Building Linkages Between Nursing Care and Improved Patient Outcomes: The Role of Health Information Technology Health IT (HIT) is capable of transforming care quality and establishing connections between patient outcomes and nursing care. This article will examine the application of health IT and nursing-sensitive measures/indicators (NSIs) for improving care quality and establishing connections between better patient outcomes and nursing care. NSIs refer to measures reflecting nursing care process, structure, and outcomes. NSIs of outcome denote caregiver or patient measurement approaches sensitive to nurse care. While a number of advocates deliberate over the perceived advantages of health IT, an honest consideration of practical experiences with real HIT systems, together with the drawbacks and obstacles associated with poorly-constructed systems, is not addressed. Ultimately, the aim must be improvements to quality, added convenience, and growth of efficiency, rather than mere creation of wired health facilities. Nursing informatics as a practice specialty is having a major impact on the way care is planned and delivered in the current healthcare environment. Nursing informatics refers to that component of informatics designed for and relevant to nurses and includes information management, knowledge from sciences other than nursing, and the importance of informatics within all areas of nursing management (Chapter 3, n.d). This paper will illustrate HIT's role in managing better patient outcomes and nursing care, by concentrating on the following 2 mechanisms: 1) HIT interventions, and 2) eMeasurement, which directly target nursing-sensitive measures.

Background

Longstanding evidence exists of nursing care's relationship with better patient outcomes. Pioneer of nursing, Florence Nightingale, employed quality improvement facts and figures for supporting a hand-wash effort to prevent death of Crimean war soldiers due to infections acquired in the hospitals. In the last ten years, the Interdisciplinary Nursing Quality Research Initiative (INQRI) of Robert Wood Johnson Foundation demonstrated nursing care impacts upon patient-sensitive care outcomes, like delirium prevention, fall prevention, and pain management (Balas et al., 2012). In spite of scientific advances occurring since the middle of the 19th century, U.S. patient care quality continues to be suboptimal. A collection of reports by the IOM (Institute of Medicine), issued in the last 10 years, indicate that care quality across the nation (or the nation's healthcare structure) is variable, and rates of error are high. Even in places where evidence can be found, it is not applied consistently in practice. Another concern is mounting healthcare expenditure, which presently accounts for 18% of GDP (gross domestic product). If this trend persists, healthcare expenses for 2040 will be as high as 34% of GDP (Council of Economic Advisors, 2009; Dykes & Collins, 2013). Variable care quality and unsustainable expenses are fueling changes to healthcare practice and policy. HIT adoption has been recommended for long as an approach that will facilitate safe, economical, and superior quality patient care and management.

Review of Literature

Healthcare information technology contributes to evidence-based care through a standardization of terminologies and structure in documentation. In addition, the use of digital information, the standards allowing for data exchange between heterogenous entities, the ability to capture data relevant to actual care provided, and competency among practitioners to use data will all contribute to evidence-based care. Institute of Medicine (IOM) Reports support the use of healthcare information technology to improve practices and promote patient safety. Informatics is a core competency for all healthcare professionals and is seen as an important force in improving health care management (Chapter 3, n.d).

Since long, technology's role has been taken into consideration by nurses at the time of processing extensive data sets required to validate outcomes sensitive to nursing, and while grouping these outcomes. The ANA (American Nurses Association) has backed attempts to define such measures using the NDNQI (National Database of Nursing Quality Indicators) and Nursing Care Report Card for Acute Care. At present, the NQF (National Quality Forum) is at the top of an endeavor to create e-measures for ensuring reutilization of data employed for clinical/medical documentation for measuring patient health results as a care management byproduct. NQF's QPS (Quality Positioning System) represents a web tool that aims at improving access to every NQF-approved measure. QPS includes a few NSIs, like patient fall frequency and patient falls causing injury. Quality measurement using NSIs is a complex process, since information required for populating the indicators stems from various sources, of which several are non-electronic. HITs integrated into clinical workflow, and which produce structured coded information as an offshoot of patient care as well as administrative processes are required for populating eMeasures and supporting nursing workflow and management. Large-scale eMeasure application will guarantee measures employed across different HITs...

HIT's significance in connecting nursing care to patient outcome improvements has been examined. Through leveraging of eMeasures, effectively-designed HIT interventions will be able to aim at processes of care delivery and forge linkages between patient outcomes and nursing care. Though literature indicates that HIT may be utilized for improving patient outcomes in terms of treatment safety and care quality, few studies have investigated the link between NSIs and HIT use. A 2009 Cochrane Review assessed the impacts of nursing documentation systems on patient outcomes and nursing practice. Study authors came across just nine research works performed with adequate rigor for meeting inclusion conditions. Of these researches, only 4 could assess computerized nursing documentation systems, while the rest assessed paper-based (manual) systems. Researchers arrived at the conclusion that some evidence could be found, of the fact that HITs can help improve certain issues like decreasing time devoted to data collection. However, no evidence existed of nursing care recording and planning systems' ability to improve patient outcomes or nursing practice (Dykes & Collins, 2013).
Patient care delivery is chiefly dependent on information to make effective decisions. All nursing actions are reliant on data-based knowledge. The process of nursing commences with information gathering and communication initially, as well as in continuous assessment. NI or nursing informatics refers to management of information, data, wisdom, and knowledge applicable to nursing. With the advent of the EHR (electronic health record) era, NI has grown to be a crucial element in nursing practice. Every nurse in practice now employs informatics skills (Hughes, n.d).

Discussion

Knowledgeable, astute, and empowered medical consumers (i.e., patients) are driving hospitals' business and clinical cases for improving patient experiences and gauging these improvements with time. One critical factor that forms part of HCAHPS' (Hospital Consumer Assessment of Healthcare Providers and Systems') 6 axes is nursing care; a number of hospital patient care and nursing services have programs in place for improving pain control, communication, respect, courtesy, etc. for ensuring positive patient experiences (Dykes & Collins, 2013). In places where it seems right, from a business perspective, health IT has been adopted successfully either by making one's offering better than rival organizations' or lowering overall costs. One potential benefit of electronic patient record storage is that for certain physician consultations, the element of distance can effectively be made irrelevant. Moreover, a few consultations might be sufficiently simple and can be performed by any doctor who has examined a patient's health records. Therefore, HIT can provide patients with improved care and management access (Herrick, Gorman & Goodman, 2010).

Public health proponents and federal lawmakers claim that expanded HIT implementation will reduce costs and lead to quality improvements. However, one setback is: HIT represents a vehicle, rather than a destination. HIT systems installation in a clinic or hospital is more difficult than software installation from a compact disk or setting up an Internet connection on a computer. Furthermore, most health information (both electronic and manual) continues to be compartmentalized into "silos," in which records stored by any one healthcare provider on any system may not be accessed by other providers. While HIT systems ensure prevention of common errors, new ones are also introduced. The risk with HITs is, these systems foster, rather than decrease, likelihood of errors. HIT employed by clinicians has to appropriately work with one among the most varied and complicated work settings information technology has attempted to support, while focusing on real-world complexities and subtleties, linked to exacting consequences. Effective HITs should be customized to user requirements, increasing the possibility of failure of government-imposed systems (Herrick, Gorman & Goodman, 2010).

EHRs' advantages to healthcare facilities, patients and physicians alike are substantial. However, the "ugly" and the "bad" are frequently capable of outweighing the "good." For avoiding such issues, healthcare systems and hospitals should conduct a comprehensive HER system evaluation prior to purchase and adoption. The profession of nursing is vital to discipline-specific as well as interdisciplinary modifications essential for achieving effective, efficient, and safe care. New to the clinical skills and vernacular set are the aspects of microsystems change, systems thinking, evidence-based practices, high-reliability health organizations, innovation, implementation and translational science, team-based patient care, and transparency (Stevens, 2013).

HIT interventions prove most efficient when management as well as clinical processes are dealt with, and when organizational leaders strongly support improvement strategies. Also, the use of clinical experts for bridging knowledge gaps as well as the involvement of peer champions within the process of implementation promotes HIT intervention adoption and constant use.…