mydesygn

There should be a downtime process available. I would contact the Info Systems or Education depts so they can get you the correct information if you are unsure what to do. Generally, each institute does something slightly different - typically orders are entered once the system comes up. This may be done by the ancillary depts such as lab, pharmacy etc... There may be a timeframe for documentation. For example, if the system was down less than 2 hrs - you would enter your documentation - if it was more than 2 hrs, you would have the paper documentation scanned in and enter a note in Epic stating the timeframe in which the paper documentation that was scanned covered.

I was wondering the same thing- typically - mapping LOINC codes to lab tests is done by a LIS (Lab info systems) coordinator. Depending on your EHR, you should have a nomenclature vendor who would assist with that also

I'm not exactly a nurse informaticist but a nurse who works as a systems analyst... My day 08: 00 spend an hour reading and responding to email. Most consist of questions / tasks regarding projects 09: 00 review the ticket que - I see 2 tickets to (1) build new orders for our EHR and the (2) other to update an orderset - I review the tickets and revise the orderset in both our Live (Production) system and Test. the second ticket I email our nurse informaticist - it's from a nurse manager requesting an order to remind the nurses to complete an assessment - question whether this is appropriate as an order - possibly better suited as a nursing assessment 10:00 attend CPOE committee meeting 11:00 lunch 11:30 testing new custom developed application - found 2 crash errors, functionality for approval working for all physicians instead of design 12:30 more email 1300 attending project meeting 1400 EHR running slow - called major outage - turns out to be a network issue not EHR related 1430 meet with case management 1530 spent next 2 hrs working on report to display patients pending lab orders 1630 chatted with co workers regarding earlier outage 1700 went home

I distinguish informatics from analyst. The informatics jobs are usually looking specifically for nursing/healthcare and focus on implementation / workflow. It's typically your analysts that do building / maintenance etc.. Depending on the facility, they may do both. I work as an analyst - currently the job market is light on pure informatics jobs in my area (but may be better dependong on the location you are looking and if you are willing to relocate) - you will want to search healthcare analyst as well as informatics. Many of the open HIT positions at major hospitals are focused on SQL, reporting, interface etc.. From what I have heard from one recruiter, even the consultant firms are letting go of consultants. Easiest thing is to set up searches on some of the major job sites (Indeed, Careerbuilder) and just see what the qualifications are for various listings.

I think with your background, you don't need to look specifically for informatics - there aren't that many. You have technical skills - a business analyst and/or systems analyst would be a better fit and more opportunities. Typically, informatics position don't require significant technical skills - generally they tend to be geared toward education and workflow changes. With most healthcare having implemented CPOE, documentation etc.. there isn't as much of a need. However, having technical skills such as SQL, programming, database development etc.. are far more valued. Most healthcare are needing the technical - they need people who can write and pull metrics and stats, who can test and build, who can help in terms of data mining , interface development etc.. Business analysts tend to have more contact with the customers so it helps being a nurse but they also are expected to work a variety of projects / implementations etc.. where the technical skills are more valued. I don't know how much value there is in an informatics degree - I don't know of any staff working in informatics that have a degree specifically in informatic- a MSN is just a valuable from my perspective. But other areas of the country may be different.

Hopefully, large hospital systems are starting to see how critical it is to maintain adequate staff to support, build and maintain their documentation. One great thing about Meaningful Use money is that healthcare began taking IT more seriously and devoting resources. I still hear stories of facilities maintaining low inhouse staff to support the EHR. The end users don't know any better and blame the EHR for the facilities failure to have current PC's, servers with another memory, strong wi fi, adequate staff to build and modify documentation and ordering, end users who are invested in the development etc.. But there is also the opposite spectrum where end users expect the EHR to perform critical thinking. I seem to get these requests constantly. I had a physician ask if the EHR could auto-renew their restraint order. When I replied back that the purpose of renewing an order every 24 hrs is so that YOU (a thinking skilled person) will EVALUATE the patient and the continued need for the order. Auto-renewing is no different than have a series order for a patient. I get questions to flag for every conceivable condition and yet they are annoyed by the number of pop ups they have to see. I generally take the approach that the alert is an easily missed or critical component of patient care that would be important for caregivers - not merely a convenience to prevent YOU the caregiver from reviewing and evaluating the appropriate patient information I remember with the Ebola scare last year, the very first thing the hospital did was blame the EHR stating the patient's travel information was "lost" by the EHR (which was Epic - I believe) I knew the moment I heard it - that it was not true that most likely it was recorded but simply had not been reviewed by the ER physcian as it wasn't their habit to even take into consideration foreign travel and regards to infectious disease. Can the software flag when foreign travel and fever are documented - yes you can still ignore the flag as another annoying popup. Humans are always the critical piece - no software should replace them. I recognize the overwhelming amount of documentation and verification that caregivers must do but until they realize that ultimately the purpose of the EHR IS NOT to make you work as a caregiver easier but to make the CARE OF THE PATIENT better then you will consistently focus in the wrong ends. The best builds and solutions I have found come from workgroups that focus on how to get and maintain accurate patient information as opposed to what the system needs to do for me. The best documentation builds have come from clinical staff who had the right mindset and approach and because they participated in the process of the build , they understood what they were documenting/alerted on and why Most EHR vendors are becoming better about focusing on ease of use and reducing clicks but that can't be at the sacrifice of accurate patient information.

Typically, I find that expectations are unrealistic. An EHR is not Itunes - all Itunes has to do is play and purchase music. So, the software can be very simple and easily maintained. An ehr has to maintain extremely complex and personalized data on thousands of different people. It has to calculate and warn on changing medications and doses from age 1 day to 100 years, It has to have customized documentation for a variety of healthcare providers from pathologists, child life, chaplains, respiratory therapists, not just nurses and doctors. It has to try to maintain rules and warnings for staff who no longer have the critical thinking skills to carefully review their care before they provide it. The build and maintenance of healthcare ehrs is enourmous and expensive. Ask yourself why Microsoft and Google failed to get anywhere in the market. Most EHR's cost 70 - 80 million just to purchase let alone millions of dollars each year to the vendor There is no such thing as stopping supporting a system that contains the health records of 100's and thousands of people. The technology in the 80's still has to maintained and accessible. Unlike Microsoft can't simply decide to stop supporting a version of software (win 98 for example) - they don't have that luxury Hospitals made multiple attempts to not pay and provide staff to adequately maintain and support the hardware and software - often trying to outsource and failing. That slowness is not the software , it could be a poorly maintained network, servers that lack enough memory and outdated pc's

I agree - at the end of the day - there is no magic formula - sometimes it's just having some skills and applying for the job at the right time. Most employers will overlook lack of education for experience, sometimes a little experience with a little education may put you ahead. I can say there is nothing worse than a bad hire on a team - we've hired staff with years of technical experience to only realize that they have little self motivation or intellectual curiosity and have to be told what to do and how to do it. They barely understand the customers they serve and don't actively seek to learn the healthcare business. Staff like that are dead weight on a team. Yet Having years of clinical nursing in no way assumes that you have the technical curiosity and intelligence to test and troubleshoot clinical systems. How can you be effective if you barely understand the system any better than the clinical staff the use it. I think informatics like other specialized professional occupations don't have a clean route of entry.

I think having a Masters in Nursing is helpful - it demonstrates that you have some advanced education. That does help a lot cause it separates you from the pack. I can certainly see not wanting to jump into another degree program. I'm not sure if I would either but I think trying to look into bridge positions where you can gain some IT experience might be helpful and you may also get lucky and happen to apply for a position where they are willing to take a chance. You never know until that happens so I would keep looking for opportunities, beef up your resumes and just apply - won't hurt. Also, look for bridge positions , don't rule out positions just because they are not specifically informatics - a technical trainer in Education or a Research Data Analyst or a Clinical Documentation Auditor can often get you exposure, experience and networking to get you where you want to be. Management is also helpful.

In general, our facilty has over 120 staff in the IS dept which is pretty good for a large metropolitan area. Of the staff - not one has a degree specifically in informatics. The two nurses hired with the title of informaticist both came from Education and have a BSN. As a pure informaticist, you actually don't do the high volume of technical work (ie server support, databases, interfaces etc..) this type of work is typically performed by the technical staff. I am not an informaticist nor are the 4 other nurses working with me - we are systems analysts . This is the distinction. As a systems analyst, you are not limited to purely clinical projects involving nursing and providers. I have worked on various software implementations for our dietary dept, bed management dept, ehr upgrades, rehab, respiratory, lab, meaningful use etc.. None of which utilized my nursing patient care background specifically; however my knowledge of the healthcare systems and the workflows is what is valued not so much my patient care experience. The informaticist tend to focus more on nursing and provider workflows (documentation, order entry etc..) My issue with focusing nursing informatics as opposed to healthcare information systems is eventually most facilities will have implemented documentation, barcoding, cpoe etc.. There is a pretty good market now. I have seen many institutions bring on consultant for 6 mos stints with these implementations but not necessarily hire for informaticists. They tend to hire for analysts with technical skills such as interfaces, report writing, sql, etc.. nice way to see what is available is to search the job postings of various hospitals filtering for information systems - there are very few postings specifically for informatics. Your informatics posting are usually posted in the Education dept as technical trainers. As far as other positions, it's tricky without demonstrated experience - some of the nurses I have worked with tended to work within hospitals, case management, research etc.. Research (in addition to Education) is also a good place to transition from if you can.

Most employers are looking for experience with the big EHR's. Having a degree in computer info systems and a RN will get you looked at but hospital based informatics tends to rely a lot on having worked with IS staff at the hospital in a super user role. My suggestion would be to try to gain experience with the EHR at your hospital - you are right, it is tough but you may be able to volunteer for doing chart audits but I'm sure your current manager wants you on the floor in staffing and so getting in the superuser role can be challenging. I wouldn't expect support in your dept - it is of no advantage to them to encourage your growth in another position. Like most positions, you want to network - joining local chapters of informatics groups might be helpful if you live in an area large enough to have an active chapter. I have a degree in info systems as well as nursing and happened to apply for an opening at my hospital at the right time when the IS dept was specifically looking for a nurse. I didn't have any EHR experience but a lot of nursing and management but I was quite fortunate. I would recommend getting a degree in information or computer systems and not informatics specifically. Like you said, a master in informatics is not particularly useful without experience however a general computer degree demonstrates that you have learned a wide variety of platforms and can demonstrate an understanding of information systems plus it is useful in other fields besides healthcare. I would suggest trying to get on with a consulting firm to gain experience with EHR - obviously that's travel and they want experience too but you may at the minimum get on somebody's radar.

Don't miss bedside nursing one bit. Once I left bedside nursing, i never looked back. As a pediatrics nurse, I miss caring for the patients but I gladly accept the long IT hours to the long nursing hours. I feel much more valued as a clinician in IT than I ever did as a staff nurse. It has been nice to be valued as a professional. Would I go back to the bedside - only if I had to.

For a systems analyst, you would not necessarily need a clinical degree/background. A systems analyst could support any part of the healthcare IT - anything from financial applications (such as Kronos) to administrative applications to medical records. As a systems analyst, you can work with any application or dept within the healthcare system. You may be expected to do development or programming, report writing etc. An informaticist is mainly dedicated to clinical applications - they tend to focus almost exclusively on clinical depts (nursing, respiratory, physicians, pharmacy). They tend to help develop training/ education and serve in a liaison role with clinical user. As an informaticist, you would be expected to have worked as a clinician (nurse, therapist, physician) whereas a systems analyst does not need or require a clinical background or clinical job experience - a technical background is sufficient

In our dept, we rotate call daily for the clinical team and then we rotate night/weekend call each week. You are on call for all the clinical apps not just the apps that you are a specialist for. Initally, they tried the specialist route but some staff would end up never getting a calls and other staff were constantly resolving issues. In general, if we are up at night late with a call, we can take off a half day but generally it's really not worth it. I may sleep a bit later the next day. Having been a nurse, I understand a hospital is a 24 hour organization. We have had quite a few analysts from outside healthcare who left because of night/weekend call. No sympathy from me - it was well explained at hire that hospitals are not 9 to 5 and you may get called even when you are not on call

Not sure of the area you live in - if it is fairly competitive. I would wonder if they are holding out for that "perfect" candidate. It sounds like they may be looking harder for a perhaps clinical experience in a specific area. You can teach the technical aspects - it's harder to teach the business. If they are looking for an analyst to support software in the surgical area and you have no clinical background in surgery - I would likely hold out for someone with that specific background. The dept may have many "analysts" with strong technical experience but lacking relevant clinical experience. Many facilities will do a consultant to hire. It gives them a chance to "try" someone out. It's cheaper to pay a consultant that you can simply contract for a few months then hire someone that really is ineffective. My suspicion is that they have contracted consultants so they can leave the permanent position open for the right candidate. All that being said, I would find it difficult to beleive that happened to you twice particularly if you have had 2 different interviews. I would approach the HR dept to inquire the reasons why - perhaps calling the recruiter and thanking them for the opportunity to apply and interview, stating you were highly interested in any information they could give you in improving your skills and presentation. They may open up.