By Whende M. Carroll, MSN, RN-BC
The evolution into the age of automation and emerging technologies such as intelligent, immersive, connected, and personalized technologies in healthcare, is both exciting and challenging. Hype and excitement about using novel technologies in practice, and the development of new technology at lightning speed are flourishing. With this, nurse informaticists need to address one aspect not readily discussed in the whirlwind of the development and application of these technologies: safety. Nurses informaticists have a massive opportunity to thoughtfully assess the inputs and outputs of emerging technologies in clinical settings. As decisive critical thinkers, they will be a voice of safety in the use of emerging technology to safeguard their application in care delivery.
In clinical practice, clinicians are held to the high standard to promote safety and quality (National Academies of Sciences, Engineering, and Medicine, 2018) and prohibit implicit bias (The Joint Commission, 2016). Health IT that transforms care delivery and significantly impacts patients and families, communities, and clinicians, requires the same level of safety, quality, objectivity, and fairness. With the new collaborations between healthcare organizations and big and small IT companies that expedite the development of new technology-based products, careful consideration about the why, how, what, who, and when we should develop and implement new scientific advancements is imperative (Browne, 2018).
While there is a place for emerging technologies in healthcare, avoidance and skepticism by many clinicians remain due to safety, quality, and ethical concerns. These behaviors are leading to the slow adoption of novel technology in practice. Characteristics of revolutionary technology, particularly their nature of rapid development and ambiguity (Rotolo, Hicks & Martin, 2015) are concerning. However, these traits spark innovation and are essential for healthcare to keep pace with other industries. In all phases of the emerging technology lifecycle, including conceptualization, needs assessment, development, testing, and validation of new technologies, patient and workforce safety needs to be at the forefront. With this mindfulness, and the courage to ask crucial questions that abound despite a precipitous environment where ambiguity thrives will safeguard emerging technologies and ultimately mitigate patient harm.
Ambiguity and velocity are vital elements in the development and implementation of emerging technologies in health IT. Understanding this, it is clear that these elements can lead to developers missing critical societal fragments, unleashing an explosion of ethical issues and unsafe conditions in practice. Human representation, well-being, impact, and accessibility need careful reflection during the conception, evaluation, development, testing, employment, marketing, and research of emerging technologies. Innovative services, products, and new models “Rush to Market” tendency can be misleading and not representative of those intended. In the feasibility and validity phases of technology innovations, the human element of design, usability, and experience need close consideration (Lehoux et al., 2014). Nurse informaticists are well-positioned to influence the transparency of emerging technologies. An example of this is insisting on functional explanations and ease of interpretability with artificial intelligence solutions. Informaticists can also affect proper marketing and expose authentic proof of return and value on investment for both healthcare organizations and patients–those emerging technologies ultimately serve.
In the post-informatics era, transforming roles require nurse informaticists to become experts in all forms of new health technology. With this, we will need to insert classical nursing informatics knowledge into these systems and the processes they enable (Booth, 2016). One specific area is adhering to our oath to protect as we develop, adopt, and implement emerging technologies. Nurse informaticists, starting now, need a better understanding of the full lifecycle development of emerging technologies. With this, the roles of nursing informaticists will be to become purveyors of safety, as they come to understand the fundamentals of using emerging technologies better. Safety guidelines brought on through policy, governance, and ethics surveillance will fall to the informaticist by default.
During the early stages of emerging technology adoption, nurses can prepare themselves to support a culture of safety within their healthcare organizations. Whether home-grown or health IT vendor-developed, emerging technologies’ solutions, safety, and quality for patients end-users are paramount. For this reason, nurse informaticists should have adequate background and knowledge of the development process. Also, the intricacies of the specific use case, expected outcomes, intended users of the technology, and the projected timing of application must be considered. All play into patient and end-user safety. Before implementation, informaticist questions for the organization’s internal analysts and innovators, and health IT vendors about the new emerging technology process, model, or product should include:
Why: Is this an appropriate use case for the solution?
How: Explain the development process and performance of the technology during testing.
What: Describe the intended outcome for the solution.
Who: Clearly define the users of the technology.
When: What is the timeline for the solution’s implementation?
The answers to these critical questions will allow nurse informaticists to help make better decisions about applying the technology with quality and safety in mind. This knowledge will help identify gaps and problems that may lead to potential clinician and patient harm. Understanding these crucial elements will ensure we use novel technologies safely, and that they serve their purpose to assist in clinical decision making to give the right care to the right patient at the right time. As stewards of health IT, nurse informaticists can keep patients protected. The use of their invaluable informatics skills and abilities will support a culture of safety as healthcare ventures further into rapid change and ambiguity in the development of innovative emerging technologies.
CITATION: Carroll, W. (Fall, 2019). Nursing informaticists safeguarding the use of emerging technologies. Online Journal of Nursing Informatics (OJNI), 23(3).
Booth, R. (2016). Informatics and nursing in a post-nursing informatics world: Future directions for nurses in an automated, artificially intelligent, social-networked healthcare environment. Nursing Leadership, 28(4), 61-69. https://doi.org/10.12927/cjnl.2016.24563
Browne, R. (2017, May 19). Tech firms say A.I. can transform health care as we know it. Doctors think they should slow down. CNBC LLC. Retrieved from https://www.cnbc.com/2018/08/17/healthcare-and-ai-doctors-warn-on-the-pace-of-technological-change.html
Lehoux, P., Gauthier, P., Williams-Jones, B., Miller, F. A., Fishman, J. R., Hivon, M., & Vachon, P. (2014). Examining the ethical and social issues of health technology design through the public appraisal of prospective scenarios: A study protocol describing a multimedia-based deliberative method. Implementation Science: IS, 9, 81. https://doi.org/10.1186/1748-5908-9-81
National Academies of Sciences, Engineering, and Medicine. (2018). Crossing the quality chasm: The IOM Health Care Quality Initiative. Washington, DC: The National Academies of Sciences, Engineering, and Medicine. Retrieved from http://www.nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx
Rotolo, D., Hicks, D., & Martin, B. R. (2015). What is an emerging technology? Research Policy, 44(10), 1827–1843. https://doi.org/10.1016/j.respol.2015.06.006
The Joint Commission. (2016, April). Implicit bias in health care. Quick Safety, Issue 23. Oakbrook Terrace, IL: The Joint Commission, Division of Health Care Improvement. Retrieved from https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_23_Apr_2016.pdf