Nurse Informatician Series

1. How did you start your career in nursing? What first drew you to informatics?

I worked in public health and acute care pediatrics to begin my nursing career, transitioning to nursing education where I have spent the last 16 years engaged in teaching and research. Very early in my research career, I realized that my interest in technology in the classroom was going to be a significant driver of my overall program of research. I had focused on communities of practice in my doctoral study and felt that technology was rapidly creating new communities in health and beyond, and that was that!

2. What was your first role in informatics?

I have been engaged in nursing informatics research since completing my doctorate in 2014! It is a rapidly changing, exciting field that has afforded me many different opportunities to partner with practitioners and patients in the pursuit of improved health outcomes through the use of digital tools.

3. What is your current role and what is the focus of the role?

I have recently moved into an Associate Professor role in the Faculty of Nursing at the University of Calgary. Here I will continue to advance my informatics research and scholarship at an institution committed to social innovation that influences positive societal change.

4. What messages do you have for nurses interested in working in the informatics field?

Even prior to the pandemic, the world was rapidly moving towards a digital future and this journey has only been accelerated in many areas as the result of the global COVID-19 challenge. Given where we are on this trajectory, there has never been a better time for nurses to engage in informatics education, ongoing professional development, or other data or digital based learning in order to enrich and evolve their professional roles.

1. How did you start your career in nursing? What first drew you to informatics?

I began my nursing career at the tender age of 18, completing a geriatric aide course, and working in long term care all through nursing school, eventually graduating from Victoria’s first college-based diploma program. After moving to the Yukon Territory, newly married, I was beyond excited to launch my nursing career as a new grad at Whitehorse General Hospital on the medical/surgical units. With over 40 years in health care, what an incredible journey it has been, providing direct patient care in med/surg, critical care, perioperative, and PeriAnesthesia areas. I have also had the privilege to work in multiple education and leadership capacities all while continuing my academic studies. All of these years combined have informed my direction towards Nursing/Clinical Informatics and I am so very proud to have joined the many nurses who came before and after me in this regard!

While working in ICU in the Yukon, I found myself curious about how biomedical technologies augmented our everyday practice - ultimately becoming the extension of our senses and intuitions. In other words, I realized early on that these devices enable us to visually incorporate the data outputs into our assessments and ongoing monitoring of the patient; essentially, they adding to my assessments and/or validating the patient’s often invisible physiological queues. These technology enablers excited me and I wanted to learn more about how they could fully optimize my practice in the context of the care delivery workflows. Fast forward to the bedside computer age - and an incredibly informative undergrad course delivered by none-other than Dr. Kathryn Hannah, one of our true Canadian pioneers in Nursing Informatics - who was my professor in Nursing Applications in Computers - she and Dr. Lynn Nagle continue to be my inspiration in this area; and because of them and many others, we as nurses get to realize fully integrated and digitally enabled care environments that include a completely digitized patient record with highly integrated biomedical solutions!

2. What was your first role in informatics?

While working towards a Masters in Nursing Science with directed study in Health Information Science, I became a PowerChart (Cerner EHR) Trainer in 2005 at my local health authority. I then went on to become the first Clinical informatics Specialist and eventually established the inaugural Clinical Informatics program at Island Health.

3. What is your current role and what is the focus of that role?

I have recently retired from Vancouver Coastal Health as Regional Director, Clinical Informatics and Standardization and am now acting in a consulting capacity with Cross-Owl Consulting in health informatics.

4. What key message do you have for nurses interested in working in the informatics field?

Oh my goodness, this domain of digitally-enabled practice is likely one of the most exciting, intellectually challenging and opportunistic growth areas in nursing and health care! There is no other practice domain in nursing that encompasses your practice, knowledge, clinical data analysis and standardization, health systems thinking, transformational leadership and change knowledge and experience, demands for the translation of practice and clinical standards across digitized practices and workflows at/near the point of care, and the ultimate integration of all of the technology solutions imaginable! This the most exciting and ever-expanding area of practice in health care!

How did you start your career in nursing?  What first drew you to informatics?

I graduated from a community college (CEGEP) nursing diploma program in Quebec in the 1970s and after moving to Ontario in early 1980s, worked at SickKids Hospital in Toronto for 40 years, retiring from there just 2 months ago. During my career I continued my academic preparation, completing undergraduate and graduate degrees. As nurses we collect, analyze, and communicate patient assessments, using their data to adjust care. We rarely acknowledge that this is “doing” informatics. My interest in informatics grew as I participated more in technology acquisitions and implementations.

What was your first role in informatics?

In the early 2000s I led a project to implement new physiological monitors and patient monitoring practices across the hospital. This first formal informatics role was followed by being the liaison between nursing and IT for the implementation of a new electronic health record. In November 2003 I was named the Director of Nursing Informatics and over the years expanded my portfolio to include more operational and strategic responsibilities.

What is your current role and what is the focus of the role?

After successfully implementing a new health information system (Epic) in 2018 I was promoted to Chief Nursing Informatics Officer. My responsibilities included operational oversight of a number of clinical application/informatics teams/staff; translating clinical business needs to determine the best path for new technologies or optimizing existing systems – often through revising or cementing processes and accountabilities; designing workflow in the context of technologies; addressing patient safety issues that could be addressed/ prevented through informatics. 

Although I retired at the end of May this year, I continue to be on the CNIA Board and support the University of Toronto Master of Health Informatics program, and I have started some consulting work.

What key messages do you have for nurses interested in working in the informatics field?

Recognize that you “do” informatics every single day, even if you don’t recognize that is what you are doing. Participate in activities or forums where you can influence the introduction or improvement of systems that you use. Nurses are in a unique position to provide insights into patient journeys and how the various disciplines interact when providing care to a patient. Your voices are important and can lead to improvements in patient care and clinical operations.  

How did you start your career in nursing?  What first drew you to informatics?

Nursing was not actually my first career after High School.  I honestly wasn’t sure what I wanted to do, but my brother was in his 3^rd year of Computer Science at the University of New Brunswick (UNB) and was really enjoying it.  He was especially enthusiastic about the co-op program, and since it would allow me to gain experience and help pay for tuition, I decided it was worth a try.  I enjoyed the program, but when I graduated in 2006 it was with the realization that what I’m passionate about is helping others.  During that time, I also joined Weight Watchers and lost 65 pounds, and decided that I wanted to learn how to help others be healthy.  In 2007 I applied for UNB’s accelerated BN program with the vague hope that my IT skills might still be useful at some point in my future career.  I was accepted into the program, and after the first few courses, I had the realization that I was MEANT to be a nurse.  This is where I belonged.

What was your first role in informatics?

I was fortunate to obtain a permanent position at my local hospital immediately after graduation as a bedside RN on a Family Practice / Cardiac Step-Down unit.  Unfortunately, a back injury led me to leave bedside nursing 8 months later, and I have been working in informatics ever since.  My first Nursing Informatics role was as a Business Analyst with the hospital’s IT department, supporting their Electronic Health Record system (Meditech), along with several other clinical applications.  I really enjoyed that role as it allowed me to learn an enormous amount about these applications and provided the opportunity to work with a wide variety of people in other areas of the organization.

What is your current role and what is the focus of the role?

I am currently a Business Intelligence Analyst for Horizon Health Network.  In this role I am responsible for creating visually engaging, interactive reports based on hospital data in the Microsoft Power BI application.  This role is a fantastic fit for my background as it allows me to combine the skills I acquired during my Computer Science program with my Nursing background and my knowledge of our Electronic Health Record system.

What key messages do you have for nurses interested in working in the informatics field 

The thing I enjoyed the most from my Computer Science program was learning computer programming.  It’s super fun, a useful skill, and aligns incredibly well with the problem solving we employ as Nurses.  If you are a student and have a chance to take a programming elective, take that chance.  Otherwise, there are a ton of free learning experiences available online.  Canada Learning Code is an organization I have volunteered with in the past; they provide a variety wonderful free learning experiences.

How and why did you become interested in nursing informatics?

The mid 90’s, working as a charge nurse on a Thoracic Surgery unit, was my first exposure to the impact technology, specifically informatics, could have on patient care and outcomes. Between the devices and applications we were using daily and the opportunities provided because the unit manager, who already appreciated the potential of technology in patient care, would volunteer to participate in trials of new systems. The hospital was still very paper centric with paper charts, processes and records. That said the organization was taking steps towards expanding implementation and use of clinical systems and applications.
As part of that expansion, the implementation of an electronic clinical documentation system was being planned. To do this they would need to build a team of folks with clinical expertise and an aptitude for technology to plan, build and implement a system that supported clinical practice. A posting for an Informatics Nurse for this team caught my attention. Some of the key responsibilities for this role included working with multidisciplinary teams, providing design guidance, building documentation screens and reports and finally insuring review and approval. All of which I knew I could do and was very interested in doing. I was successful and have been working in clinical informatics every since.

The more I learned about informatics, the more I knew I had to be part of it. The informatics nurse position saw me facilitating design groups, providing education and training, and seeking out new opportunities to introduce new technology tools to existing clinical groups.

I joined the Nova Scotia Nursing Informatics Group and have been an active member for the last 20 years. Through the years I have held many of the executive positions, currently I am the treasurer.   We are a small dedicated group that has organized many conferences, educations sessions and serve as a resource for the College of Registered Nurses of Nova Scotia.   Membership and participation in this group helps me to stay in the loop of current trends and attended national conferences.

While the clinical documentation system was not implemented even though a great deal of time and effort went into the design and build, leaders in the organization recognized that clinicians working in collaboration with technical team are a positive. The new role in the Information Technology (IT) department was created, Clinical Informatics Coordinator which is my current role.

Describe what your current role involves?

My role, as a Clinical Informatics Coordinator allows me to wear many hats, so days are never boring.

I am responsible for many aspects of integrating technology into practice – working with users to understand the wants and the needs, analyze the options related to available technology, and identify the opportunities for change. I then translate these findings into design, work collaboratively with IT folks to build and ultimately introduce the changes back to the user group. My goal is to insure the changes bring process improvement whether through better and/or easier data capture, improved patient care, access to clinical information or improved reporting.

Each of the hats is just another aspect of clinical informatics. From education to design to delivery to evaluation I am the liaison between the clinical and technical worlds.

Which areas of nursing informatics do you find most interesting?

I find the change management piece most interesting. Working thru the changes with clinicians enabling them to make informed decisions is both challenging and rewarding

What advice do you have for others who are interested in nursing informatics?

Your level of technical expertise is not important; it is your clinical knowledge that is the key.

Join your local and national Informatics groups. Get involved. Attend workshop, conferences, and webinars.   These opportunities will help to develop a network of people with the same interests and expertise.

Why did you join CNIA?

I joined CNIA to become part of the bigger picture. I wanted to know what was going on across the country and learn from others and to share my knowledge.

How and why did you become interested in nursing informatics?

I became interested in nursing informatics when I began working at one of the most highly digitalized hospitals in Toronto, Ontario. I was there working on a project where I implemented Registered Nurses Association of Ontario wound and skin care best practice guidelines. During the implementation I learned about the importance of electronic health records in providing nurses with point of care support in the form of clinical documentation, decision support tools, online educational resources and tools in supporting nurses’ and other health professionals’ work as well as data analytics. As part of this initiative, I had the opportunity to re-design and modernize components of the electronic health record to support nursing wound and skin care activities.

As my interest in designing and implementing health information technology grew, I sought out opportunities to be more actively involved in the implementation of clinical information systems. I moved into a clinical informatics specialist role where I had the opportunity to work on implementing and testing health information systems in another highly digitalized acute care hospital. I found the work interesting and enjoyed learning about and implementing cutting edge technologies that could improve the quality of health care processes and patient outcomes.

It was during these two experiences: working as a user of electronic health records and then as a designer/implementer that I became interested in nursing and health informatics research surrounding the design and implementation of technologies and their effects on health professionals’ cognitive and workflow processes. It was at this point in my career that I decided to pursue doctoral studies in the Department of Health Policy, Management and Evaluation with a research focus on management and health information technology systems.

Shortly, before completing my PhD, I took a faculty position at one of the oldest and largest health informatics schools in Canada – the School of Health Information Science at the University of Victoria in Victoria, British Columbia, Canada. Over the past few years I have been involved in teaching, consulting and research with a focus on studying and improving the quality and safety of health information systems, mobile health care software applications and social media applications to improve the quality and safety of clinical, patient and citizen health care. As a result of this interest I founded a new international working group devoted to healthcare safety through health information technology as part of the International Medical Informatics Association (IMIA) – the Health Informatics for Patient Safety Working Group.

I have also been honoured with the opportunity to serve as an Academic Representative for Canada on behalf of COACH – Canada’s Health Informatics Association (2007-2013) and as Vice President representing North America (2010-2013) on the Board of Directors of IMIA. In both these roles I was fortunate to be able to represent Canada, travel internationally and observe the best practices that could be brought back to Canada and integrated into my classroom teaching.

Describe what your current role involves?

I am currently an Associate Professor at the School of Health Information Science at the University of Victoria. I teach health informatics courses to undergraduate and graduate students in the School of Health Information Science. As part of this work I have had the opportunity to co-design the first nursing informatics graduate degree program in Canada (i.e. a joint, online program between the School of Nursing and Health Information Science), and I currently supervise students in this program. I am also involved in developing health informatics undergraduate and graduate curricula in the School of Health Information Science. In addition to teaching and curriculum development, in my role I am heavily involved in research and community outreach activities focusing on health informatics competency development for clinicians and health informatics/information technology professionals.

Which areas of nursing informatics do you find most interesting?

Over the last few years, I have been involved in developing several streams of research. I have been conducting research in the area of technology safety focusing on identifying technology-induced errors and methods for improving the safety of health information technology. I published one of the first articles about technology-induced errors and the relation of user interface design features, functions and workflows to technology-induced errors. Since then I have been working on developing methods that can be used to improve the safety of health information technology by studying how safety heuristics, usability testing, clinical simulations and techno-anthropologic approaches can be used to identify the root causes of technology-induced errors and the technological factors that can lead to their occurrence.

I have also been involved in research studying and evaluating the design and implementation of clinical documentation systems, medication administration systems, medication reconciliation systems, bar coding technologies, clinician order entry systems, telehealth and mobile eHealth applications.

In addition to this work I have spearheaded educational research focusing on developing clinical and health informatics competencies in nurses, physicians and health informatics professionals. Much of this research has been focused on introducing electronic health records into undergraduate and graduate curricula. Lastly, I have been spearheading research in the area of clinical informatics, evaluating the impact of health information technology on patient outcomes and how technology can be improved to support health professionals’ work in hospital, home care, public health and community settings.

What advice do you have for others who are interested in nursing informatics?

If you have an interest developing a career in nursing informatics, consider pursuing formal nursing informatics education. Over the past several years there have been many changes in the educational landscape of nursing informatics programs. There are currently graduate programs in nursing and health informatics in both online and on-campus formats. Seek out opportunities to extend your knowledge around the design, development, implementation and maintenance of health information technologies. There is a significant need to advance nursing and health informatics knowledge and there is a need for nurses to contribute their expertise to this growing field of study and practice.

Back in the early 80’s, I had the opportunity to work in one of Canada’s first fully computerized hospitals located in New Brunswick. After adjusting to the world of online documentation, care planning, order entry, results review and a variety of other functional components, I came to realize the significant benefits to be derived from such a system. Most notable was to no longer struggle to decipher hand-written orders, clear and consistent documentation, and new safety nets for medication administration. Despite the system not having an intuitive, colourful interface, it did have light pen, point and click device which worked marvellously – of course the notion of a “mouse” had yet to be conceptualized. I always wondered why that particular design disappeared, tethered to the monitor, it required minimal time and training to become comfortable with its use. While the system was one of the earliest to market, it endured for almost 3 decades, ultimately being lapped by new technology, new vendor products and of course, was incompatible with new notions of systems design and architecture, standards, interoperability, and a new generation of computer savvy users.

During those early years, I made a move from NB to Toronto to pursue graduate studies. As a full-time student I found a casual staff nurse position in a large academic health science centre. Initially dumbfounded to learn that computerized systems were not the norm in a majority of healthcare organizations, I quickly learned that my previous employer was among a handful of early adopters of these new tools. Having to revert back to paper processes was disappointing but also the impetus for the pending turn in my career path. Immersing myself into the world of “informatics”, I found organizations like COACH and AMIA and began to meet and network with other like-minded nurses. My informatics career path has taken many interesting turns including different practice and leadership roles, participating in research, setting policy directions, developing health informatics competencies and programs of study, consulting, and the opportunity to work nationally and internationally. At times very challenging and frustrating, it has also been exhilarating to ride an evolving wave for almost 30 years!

Describe what your current role involves?

Today I spend my time in a variety of ways. I love teaching so dedicate a good portion of time to educating our future nurse leaders and health informaticians. Although working primarily with graduate students, I am also working with other faculty to advance the integration of informatics into undergraduate nursing programs across Canada. The current Digital Health Faculty Peer Network is providing an opportunity to extend our capacity to ensure that nursing grads of the future are “informatics ready” to work in the majority of healthcare organizations that are now much more advanced in their use of information and communication technologies as compared to 30 years ago.

I also spend a good portion of my time focused on my health informatics consulting practice that affords me a chance to work with many different organizations. I have truly enjoyed the variety of work in my independent practice in the world of informatics – tackling everything from IT strategic planning systems acquisition, implementation, and evaluation. Overall, developing health informatics leadership capacity for the future is probably the biggest focus of my work activities these days.

Finally, volunteer and Board activities are now a big part of my work life; there’s lots of more work to be done, so no shortage of things to do!

Which areas of nursing informatics do you find most interesting?

While I enjoy all aspects of informatics, the most challenging but also most rewarding is working with clinicians and health leaders to develop their understanding and appreciation of the potential of informatics. I want them to embrace the centrality of informatics science and practice that enables safer, quality care but also garners efficiencies and cost-savings for our health care system.

The implementation of health information systems has presented us with an unprecedented opportunity to standardize approaches to the measurement and capture of health data. However, we have yet to capitalize on this opportunity; instead persisting in designing organizationally unique tools for universally common practices much as we did in the paper world. Time to put this discussion to bed once and for all.

Historically, organizations have not done a good job at evaluating the outcomes of their ICT investments so I have a particular interest in advancing our collective discipline in this area.

What advice do you have for others who are interested in nursing informatics?

In a word, “network”; discover and connect with others doing this work, get to know others and be known. There are a number of forums in which to do this: join CNIA and your jurisdictional chapter if one exists and get involved with COACH. The best thing you can do to develop your career in informatics is to participate in meetings and conferences, volunteer for working groups, and identify opportunities to advance your formal education and training. Lastly, if possible, find yourself a mentor. All of these options were few when I started, but they are there for the taking now.

What was your goal in founding CNIA?

Although there was once a nursing special interest group within COACH, this group was disbanded in 2000. All of sudden our small but important network of nurse informaticians had no home. Thinking about the time, it was post-Y2K, many organizations were beginning to implement EHR’s, nurses were being seconded to IT departments to support these projects, Infoway’s predecessor (Office of Health Information Highway) was inviting clinicians to strategy and planning tables and nurse participants were few and far between. At the time, CNA was being asked to provide input and did not have an identified community of nurse informaticians to draw upon.

In discussing these unfolding events with a group of interested colleagues, it became apparent that we needed to organize. The primary focus: to ensure that the voice of nurses would be part of Canada’s thought leadership for health informatics immediately and for the long-term. Moreover, advancing informatics opportunities and creating a network for communicating with like-minded nurses in Canada was a necessity. Affiliating with CNA served secure a home for our group and has provided them with immediate access to CNIA expertise over the years; the rest is history!

Follow Lynn on Twitter @LMNagle

How and why did you become interested in nursing informatics?

My nursing informatics path has been a little different than most. I had looked to nursing as an area of study but this was during the early 90’s in Alberta when we were experiencing health care cuts, and there were limited employment opportunities. I also had an interest in technology so decided to enroll in a post-secondary undergraduate program in computer science, since this type of knowledge could be applied to many areas. I then worked for seven years as a computer programmer in the field of military defense research. However, my need to be in the healthcare field resurfaced, so re-entered school to receive my Bachelor in Nursing. I had a wonderful opportunity come forward shortly after graduation that would use both my nursing and computer science training: implementation of a clinical information system for homecare, within my jurisdiction. Being able to work with both clinical and technical team members to ensure the clinical system met the needs of the business related to clinical practice, change management, safe usage and adoption peaked my greater desire to learn more about nursing informatics. I researched many options to learn more and eventually enrolled into a Masters in Science in Nursing Informatics, which I completed in 2010. Since then, I have been involved in additional home care CIS projects within Alberta, as well as the selection and implementation of a standardized multi-disciplinary care planning taxonomy within Alberta home care. I have had roles within the clinical business, information technology, and the Chief Medical Information Office: all of which have provided me with opportunities to describe the role and how nursing informatics clinicians are foundational to transforming care delivery with technology supporting the health outcomes for our patients/clients.

Describe what your current role involves?

My current role is with Alberta Health Services (AHS) Chief Medical Information Office. I am the Program Director responsible for informatics competency and practice standards. Basically, I am responsible and accountable to ensure that healthcare professionals and others are prepared for the adoption and ‘meaningful use’ of health information and health information technology in the effective delivery of healthcare services of the future.

One of the key elements of my portfolio is the development of strong relationships with AHS internal stakeholders including clinical, operational, corporate, and information technology leadership, in identifying key priorities and opportunities for the development of informatics training and career development. I’m also involved in the development of Informatics training programs, curricula and competency assessments within AHS. Within the CMIO, we strive to provide opportunities for advanced informatics training and research by supporting undergraduate and graduate student practicums.

Networking with other nursing informatics clinicians is something I enjoy greatly, so I’m always looking for opportunities to get involved, such as, an abstract reviewer for annual conferences including Canada’s eHealth and HIMSS. Recently, I have accepted the President position with our Nursing Informatics Association of Alberta (NIAA). I believe there is a great deal to learn from our United States colleagues, so I’ve maintained connections with classmates as well as having an active membership with the American Nursing Informatics Association.

Which areas of nursing informatics do you find most interesting?

The field of nursing informatics is so vast. The one area that I am passionate about is the development of competencies and practice standards for the use of health information technology (HIT). Being able to work with front line clinicians to develop skills and knowledge on the use of HIT and how it can be integrated into their day to day care deliver keeps me connected to clinical care. Using these clinician connections, I am also able to build on another area of interest: adoption of HIT. Being able to support clinical adoption with clinical competencies and practice standards enables clinicians and healthcare organizations to gain the best health outcomes with the investments into HIT.

What advice do you have for others who are interested?

As I think about how to get involved in informatics, I would reiterate many of the points shared by Dr. Nagle in her CNIA profile around networking, connecting with mentors, and getting involved in HIT initiatives. Understanding the roles of the various Informatics associations such as COACH or Canada Health Infoway and how they can support informatics practice is also important.

Within Alberta, we have a jurisdictional Nursing Informatics specialty practice group (NIAA) that is available to anyone including Nurses and Allied Health. As part of my role with the AHS CMIO, we have developed a Clinical Informatics Community of Practice (CoP) which is available to anyone within our organization. This CoP has also developed connections with NIAA to support wider networking opportunities.

Why did you join CNIA?

I became involved with CNIA a few years ago and saw it as a great opportunity to support the voice of “nursing informatics” in Canada. Having a national association to represent the unique practice needs and research opportunities in Canada will help advance our practice as well as elevate the need to involve nurses (and other clinicians) into HIT initiatives. As a member, I enjoy the educational events sponsored by CNIA, as I am keenly interested in knowing what is happening in other Canadian jurisdictions.