oral comments. The call launched a flurry of activity aimed at ensuring that the testimony would be successful and Johnson was selected to testify. Multiple documents were prepared in advance, including a draft of the testimony and Johnson's curriculum vitae, biography, and financial disclosure form. The team worked to create testimony that addressed the House Subcommittee's two questions:

1.What progress has ONC made since the HITECH Act was passed in meeting the need for interoperability and information security standards for EHRs and health IT systems?

2.What are the strengths and weaknesses of the current health IT standards identification and development process and what should the top standards-related priorities be for future health IT activities?

During preparation of the written comments, previous testimony, position statements, and background materials were leveraged. Several board members, leaders in privacy and security efforts, leaders in standards and standards harmonization efforts, and volunteer leaders from the HIMSS Electronic Health Record Association were interviewed. Multiple rounds of editorial and content review took place prior to calling the testimony “final” and ready for submission.

Next, oral comments were prepared, keeping them to a maximum of 5 minutes. The testimony was boiled down to the key points that could be delivered in that brief time frame yet still make sense. Repeated practice sessions drove home the realization that 5 minutes is very little time!

Then came the “murder squad,” a dry run facing a team of experts who drilled Johnson with questions that she might be asked by House Subcommittee members. She said later that it may have been more nerve-racking to face peers than to face the House Subcommittee itself! In this practice session the key lessons learned were to get to the point quickly and use the responses to panel members' questions as an opportunity to reemphasize key points from the testimony. Other homework included reviewing the list of House Subcommittee members to recognize their faces and learn their districts, political parties, recent activities, and any relevant legislation they had recently introduced or supported.

On the day of the testimony a meeting was held with the team in the House of Commons cafeteria to share last-minute updates and further refine the strategy. Johnson then proceeded to the office of the House Subcommittee chairman, where the panelists were introduced to each other. The chairman joined the panelists at the prehearing session, facilitating the dialog in a casual setting to put the panelists more at ease. During this session the panelists learned that the hearing had been at risk of cancellation since the House had adjourned the night before and that many of the House Subcommittee members had left Washington for their home states. However, the chairman's staff commented that the chairman is very committed to the advancement of health IT as well as to the House Subcommittee's HITECH Act oversight role and therefore he did not cancel the hearing.

At the scheduled time the panelists entered the hearing room and took their seats at a row of tables on the main floor. The House Subcommittee chairman, members, and staff were seated at the front of the room, one level above the main floor, and the public audience was seated at the back of the room. In front of each panelist was a microphone, timer, and stop light that tracked each speaker's time limit. During the testimony the stop light changed from green to yellow and then to red when each speaker's 5-minute time limit was reached.

Throughout the hearing the chairman was very gracious, noting his appreciation of the panelists' contributions. In part because of her thorough preparation, Johnson gave her prepared oral testimony flawlessly. Although not asked any direct questions, she chimed in to help answer several other questions that were asked of other panelists in order to offer key points germane to the discussion. The hearing was broadcast live on the Internet, a transcript of the testimony is available in the public record of the hearing, and a video clip of the testimony can be found on YouTube.

While Mr. Smith Goes to Washington made James Stewart a major movie star, Johnson's aspirations were quite simple: that the recommendations on how to improve patient care and reduce costs would be heard and that steps toward implementation would be taken.

Discussion Questions

1. How can nurses best leverage their clinical background when providing testimony as expert witnesses?

2. When preparing testimony, should a nurse expert witness focus primarily on developing nursing-specific content or should his or her nursing background be used more as a context for the discussion? What are the advantages and disadvantages of each approach?

Pageburst Integrated Resources

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Bibliography and Additional Readings

Web Resources

Chapter 25 Health Policy and Informatics

Joyce Sensmeier

Judy Murphy

By understanding current informatics

-

related health policy issues, the role of the professional

organizations, the current federal infrastructure support for health informatics, and specific approaches

for participating in the advocacy process, health

informatics leaders can positively affect healthcare

policy.

Objectives

At the completion of this chapter the reader will be prepared to:

1.Describe key health policy issues for informatics

2.Differentiate the Institute of Medicine recommendation

s in the HIT and Patient Safety and The

Future of Nursing reports

3.Define the process for developing and implementing informatics concepts in health policy

4.Describe the impact of informatics on health policy

Key Terms

EHR adoption, 405

Health i

nformation technology (health IT), 397

Health policy, 398

Unintended consequences, 401

Abstract

All health practitioners should have an understanding of current health policy initiatives and advocate

for efforts that leverage informatics and technology to

improve patient safety and health outcomes.

Health practitioners provide care in every setting and should be involved in shaping the effective use of

information technology and related policies wherever they practice. This chapter describes how health

prac

titioners can take on leadership roles and influence health policy to improve safety and efficiency,

thereby bringing practice standards and evidence for decision making to the point of care and

empowering patients and healthcare consumers as partners.

Int

roduction

Chapter 25 Health Policy and Informatics

Joyce Sensmeier

Judy Murphy

By understanding current informatics-related health policy issues, the role of the professional

organizations, the current federal infrastructure support for health informatics, and specific approaches

for participating in the advocacy process, health informatics leaders can positively affect healthcare

policy.

Objectives

At the completion of this chapter the reader will be prepared to:

1.Describe key health policy issues for informatics

2.Differentiate the Institute of Medicine recommendations in the HIT and Patient Safety and The

Future of Nursing reports

3.Define the process for developing and implementing informatics concepts in health policy

4.Describe the impact of informatics on health policy

Key Terms

EHR adoption, 405

Health information technology (health IT), 397

Health policy, 398

Unintended consequences, 401

Abstract

All health practitioners should have an understanding of current health policy initiatives and advocate

for efforts that leverage informatics and technology to improve patient safety and health outcomes.

Health practitioners provide care in every setting and should be involved in shaping the effective use of

information technology and related policies wherever they practice. This chapter describes how health

practitioners can take on leadership roles and influence health policy to improve safety and efficiency,

thereby bringing practice standards and evidence for decision making to the point of care and

empowering patients and healthcare consumers as partners.

Introduction