Health Information Technology Still Not Fully Embraced

February 28th, 2012

By Jennifer Olin, BSN, RN

Just recently a friend of mine was asking me questions about the use of lasers in cataract surgery. I have a little experience in eyes but not enough to answer her questions. Besides, most of the eye guys I know still use a standard metal blade for the standard cataract surgery. What this question did make me think about was all the high tech changes there have been in every area of medicine and nursing. With every passing day we in healthcare become more technology dependent. It is a matter of necessity and, in fact, a matter of mandate.

The general public is, at a minimum, Google savvy and will look up the latest information on any illness with which they or their loved ones are diagnosed. They will see stories on the latest research, the latest tests, and the latest equipment and they expect their doctors and nurses to know and understand all of it. Nursing students are expected every day to understand the uses of healthcare information technology (HIT) and to understand new ways to treat old symptoms. When they are done caring for their patients they must be able to chart everything they do with the latest in Electronic Medical Records (EMRs).

In 2004 the Office of the National Coordinator of Health Information Technology was established and it embarked on a plan named the “Decade of Health Information Technology.” The agenda for the “Decade” strategic plan set four major goals to be accomplished by 2014:

1. Encourage the widespread adoption of electronic health records.
2. Interconnect clinicians so that data and information can be more easily shared.
3. Personalize care through the use of personal health records and telehealth.
4. Improve public health through accessible information.

In order for these changes to come about there had to be buy in from the academic world, particularly health care education. The American Health Information Management Association and the American Medical Informatics Association held summits that focused on building a workforce for health information transformation. Numerous recommendations were posed, including these suggestions for academic institutions:

• Collaborate to ensure that standardized informatics educational competencies are embedded in a variety of relevant curricula.
• Promote faculty professional development in electronic information technologies.
• Support the passage of legislation to strengthen programs and increase funding for health informatics, education programs, student recruitment and retention, and faculty development.

Technology Informatics Guiding Education Reform (TIGER) Initiative

As technology and time continues to race ahead the TIGER Initiative was conceived as a response to the lack of nursing involvement in meeting federal initiatives. More then 40 nursing professional organizations came together in 2007 to create a vision and a three-year action plan. The TIGER Initiative was aimed at enabling practicing nurses and nursing students to fully engage in the unfolding digital era of health care. To reach its goals, TIGER established the following recommendations for schools of nursing:

• Adopt informatics competencies for all levels of nursing education (undergraduate/graduate) and practice (generalist/specialist).
• Encourage faculty to participate in development programs in informatics.
• Develop a task force or committee at each school to examine the integration of informatics throughout the curriculum.
• Encourage the Health Services Resources Administration's (HRSA) Division of Nursing to continue and expand its support for informatics specialty programs and faculty development.
• Measure changes from baseline in informatics knowledge among nursing educators and students and 
among the full range of clinicians seeking continuing education.
• Collaborate with industry and service partners to support faculty creativity in the design, acceptance, 
and adoption of informatics technology.
• Develop strategies to recruit, retain, and educate current and future nurses in the areas of informatics 
education, practice, and research.

So here it is, 2012, and we are less than two years from the deadline initially set for the “Decade of Health Information Technology.” Following in his predecessor’s footsteps on this one topic, President Barak Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act as a component of the American Recovery and Reinvestment Act. It provides $20 billion through 2014 to promote the use of health information technology.

And yet, despite this incentive, researchers and industry watchdogs tell us that healthcare has been one of the slowest businesses to embrace the computer revolution in regards to patient care, and nursing has been one of the slowest to embrace technology to its fullest. What’s that about?

Reluctance

New nurses of the “millennium” generation have grown up using computers. Their familiarity with information technology started in the crib and today they embrace IT as part of everyday life. However, that is not true for nurses across the board. Researchers site several possible explanations for the apprehension nurses and nursing leaders have towards adopting the new technologies including fear of change, fear of losing control due to unfamiliarity with technology and the time and money it takes to invest in these upgrades.

Another area that must be considered is the rate at which physicians and hospitals are adopting EMR systems. Recent survey results released show only 50.7% of U.S. hospitals have implemented EMRs. Nurses and physicians are not accepting of technologies that do not seamlessly fit into their day-to-day activities, improve patient care or enable them to work more efficiently. I know from experience, at hospitals I’ve either worked in or observed, RNs and MDs will ignore new technology, new programs, new applications until they have no other choice.

There are also issues about security and privacy that worry healthcare providers. Computers are not infallible and the Health Insurance Portability and Accountability Act (HIPAA), which set national standards for the security of health information, protects patient health information with strict penalties for violating that privacy.

All of these issues will have to be addressed before we can have a working national health information network. And, we will need to find ways to integrate all the different companies who produce the many different HIT systems. I think getting this all done by 2014 may be a stretch.

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