The Life of a Nurse Informaticist

May 2012Andrew Schwartz

Gina Wade is executive director for clinical informatics at Adventist Health, a not-for-profit, integrated health care delivery system that has 18 hospitals, more than 100 clinics and outpatient centers, 37 rural health clinics and 14 home care agencies throughout the western United States. In 1998, she received her master’s degree in nursing informatics from UCSF School of Nursing and has been in her role at Adventist since 2000.

HIMMS (Healthcare Information and Management Systems Society) did a survey a year ago and found that an informatics nurse comes to the job based on experience. They were a nurse on a floor, helping to deploy nursing documentation, and were tapped on the shoulder by a vendor to come work for them. Informatics nurse specialists are formally prepared, as I was, with a master’s degree in nursing informatics.

At our headquarters in Roseville, where we have a large IT department and house all of our hospital data, I play a number of roles. One is contributing to the design and build of different EHR functions. You can’t just put technology on current paper process. You have to build a workflow that augments what the technology can do. You have to know how to structure, create and drive these systems so they remove what’s redundant, and incorporate what’s important and how it all aligns.

I also act as a liaison between the technical and clinical communities. When a client wants a specific functionality or workflow, I can take it and go to the application builders and speak their language to explain what the clinical folks are looking for. If technical people have issues, I can go back to the clinical folks and try to find the resolution that will technically work.

Informatics nurse specialists also work with leadership regarding regulatory and quality initiatives – and governance for technology implementation and change. For example, we work with the delivery-of-care team – the chief nursing officer, chief medical officer and quality leadership – who might give us a directive based on improving patient safety by decreasing readmissions.

We’ll identify the key areas where studies tell us problems arise: inadequate discharge education, a patient doesn’t have support at home, poor hearing or sight, or being on multiple medications. We’ll take those variables and identify how and where in the system we should alert a nurse that this is a possible red flag and give her the elements of a plan to decrease the risk for a readmit. We explain to the technical and application team what we need the system to do. They build it, and we validate the build. Then we go back to clinical leadership and demonstrate what was designed and built. If approved, we take it to the hospitals and ask for feedback, which might lead us to tweak it again.

Research is another big area for informatics nurses. A lot of the research that is done is used by vendors in their development of a product. It’s a symbiotic relationship, and good vendors sincerely incorporate and use what they hear from people in this role.

Having an informaticist makes a huge difference in an IT project, because somebody has to be able to translate and talk to leadership to bring them on board before any initiative. Without that, any type of change management can’t be successful. That’s why there’s such an increase in demand for nurse informaticists; it takes people like us to understand and then translate the clinical needs into a technology function and vice versa.