Medical Informatics Research Articles

Future Needs in Nursing Informatics - Preliminary Findings from the Global Nursing Informatics Survey.

This study investigates the evolving landscape of nursing informatics by conducting a follow-up survey initiated by the International Medical Informatics Association (IMIA) Students and Emerging Professionals (SEP) Nursing Informatics (NI) group in 2015 and 2019. The participants were asked to describe what they thought should be done in their institutions and countries to advance nursing informatics in the next 5-10 years. For this paper, responses in English acquired by December 2023 were analysed using inductive content analysis. Identified needs covered a) recognition and roles, b) educational needs, c) technological needs, and d) research needs. The initial findings indicate that, despite significant progress in nursing informatics, the current needs closely mirror those identified in the 2015 survey.

Advancements in health informatics for monitoring perioperative patient data

Advancements in health informatics are revolutionizing perioperative care by enhancing patient monitoring, improving clinical decision-making, and promoting patient safety. The integration of electronic health records (EHR) facilitates seamless information flow across all perioperative stages, ensuring up-to-date patient data is accessible to the entire healthcare team. This accessibility reduces errors, improves coordination, and enhances overall patient outcomes. EHR systems also support standardized documentation, reducing variability in record-keeping and ensuring comprehensive patient information is consistently captured. Real-time data analytics and predictive modeling are powerful tools in perioperative settings, enabling clinicians to anticipate and manage potential complications proactively. By analyzing vast datasets, predictive models identify patterns and risk factors associated with adverse outcomes, allowing for targeted interventions and personalized care plans. Real-time analytics provide continuous monitoring of patient status during surgery, offering immediate feedback and enabling prompt adjustments to ensure patient stability. Wearable devices and remote monitoring systems further augment real-time data analytics by continuously tracking physiological parameters throughout the surgical process and into the postoperative period. This continuous data stream allows for ongoing assessment of patient status and early detection of complications, enhancing patient safety and outcomes. Health informatics solutions, including automated alerts and decision support tools, minimize human error and ensure adherence to clinical guidelines. Automated reminders for critical actions, such as timely antibiotic administration, significantly reduce the incidence of surgical site infections. Decision support tools provide real-time, evidence-based recommendations at the point of care, supporting clinicians in making informed decisions and improving patient outcomes. Additionally, health informatics facilitates continuous quality improvement by enabling the collection and analysis of performance data, informing targeted interventions and process improvements. Overall, advancements in health informatics are transforming perioperative care, offering numerous benefits in terms of efficiency, accuracy, and patient safety, ultimately leading to better patient outcomes and higher quality of care. Continued innovation in this field will be essential for maintaining and improving the standards of perioperative care.

Supporting Clinical Informatics Competency Development Among the Clinical Informatics Team at Providence Health Care.

Clinical informatics (CI) competencies are crucial for health care organizations to effectively use information communication technologies (ICTs) and deliver quality care. An interdisciplinary CI team can assist organizations with leveraging ICTs, but may also require support. This case study describes a peer-led knowledge translation project designed, delivered and implemented over two years by members of the CI team at Providence Health Care (PHC). The project included CI competencies assessment of CI team members, followed by tailored education for identified knowledge gaps. The Kirkpatrick evaluation model was used to assess three levels of learning among CI team members, including a satisfaction survey, pre-and post-cognitive retention of the education intervention using a validated tool for informatics specialists, and project partner feedback of CI team performance 12 weeks after education completion. This case study provides evidence-informed guidance on 'how to' implement peer-led, practice-based CI training for CI teams.

Health Informatics: A Challenge for Nurses in Public Health in Rural Mexico.

Health informatics has significantly advanced global technology, yet challenges persist in public health and rural nursing in Mexico due to social inequalities, limited technology access, and suboptimal infrastructure, compounded by the absence of nurse informaticians as viable career options. Overcoming these barriers necessitates international collaboration, empowering Mexican nurses to contribute to universal health access and advocate for health equity. Interventions must extend beyond nursing curricula to existing workforces, ensuring they can address the needs of vulnerable populations in Mexico. Long-term international support is crucial to bridge these gaps and unleash the full potential of Mexican nurses in influencing global health.

Integrating Health Informatics into Pre-Registration Nursing Education: Insights from a Participatory Workshop.

The implementation of health informatics in pre-registration health professional degrees faces persistent challenges, including curriculum overload, educator workforce capability gaps, and financial constraints. Despite these barriers, reports of successful implementation of health informatics pre-registration nursing programs exist. A virtual workshop was held during thein 15th International Nursing Informatics Conference in 2021 with the aim to explore successful implementation strategies for incorporating health informatics into the nursing curriculum to meet the accreditation standards. This paper reports recommendations from the workshop emphasising the importance academic-clinical partnerships to develop innovative approaches to enhance theof capacity of academic teams and access to contemporary point of care digital technologies that reflect applications of health informatics in interdisciplinary clinical settings.

A Survey of Nurse Informatics Competencies of Professional Nurses in Clinical Practice Public Hospitals in South Africa.

This study used a cross-sectional descriptive survey to examine self-rated competence in nursing informatics among 205 nurses in clinical practice across two hospitals in the Western Cape. The TANIC© scale was used to rate the skills of participants in computer literacy, clinical information management, and information literacy. The highest rating was received for computer literacy, approaching a 'comfortable' competency level. Lower scores were received for clinical information management and information literacy, indicating 'novice' to 'advanced beginner' levels. The study showed that practicing nurses have a limited level of nursing informatics competence, especially in the domains of clinical information management and information literacy. These findings support the need for educational programmes to extend beyond basic computer skills and prioritize continuous professional development in nursing informatics.

Understanding Nursing Informatics: A Survey of Nurses' Perception.

This paper aims to explore nurses' understanding of nursing informatics (NI). The structured and open-ended questionnaires were used to explore their knowledge of NI. Between 17 and 18 October 2023, the survey was conducted via a web portal and targeted 124 nurses attending in a nursing management training programme at the West China Hospital, Sichuan University. A total of 57.3% (71/124) of the nurses completed the survey. Of these, 29.6% (21/71) were unaware of NI and 70.4% (50/71) were aware of NI. However, only one of the nurses gave an accurate definition of NI. The results of this study suggest that there is a limited understanding of NI among senior nurses in mainland China, indicating a need to improve NI education for nurses.

Non-Fungible Tokens (NFTs) in Healthcare: A Systematic Review.

Amid global health challenges, resilient health systems require continuous innovation and progress. Stakeholders highlight the critical role of digital technologies in accelerating this progress. However, the digital health field faces significant challenges, including the sensitivity of health data, the absence of evidence-based standards, data governance issues, and a lack of evidence on the impact of digital health strategies. Overcoming these challenges is crucial to unlocking the full potential of digital health innovations in enhancing healthcare delivery and outcomes. Prioritizing security and privacy is essential in developing digital health solutions that are transparent, accessible, and effective. Non-fungible tokens (NFTs) have gained widespread attention, including in healthcare, offering innovative solutions and addressing challenges through blockchain technology. This paper addresses the gap in systematic-level studies on NFT applications in healthcare, aiming to comprehensively analyze use cases and associated research challenges. The search included primary studies published between 2014 and November 2023, searching in a balanced set of databases compiling articles from different fields. A review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework and strictly focusing on research articles related to NFT applications in the healthcare sector. The electronic search retrieved 1902 articles, ultimately resulting in 15 articles for data extraction. These articles span applications of NFTs in medical devices, pathology exams, diagnosis, pharmaceuticals, and other healthcare domains, highlighting their potential to eliminate centralized trust sources in health informatics. The review emphasizes the adaptability and versatility of NFT-based solutions, indicating their broader applicability across various healthcare stages and expansion into diverse industries. Given their role in addressing challenges associated with enhancing data integrity, availability, non-repudiation, and authentication, NFTs remain a promising avenue for future research within digital health solutions.

Nursing Undergraduates' Perceptions of Nursing Informatics Courses.

The aim of this paper is to explore how nursing undergraduates perceive a nursing informatics (NI) course. Between 7 and 14 September 2023, a survey was conducted with 51 nursing undergraduates who enrolled in 2021. A structured and open-ended questionnaire was used to explore their perceptions of the course. A total of 90.2% (46/51) of the students completed the survey. Of the respondents, 69.6% (32/46) were unaware of NI, while 30.4% (14/46) were aware of it. Furthermore, 93.5% (43/46) of the respondents supported the introduction of a nursing informatics course. The results of this study will guide the development of NI curricula.

Using Technology to Improve the Mental Capacity Assessment and Deprivation of Liberty Safeguards Process.

The process of mental capacity act (MCA) assessment and depravation of liberty safeguarding (DoLS) was identified as an area for improvement. The project aimed to ensure that patients admitted to hospital for care and treatment were appropriately assessed if there is doubt about their mental capacity and that the subsequent legal process of DoLS is followed as needed. The project group sought to address this issue using clinical informatics through the electronic health record and data reports to re-design the process. User involvement was key to ensure the process and key pieces of documentation were designed to be easy for staff to use with responsibilities clearly defined. The importance of operational staff having good visibility of the end-to-end process was key to allow staff to identify and address any gaps in the process in real time without the need for escalation by the safeguarding team. A robust data report further supports the safeguarding team to effectively manage this group of vulnerable patients. The project has significantly increased appropriately the number of MCA assessments undertaken and subsequent DoLS applications submitted to local authority partners.

Clinical Informatics in Pre-Registration Nurse Education.

This case study explores the pivotal role Clinical Informaticians in Nursing and Midwifery in Wales can have within pre-registration education. It underscores the necessity for nurses and midwives to adapt to digital transformations in healthcare delivery and discusses the potential digital career paths within the often-misunderstood domain of digital nursing. The initiative aimed to enhance awareness at both national and local levels, collaborating with educational institutions to incorporate digital education into pre-registration nursing programs. In partnership with the University of South Wales, sessions were tailored to the existing curriculum to highlight digital career opportunities and foster digital understanding among future nurses. The session design was aligned with course guidelines to emphasize the role of digital technology in quality improvement and leadership. Evaluations using interactive tools facilitated continuous improvement and provided insights, shaping the future of digital integration in nursing education.

Technology-Related Safety Event Analysis in Community Clinical Informatics: A Case Study.

This case study presents a process that was iteratively developed for clinical informaticians to identify, analyse, and respond to safety events related to health information technologies (HIT) in community care settings (This research was supported by the CIHR Health Systems Impact Fellowship Program. We would also like to thank Vancouver Coastal Health for their valuable contributions.). The goal was to build capacity within a clinical informatics team to integrate patient safety into their work and to help them recognize and respond to HIT-related safety events. The technology-related safety event analysis process that was ultimately developed included three key components: 1) an internal workflow to analyse voluntarily reported HIT-related safety events using a sociotechnical model, 2) safety huddles to amplify learnings from reviewed events, and 3) a cumulative analysis of all events over time to identify and respond to patterns. A systematic approach to quickly identify and understand HIT safety concerns enables informatics teams to proactively reduce risks and prevent harm.

Integrating Justice, Equity, Diversity, Inclusion & Indigeneity into an Informatics Curriculum.

In this case study, we present the inclusion of justice, equity, diversity, inclusion, and Indigeneity (JEDI-I) principles into a graduate certificate in clinical informatics. We specifically focus on two assignments that were created for the program: 1) journal club, 2) usability evaluation. We found that there was limited description of JEDI-I principles in journal club articles. New criteria for authentic resource evaluation were somewhat met in the usability evaluation of a sexual health website. Incorporating JEDI-I principles into the assignments supported fulsome conversations about end-user of technology in healthcare. Identifying examples of including JEDI-I would strengthen students' experiences in clinical informatics programs.

Nursing Informatics Competencies of Graduate Nurse Educator Students: Descriptive Study.

The advancement of technology and Artificial Intelligence applied health information systems demand high informatics competencies from nurses. To prepare nursing students to meet this demand, informatics courses are designed to increase informatics competencies. We offered an online informatics course to graduate students in a Nurse Educator program and assessed their informatics competency, including subdomains. Survey data were collected between Fall 2020 and Fall 2022 using an online Self-Assessment of Informatics Competency Scale for Health Professionals. We analyzed 109 responses and found that students were competent in overall informatics competency and the subdomains of "basic computer skills" and "applied computer skills (clinical informatics)." They were proficient in the 'role' subdomain. However, students reported less competency in managing data and incorporating standard terminology into practice. These findings provide detailed insights of the current nursing students' informatics competencies and can guide informatics faculty in improving their courses.

What Is the Level of Nursing Informatics Competency of ChatGPT?

Nurses must excel in using Artificial Intelligence (AI) - applied hospital systems, making their informatics competency crucial. ChatGPT has been trained with extensive amounts of informatics- and technology-related health data and has gained popularity. Nurses could have the opportunity to enhance their informatics competency through the knowledge generated by ChatGPT. However, its informatics competency has not been evaluated. We used the Self-Assessment of Informatics Competency Scale to measure the level of informatics competency of ChatGPT. ChatGPT fell within the range of 'somewhat competent' and 'competent,' lower than that of students in graduate programs. One subdomain, applied computer skills (clinical informatics), demonstrated competency levels close to that of students. Although the results presented certain limitations and concerns, we recognize the potential of ChatGPT to help researchers and healthcare practitioners. Nursing is advancing and continuously integrating AI technology; therefore, we should now embrace both the benefits and risks associated with ChatGPT.

Supporting Digital Health Integration in a National Curriculum: The New Zealand Experience.

The World Health Organisation considers that digital health can play a vital role in strengthening health systems, including increasing equity in access to health services; however, to realise the benefits of digital health this subject needs to be included in nursing education. In New Zealand the recent establishment of the centralised Te Pūkenga Institute of Skills and Technology allows for the creation of a common unified curriculum for entry to nursing programmes among the community-based tertiary education providers. Expertise to advise on the digital health component of the curriculum was sought from the New Zealand nursing and midwifery informatics group and this group's contribution is reported here. Delays in implementing the new curriculum means that by the end of 2023 no students had yet graduated, and evaluating their success, combined with research into the students' preparedness for working in a digital health environment is recommended.

Dissemination of Strategies for Reducing Excessive Documentation Burden: 25x5 Task Force Activities Relevant to Nursing.

Burnout and workforce shortages are having a negative impact on nurses globally, particularly after the COVID-19 pandemic. Within the United States, excessive documentation burden (DocBurden) has been linked to nurse burnout. The experience of a system or system-imposed process inhibiting patient care is a core focus area of nursing informatics research. The American Medical Informatics Association (AMIA) 25x5 Task Force to Reduce DocBurden was created in 2022 to decrease U.S. health professionals' excessive DocBurden to 25% of current state within five years through impactful solutions across health systems that decrease non-value-added documentation, and leverage public/private partnerships and advocacy. This case study will describe the work of the 25x5 Task Force that is relevant to nursing practice. Specifically, we will describe three projects: A) Toolkit for Reducing Excessive DocBurden, B) Development of Pulse Survey for Health Professionals Perceived DocBurden, and C) HIT Roadmap to Promote Interoperability.

Incorporation of Generative AI in an Introductory Nursing Informatics Course.

This case study describes how one educator approached the incorporation of generative AI into a graduate-level introductory nursing informatics course. Policy for acceptable use of generative AI was set separately for each assignment and disclosure of use was included in grading rubrics. Classroom discussions were used to explore issues surrounding generative AI such as trust and ethical concerns. One assignment required the use of a generative AI output to serve as the first draft of patient education material that was then to be improved by the student. In an accompanying reflection, students described their key takeaways from the experience of completing the assignment. The approach for this course was successful in achieving the goal of familiarizing students with the uses, benefits, risks, and ethical implications of using generative AI in the classroom and in healthcare. Opportunities are identified for improvement of assignment instructions.

The National Transformation of Nursing Documentation in Wales.

In response to findings indicating poor standardisation and quality in nursing documentation, NHS Wales embarked on a transformative journey with the National Electronic Nursing Documentation Programme in 2014. Evolving into the Welsh Nursing Care Record (WNCR) by 2019, this initiative sought to streamline practices and enhance accuracy, compliance, and efficiency through a standardised digital platform. The case study explores the comprehensive project design, emphasising evidence-based practices, governance processes and the introduction of National Nursing Informatics roles. Accomplished from April 2021 to September 2023, the WNCR implementation achieved a 79% roll out across eligible wards, marked by strategic investments, robust training, and phased deployment. Evaluations to date show positive impacts on key performance indicators, exemplified by a 9-minute time saving per patient. Lessons learned noted the significance of user engagement, cultural transformation, and ongoing staff development, paving the way for future strategies including nationwide implementation, benefits realisation, and data visualisation initiatives.

Strategies used to detect and mitigate system-related errors over time: A qualitative study in an Australian health district

BackgroundElectronic medical record (EMR) systems provide timely access to clinical information and have been shown to improve medication safety. However, EMRs can also create opportunities for error, including system-related errors or errors that were unlikely or not possible with the use of paper medication charts. This study aimed to determine the detection and mitigation strategies adopted by a health district in Australia to target system-related errors and to explore stakeholder views on strategies needed to curb future system-related errors from emerging.MethodsA qualitative descriptive study design was used comprising semi-structured interviews. Data were collected from three hospitals within a health district in Sydney, Australia, between September 2020 and May 2021. Interviews were conducted with EMR users and other key stakeholders (e.g. clinical informatics team members). Participants were asked to reflect on how system-related errors changed over time, and to describe approaches taken by their organisation to detect and mitigate these errors. Thematic analysis was conducted iteratively using a general inductive approach, where codes were assigned as themes emerged from the data.ResultsInterviews were conducted with 25 stakeholders. Participants reported that most system-related errors were detected by front-line clinicians. Following error detection, clinicians either reported system-related errors directly to the clinical informatics team or submitted reports to the incident information management system. System-related errors were also reported to be detected via reports run within the EMR, or during organisational processes such as incident investigations or system enhancement projects. EMR redesign was the main approach described by participants for mitigating system-related errors, however other strategies, like regular user education and minimising the use of hybrid systems, were also reported.ConclusionsInitial detection of system-related errors relies heavily on front-line clinicians, however other organisational strategies that are proactive and layered can improve the systemic detection, investigation, and management of errors. Together with EMR design changes, complementary error mitigation strategies, including targeted staff education, can support safe EMR use and development.