Balancing the Business and Clinical Sides of Informatics


How do you balance the business side of informatics with the clinical side of informatics - advice on how to balance both for quality healthcare? Can you provide some thought processes you go through when assessing the landscape?

Answers from Rhelinda McFadden, RN:

A Unique Adevnture

The balancing act for me expands from the National Strategy for Quality Improvement in Health Care’s three broad aims: better care, more affordable care and healthy people / healthy communities.   By meshing the aspects of business informatics with clinical informatics, along with the integration of health information technology, it creates a unique adventure for every primary care practice that we work with.   

Through focused efforts in these rural ambulatory practices to address / streamline processes, maximize system functionalities, analyze the data to identify missed opportunities and to monitor for improvement in outcomes we can more effectively and efficiently identify / manage the patient populations within the practice.  By treating the incorporation of health information technology as a practice transformation and by analyzing the data, we can improve the quality of health care we are providing to our patients in addition to providing better communication and coordination of a patient’s care resulting in decreased costs for both the patient and the practice. 

Align incentive program metrics

Processes to consider when working with the small to mid-size rural practices who are striving to capture every additional dollar available to them through state and federal incentive programs (e.g., EHR Incentive Program, Physician Quality Reporting System (PQRS), e-Prescribing, Comprehensive Primary Care Initiative (CPCI), Patient Centered Medical Home (PCMH)), it is important to define and  align of as many of the incentive program metrics for the practice in order to minimize change fatigue.  In assessing each practice one of the first steps to take is to determine the technological skill level of the practice and identify gaps that can produce barriers to success.   Because many of these practices have only recently adopted / implemented electronic health record (EHR) systems and are struggling with changes in the care delivery design which necessitates an individualized approach to ensuring their success while moving away from “the way we have always done it” and toward meaningful use of the technology.  While adopting EHR technology should streamline processes the potential for huge barriers exists if nurses and other users are not educated properly on how to use the technology.  Overcoming these barriers can create culture shock for many nurses involved but by identifying ways to optimize the process and workflow for the unique environment we gain buy-in which is needed to meet the demands of health care today.   

Adopting a Pro-active Approach

We know that health care is expensive and that technology is changing the way that health care is provided, but we have to look at the big picture.  By moving from a reactive approach to practice to a pro-active approach we are transforming care by improving the efficiency, safety and quality of care being provided to the patient and are making progress toward a goal of patients receiving the right care, at the right time, in every setting, every time. 

Yoder-Wise, P.S. (2011).  Leadership and Managing in Nursing (5th ed.).  St. Louis, MO: Mosby Elsevier
McBride, S., Delaney, J., Tietze, M. (2012 August) Health Information Technology and Nursing.  AJN, American Journal of Nursing.  112(8):36-42.  Doi: 10.1097/01.NAJ.0000418095.313171b

Answers from MaryBeth Mitchell:

I like to think my passion for nursing and for the nursing experience drives everything I do.  My entire nursing career has been hospital-based, and am used to looking at everything first from a patient outcome perspective, and then secondly, from a clinician experience perspective.  Through my work in informatics, I have the ability to drive quality and improved patient outcomes, as well as impact the business side by creating efficiencies and support for nurses, not only in the hospital, but throughout the entire continuum of care.

Increased Quality at a Lower Cost

The recent 2012, Institute of Medicine (IOM) Report- Best Care at Lower Prices, really addresses this issue of how to manage both quality and costs.  Now more than ever, we must rely on our technology to provide increased quality through lower costs.  The electronic health record is certainly a tool that nursing Informaticists can use to optimize care through clinical decision support tools, such as reminders for Core Measure and Quality indicators, inclusion of evidenced-based practice criteria, and monitoring through analytics of outcomes.  In addition, organizations seek to provide additional safety, quality, and value, through the formation of Accountable Care Organizations, Patient Safety Organizations, Partnership for Patients, and other national initiatives. I believe as a Nursing Informaticist, I have a unique perspective to understand both the clinical impact, as well as the business impact or these initiatives, and can look for ways to use technology to provide the most efficient and effective solutions to deliver care, while managing all our system initiatives efficiently.  Without technology, how can a nurse or any clinician hope to meet all the requirements and remember everything they need to do throughout their day?

A Strategic Role

I also see the role of Nursing Informaticist as being very strategic, in support of ongoing and future initiatives of the organization.  As CNIO, I work with equally nursing, information technology, and health Informatics to define our roadmap for the future of our system.  This may include enhancement and optimization of the EHR, as well as development of other technologies, including patient care systems like smart pumps, or nurse call.  In addition, providing better means for patient care, through advancing technology is key, such as exploring new ways to use mobile technology to provide better access to information for clinicians.  It is an exciting time to be involved in Nursing Informatics, and a great time to be a nurse.  The HIMSS Position Statement for Nursing Informatics in response to the Robert Wood Johnson landmark document on Transforming Nursing Practice, discusses how Nursing Informatics can meet the challenges of the evolving healthcare system through leadership, education and practice.  As a nursing Informaticist, and CNIO, I can address the challenges of managing the business needs of the organization to provide quality care, within the constraints of multiple regulatory and strategic requirements, and also meet the needs of the clinician to provide the best care possible. 

HIMSS Nursing Informatics Position Statement on Transforming Nursing Practice through Technology & Informatics (2011)

Smith et al, editors, Institute of Medicine (IOM) Report (2012) Best Care at Lower Cost: The Path to Continuously Learning

October 2012