By Laura Raines, Pulse editor
In 1988, Leanne Johnston stood in the middle of a labor and delivery nursing station and declared, “I don’t need a computer; I’m a nurse.”
Now, as clinical lead senior trainer instructional designer for Kaiser Permanente of Georgia, it’s Johnston who rolls out new electronic medical records systems and trains staff how to use them.
With a talent for teaching, she gradually became more involved with computers and information technology, and was working in nursing informatics by 2005.
“I get tickled when I can show nurses and doctors how these systems can make their jobs easier,” said Johnston, RNC, MSN-Ed. “Since I still type with two fingers and didn’t grow up with computers, I have instant credibility with others. I tell them, ‘If I can do it, you can do it.’ ”
Health informatics — combining information science, computer science and health care — is an emerging nursing specialty.
“The field is evolving as we go along, and in the last five years it’s really taken off,” she said.
Bachelor’s and graduate-level training is available now, and the American Nurses Credentialing Center offers a certification for nurse informatics specialists.
Most health care facilities need someone on staff who can communicate between the IT and clinical worlds. The titles, background and responsibilities differ, depending on the needs of the organization.
Versatility a plus
Informatics specialists may help design and customize electronic records systems for health care use, train end-users, solve technology problems and implement new functions, as well as provide system surveillance and user support.
“By default, the role usually falls to a nurse, because they have a broad overlap of clinical experience working with physicians, pharmacists, radiologists and others,” Johnston said. “Knowing the language makes it easier to train people.
“I can’t imagine doing this job well without having practiced nursing first. You have to understand the flow of clinical processes and procedures to be able to show nurses and doctors what they can get out of electronic medical records.”
Making medical records visible to all health care providers saves time, decreases medical costs and errors, and improves patient safety.
“You don’t have different physicians ordering the same test,” Johnston said.
Electronic systems also make it easier to conduct research while protecting patient confidentiality.
“Our new KP.org program allows patients to e-mail their physicians, ask questions, make appointments, order prescription refills, look up terms in a medical dictionary and get health tips,” Johnston said.
The program also improves access and customer service.
Because she thinks enhanced technology and good training are important to patient care, Johnston says her role is as satisfying as delivering babies. “Informatics is another route for nurses to take, and one that advances the image of the nursing profession.”
Seeing the big picture
Beth Singleton, manager of clinical informatics at DeKalb Medical in Decatur, likes the broad scope and challenges of her job.
“I’m the only informatics nurse for three campuses, so I have to be a big- picture person, and [I am] constantly adding to my clinical knowledge,” said Singleton, RN, MSN.
She knows that one tweak of the system can affect practice guidelines, regulation compliance and standards. Nursing has prepared her to listen and observe.
“You have to be a good communicator and not afraid to ask difficult questions,” she said. “Just because you’ve always done something one way doesn’t make it right.
“You don’t want to take a bad process and computerize it. That doesn’t help anyone.”
Singleton, who graduated from nursing school in 1983, eventually became an oncology clinical nurse specialist.
“I never in my life thought I’d be working with computers. I’m more of a people person, but I recently read that the computer is going to be as important to health care as the stethoscope,” Singleton said. “It’s where you get your orders, results and information, and [you] can see changes happening. Everyone needs computer competency now.”
As a member of the medical documentation committee at DeKalb Medical, Singleton was part of the organization’s move toward electronic medical records, which started in 2000. The hospital created a team of nurses, doctors, lab technicians, radiologists and pharmacists to work with DeKalb Medical’s IT vendor to design and build systems for the hospital.
“We didn’t know what we were doing at first. It was like learning Mandarin Chinese,” Singleton said.
Along the way, she took plenty of IT courses and took on a new job.
“I love what I do and still get excited when we go live with a new system, as we did recently in the emergency department,” she said. “It takes months of planning, designing, testing and more testing to make sure we have all the pieces we need and the system is doing what we designed it to do.”
Teaching comes in when staff has to be trained and then a command center is set up for troubleshooting. Johnston once lived at the hospital for three days during a go-live rollout.
“As a nurse, I want to make sure it’s not only working, but effective,” she said. “There’s some stress, but it’s exciting to see the lightbulbs go off with end-users as they begin to see the benefits — not that there aren’t usually some glitches.”
In the past, staff resistance to new technology was a challenge, but now most users accept it.
“Now a lot of my job is to help them gain competency and to be aware of new changes and improvements. We want them to use all the bells and whistles,” Singleton said.
Singleton has no doubt that her job results in better patient care and safety. She also has few worries about job security.
“I’m like the clinical nurse specialist of the IT world,” she said. “Often, I have a hard time getting from point A to point B.
“People will say, ‘Don’t leave yet. I’ve got a question about this.’ More nursing students are asking to shadow me, and that’s good. There will be an ongoing need for this specialty.”