Nursing informatics is an evolving field in the burgeoning context of technologic and digital advances in health care. Nurse informaticists are integral in translating these advances into evidence-based clinical practice to improve the quality and safety of patient care and professional practice. This article describes the role and operationalization of nurse informaticists in the oncology setting. A case study is presented to exemplify how nurse informaticists can lead interprofessional teams in evaluating opportunities for process or quality improvement and implementing and evaluating digital solutions to improve oncology care.
AT A GLANCE
- Nurse informaticist is an evolving role that leverages technologic advances to support clinical practice.
- Nurse informaticists have many opportunities to enhance the care of individuals with cancer across practice settings.
- Building efficient, effective patient- and nurse-centered workflows can improve patient care delivery and the comprehensive nature of information in the patient’s health record.
First recognized as a specialty role in 1992 (Sewell, 2018), nursing informatics is defined as “the specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice” (American Nurses Association, 2015, p. 1). As a profession, nursing informatics has emerged to help drive evidence-based clinical practice through integrated electronic methods (Mills, 2019). An integrative review of 40 articles reported that nursing informatics affects nursing outcomes and healthcare quality and recommended further expansion of nursing informatics education and application of the role (Darvish et al., 2014). In an era of increasing digitalization of health care, including the nationwide implementation of electronic health records (EHRs), the nurse informaticist role is expanding in diverse clinical settings. This overview of the nurse informaticist role in the oncology setting includes a case study, which illustrates how the role influences clinical care delivery for individuals with cancer.
Role of the Oncology Nurse Informaticist
The complexity of oncology care, including care management, potentially by multiple specialty areas and across multiple care settings, creates the need for innovative technologic solutions in the oncology space (Dicker & Lim, 2018). Such solutions include interactive decision aids, mobile applications, web-based technologies (Dicker & Lim, 2018), and optimized EHRs. In oncology nursing, electronic solutions, such as the Oncology Interactive Navigator™, aid enhanced patient support and nurses’ professional engagement (Lau & Loiselle, 2018). As digital solutions, including and extending beyond the EHR, provide new opportunities to connect patients and providers to clinical resources, an oncology nurse informaticist has a critical role in supporting technologic advances that enhance practice in the oncology setting to improve safety, quality, and standardization of care. Oncology nurse informaticists may contribute to such advances through many roles, including educating staff about new technologic opportunities to enhance clinical practice and leading quality and process improvement initiatives to evaluate the impact of such solutions on clinical practice and care outcomes (American Nurses Association, 2015).
By virtue of their education (American Nursing Informatics Association, 2020b; U.S. News and World Report, 2019), certification (American Nurses Credentialing Center, 2020), training (American Nursing Informatics Association, 2020a; Nurse.com, 2020), or practice experience, oncology nurse informaticists are prepared to design and implement new electronic tools, conduct workflow analysis and enhancement, and train interprofessional colleagues in the use of such digital solutions. Clinical experience and certification in oncology supports understanding of the complex and rapidly changing practice environment and emerging evidence-based practice and guidelines that affect patient care, nursing processes, workflows, and communications. Informatics nursing certification, offered by the American Nurses Credentialing Center, further advances the nurse informaticist’s knowledge base. Strong personal interest in informatics (e.g., computer applications, databases, information systems) is helpful. Collaboration with interprofessional teams, including informaticists in other specialty areas, such as pharmacy, is necessary for successful implementation of this role (American Nurses Association, 2015). In this article, the authors present a case study of how an oncology nurse informaticist was operationalized at a fully integrated healthcare organization in the northwestern United States.
Billings Clinic is a Magnet®-designated, not-for-profit health organization serving Montana, northern Wyoming, and the western Dakotas (Billings Clinic, 2020). The Billings Clinic Cancer Center is accredited by the Commission on Cancer and serves more than 1,800 patients annually (Billings Clinic, 2018). More than 70 RNs are employed as part of an interprofessional cancer healthcare team. In 2009, the Billings Clinic first introduced the formal role of oncology nurse informaticist; currently, one full-time oncology nurse informaticist is employed at the center. The nurse informaticist engages with the following clinical practices: medical oncology, gynecologic oncology, radiation oncology, adult infusion center, clinic infusions, and pediatric oncology. The oncology nurse informaticist supports multiple operations of the EHR, including the build and maintenance of detailed order sets for chemotherapy administration and patient care, and nursing documentation. Nurse informaticists serve on the information technology committee to stay informed of constant evolution of the EHR, because changes from other specialty areas may affect workflow and documentation needs, both within the organization and at regional sites.
The oncology nurse informaticist leads evidence-based practice changes in collaboration with the oncology interprofessional team, among many responsibilities (see Figure 1). This is achieved by conducting gap analyses to identify opportunities for improvement, identifying key stakeholders to assist in process evaluation, and developing an implementation and evaluation plan that takes into consideration workflow and targeted outcomes. The oncology nurse informaticist follows national guidelines and regulatory standards to design, build, and maintain order sets, and to ensure that they function smoothly in the EHR. Management of symptoms and toxicities, laboratory and vital sign monitoring, therapies, referrals, and nursing orders are available with one click for ease and efficiency. This allows providers to electronically order everything needed to provide the best care possible to patients.
An oncology nurse informaticist identified the need to improve EHR documentation of cerebellar toxicity for patients receiving high-dose cytarabine treatment. Cerebellar toxicity assessment of patients on high-dose cytarabine was discovered to be inconsistently documented by nursing staff in the medical record on the acute inpatient oncology unit. Working in collaboration with the inpatient oncology nurse educator, the oncology nurse informaticist worked to create a new evidence-based assessment tool in the EHR. A review of the literature informed the development of a new electronic documentation tool that facilitated improvement of nursing assessment and documentation of this possible complication at point of care delivery (see Table 1). This tool was crafted in a flowsheet-style design and functioned to standardize assessment and documentation across inpatient and ambulatory settings. Reference text linking was added to provide an easy resource guideline for nurses to print and use to perform the assessment. The assessment tool prompted documentation of a critical nursing evaluation, and the required witness setting in the EHR ensured that the standard practice of two nurses witnessing the assessment was met.
Together with the nurse educator, the oncology nurse informaticist trained inpatient nurses on the new electronic assessment tool in small group settings. A training document provided step-by-step instructions on how to perform the assessment, as well as the rationale for why the assessment was valuable. To assess the implementation outcomes, nurse leaders conducted an audit of EHR documentation for patients on high-dose cytarabine, which revealed 100% adherence to flowsheet documentation. The oncology nurse informaticist rounded on the unit and gathered feedback from the nursing staff about their experience using the flowsheet, which suggested that having the assessment in an electronic format allowed them to quickly refer to previous assessments and immediately identify changes in patient status, thereby positively affecting patient care.
Implications for Practice
Organizations should embrace the opportunity to have an oncology nurse informaticist on the oncology team. If a facility hires a nurse with oncology experience into the oncology nurse informaticist position but that nurse lacks informatics experience, there are many ways to gain skills and nurse informatics knowledge through webinars, EHR vendor classes, reaching out to other oncology nurse informaticists, networking through professional organizations, and the core curriculum for informaticists (American Nurses Association, 2015).
In practice settings where staffing or budget may not permit full-time oncology nurse informaticist role implementation, a superuser model can be employed to identify emerging evidence and then effectively collaborate with healthcare teams to implement evidence into practice (Taylor, 2019). These specially trained nurses serve as content leaders who can either train or serve as a reference point for other nurses in the clinic setting.
The example of high-dose cytarabine documentation in this article can be applied to other populations or treatment types, as demonstrated in similar documentation development for chimeric antigen receptor T-cell therapy (Reimschissel et al., 2017).
As demonstrated at the healthcare organization in this article, implementation of the nurse informaticist role at point of care delivery offers unique opportunities for nurses to lead interprofessional teams in transforming clinical care delivery and professional practice. Driving changes through the EHR can effectively standardize practice and minimize variation in practice. The oncology nurse informaticist, who has experience and specialized knowledge in cancer care, can facilitate the successful implementation of evidence-based practice oncology initiatives. As guidelines rapidly change based on new research, the oncology nurse informaticist can efficiently update documentation measures to meet national guidelines and accreditation standards. The oncology nurse informaticist role can be operationalized formally in designated positions and in superuser roles to support translation of evidence-based digital and technologic solutions to clinical practice.
About the Author(s)
Brianna D. King, BSN, RN, OCN®, is an oncology nursing informaticist, Laurie A. Riemann, BSN, RN, is a research nursing informaticist, and Jeannine M. Brant, PhD, APRN-CNS, AOCN®, FAAN, is an oncology clinical nurse specialist, director, and lead nurse scientist in Collaborative Science and Innovation, all at Billings Clinic in Montana. The authors take full responsibility for this content and did not receive honoraria or disclose any relevant financial relationships. Riemann can be reached at firstname.lastname@example.org, with copy to CJONEditor@ons.org.
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