348chapter FOURTEEN
Refl ective Response 1
Victoria M. Bradley
Informatics knowledge and skills are essential for all of the roles of the doctoral ad-
vanced practice nurse (APN) as technology increasingly permeates every component of
the health care delivery system. The authors provide an extensive, informative review
of the technology tools available to the doctoral APN and suggest ways they can be de-
ployed to enhance practice and transform care. I absolutely agree that at the doctoral
level, advanced practitioners need a higher level of technical competency to practice and
lead in this technology era. I also agree that Doctor of Nursing Practice (DNP) graduates
should contribute to the evidence base of their discipline, through an ongoing measure-
ment of both process and outcomes. I have, however, a few considerations and additions
gained from my experiences as a DNP graduate with clinical informatics as my specialty.
I was delighted to see the T echnology I nformatics G uiding E ducational R eform
(TIGER) initiative reference. This is a rich resource of information for incorporating
informatics into all levels of practice. Increasing knowledge about health information
technology (HIT) among practicing nurses and nursing faculty is a recognized chal-
lenge and is also being addressed in a number of ways by the organizations within the
Alliance for Nursing Informatics. It will be interesting to compare the results of TIGER’s
current project to identify international competencies for: nursing management; IT man-
agement in nursing; quality management; interprofessional coordination of care; and
clinical nursing, to ones identified for the doctoral APN (Healthcare Information and
Management Systems Society [HIMSS] , TIGER, International Competency Synthesis
Project, 2016).
In the knowledge management section, the authors recommend that the doctoral
APN champion use a standardized nursing language system integrated with universal
clinical care terminology. I would more specifically recommend that the data elements
in the electronic health record be mapped to Logical Observation Identifiers Names and
Codes (LOINC) and SNOMED Clinical Terms. Resources can be found on the National
Library of Medicine site on Nursing Standards and Interoperability (International Health
Terminology Standards Development Organization, 2016; U.S. National Library of
Medicine, 2015). Warren, Matney, Foster, Auld, and Roy (2015) describe the background
of this resource on nursing terminologies and standards. As future leaders, it is impera-
tive that the doctoral APN understand, advocate, and contribute to the use of clinically
specific vocabularies to enable data exchange and expand retrieval of health information.