BUSI 505 Week 1 Discussion Board Forum 1 Example

Discussion Board Forum 1: The Purpose and Promise of Health Informatics

BUSI 505 Healthcare Informatics, Discussion Board Forum 1

Thread by [Student Name]

The health system, its data and the classmates are composites; the textbooks, Scripture and the peer-reviewed sources cited are real.

At my health system, the information technology department's annual report still celebrates installations: a new electronic health record module, a patient portal upgrade, two new interfaces. Those achievements matter, but they answer the question of the last decade, whether we have the systems, rather than the question of this one, whether the information they hold improves care and decisions. When I asked our chief medical information officer which of last year's projects had changed a clinical outcome, the honest answer was that no one had measured it. Braunstein (2014) presents health informatics as the discipline of putting information and technology to work for better care, and Nelson and Staggers (2014) picture a ladder that rises from raw data through information and knowledge to wisdom, so that a system's worth depends on how far up that ladder it helps people climb.

The adoption phase was a policy success. Adler-Milstein and Jha (2017) compared hospitals eligible for the HITECH Act's incentive payments with hospitals that were not eligible and found that eligible hospitals' yearly adoption gains climbed from about 3 percentage points before the incentives to about 14 afterward, while hospitals left out of the program barely moved, going from almost nothing to about 3. The difference suggests the incentives themselves drove most of the change, and today nearly every U.S. hospital uses a certified electronic record. Few federal programs have moved an entire industry so quickly, and the lesson for administrators is that well-designed incentives can change technology adoption at scale. The harder lesson is that adoption was rewarded far more directly than results.

Success brought new problems. Arndt et al. (2017) matched record event logs against direct observation for 142 family physicians and found nearly six hours a day of record work, 355 minutes in all, within workdays averaging just over eleven hours, and close to an hour and a half of it came after clinic hours. Much of that time went to documentation, ordering, inbox management and billing tasks rather than to information that helped them care for the patient in front of them. When systems consume this much clinical time, the question is no longer whether they are in place but whether they return enough value for the attention they demand. Time spent in the record is time not spent listening to patients, teaching residents or resting, and physician burnout surveys consistently name documentation burden among its leading causes. An informatics program that ignores this cost is measuring only half of its own effect.

I would propose that our health system judge its informatics program by three measures of value rather than counts of installations. First, decision support that changes care, such as the share of recommended screenings completed after a reminder. Second, burden, measured by clinicians' time in the record per patient seen and after hours, tracked by department so leaders can see where workflow changes are needed most. Third, information flow, such as the share of discharge summaries available to the next clinician within a day. Each measure ties informatics to outcomes that patients and staff would recognize. Reporting these measures alongside installation milestones would also change conversations with vendors, since contracts could include expectations for burden and usability, not only uptime and features. Nelson and Staggers (2014) stress that usability and workflow fit are part of a system's quality, which supports writing those expectations into how success is judged. A system that stores every fact but improves no decision is a filing cabinet, not an information system.

Proverbs says that the wise should hear and increase in learning, and that one who understands gains guidance (English Standard Version Bible, 2001/2016, Proverbs 1:5). Climbing from data to wisdom is a modern version of that instruction, and health care leaders are responsible for making sure the systems they buy help people learn and decide well.

Reply to Jasmine

Jasmine, you argued that electronic health records were designed mainly for billing and that clinical value was an afterthought. There is truth in that history, since documentation requirements tied to payment shaped much of what records contain, and many clinicians still experience the record as a billing tool first. Still, I think the more useful question for managers is where the burden now falls and how to reduce it, because the record is not going away and its clinical uses keep growing. Recent evidence shows the burden is unevenly distributed. Portal messaging illustrates the point well. Holmgren et al. (2026) examined patient-initiated portal messages at a large academic health system and in national data from more than 224,000 ambulatory physicians and found that the top 5% of patients sent more than half of all messages, and that while the median primary care physician received about 10 messages a week, physicians in the top quarter received more than 53. Higher message volume was associated with more work in the record outside working hours, which is exactly the kind of after-hours work linked to exhaustion and intent to leave. Arndt et al. (2017) had already found that primary care physicians spent more than an hour a day in the record after clinic, and the growth of portal messaging adds to that load. Braunstein (2014) notes that patient engagement through technology is one of the field's great promises, and portals deliver real value, but without workflow design the promise becomes a new burden. Informatics is work shared across professions (Nelson & Staggers, 2014), so nurses, pharmacists and medical assistants could take on part of the portal load rather than leaving it all to physicians. A health system could triage messages by type, route medication refills to pharmacists and set clear expectations with patients about response times, and it could monitor the physicians receiving the heaviest volumes for burnout. Because a small share of patients generates most messages, outreach to those patients, such as scheduled visits or care management, might serve them better than a stream of asynchronous questions. Jesus invited all who labor and are heavy laden to come to Him for rest (English Standard Version Bible, 2001/2016, Matthew 11:28), and leaders who design the systems clinicians use should take seriously the weight those systems add. Would your organization consider sharing message volume data with clinicians so that the heaviest loads can be redistributed? Seeing the numbers is often the first step toward a fairer arrangement. The same data could also inform payment discussions, since some organizations now bill for message-based care that involves medical decision making, which recognizes the work and may moderate volume. Whatever approach your organization takes, measuring the load is the starting point, because a burden that is invisible to leadership is unlikely to be addressed.

Reply to Brandon

Brandon, you asked which informatics competencies health care managers need, since most of them will never configure a system themselves. That question deserves attention, because managers make many of the decisions that determine whether systems succeed: approving workflows, allocating staff for training and deciding which data to review. A manager who cannot interpret a dashboard or recognize a privacy risk can undermine an expensive system without meaning to. Evidence suggests many managers feel underprepared. Abou Hashish et al. (2025) interviewed 42 nurse managers at a large hospital during its digital transformation and found that 61.9% reported lacking digital leadership training, even though most held master's degrees. Participants identified knowledge, skills and attitudes for leading through technology, along with barriers such as limited training, infrastructure gaps and hierarchical cultures that slowed change. Many said they learned digital leadership on the job, by trial and error, which is a costly way to build a skill that affects patient care. Hariyati et al. (2024) surveyed 100 nurses and 83 nurse managers and found acceptable but incomplete computer literacy, with informatics competencies linked to education, experience and position. Nelson and Staggers (2014) lay out informatics competencies in layers, from comfort with computers to finding and judging information to managing it, and they argue that leaders need especially strong information management skills to make sense of data and guide others. Braunstein (2014) adds that understanding how data flow among systems is essential to judging interoperability claims and vendor promises, a judgment managers make whenever they approve a new tool or interface. Taken together, the two studies suggest that education and position help but do not guarantee informatics readiness, which means organizations cannot assume their managers will learn these skills on their own. For our program, I would suggest three competencies for every manager: reading and questioning a dashboard, understanding the basics of data privacy and security and leading a workflow change when a new system arrives. Paul urged Timothy to present himself as a worker who has no need to be ashamed, handling the word of truth rightly (English Standard Version Bible, 2001/2016, 2 Timothy 2:15), and managers who handle information about patients and staff carry a similar responsibility to handle it rightly. Would your organization add an informatics component to its manager orientation, perhaps built around the dashboards those managers will use every week? Training tied to real tools tends to stick better than general courses, and it gives managers a chance to ask how each number is calculated before they act on it. Pairing new managers with an experienced colleague who uses data well could reinforce the training, and periodic refreshers could cover new tools as they arrive. Over time, a management team that understands its data becomes an organizational capability that competitors cannot easily copy.

References

Abou Hashish, E., Alsayed, S., Alqarni, B. H. M., Alammari, N. M., & Alsulami, R. O. (2025). Nurse managers' perspectives on digital transformation and informatics competencies in e-leadership: A qualitative study. Journal of Nursing Management, 2025, 8178924. https://doi.org/10.1155/jonm/8178924

Adler-Milstein, J., & Jha, A. K. (2017). HITECH Act drove large gains in hospital electronic health record adoption. Health Affairs, 36(8), 1416-1422. https://doi.org/10.1377/hlthaff.2016.1651

Arndt, B. G., Beasley, J. W., Watkinson, M. D., Temte, J. L., Tuan, W.-J., Sinsky, C. A., & Gilchrist, V. J. (2017). Tethered to the EHR: Primary care physician workload assessment using EHR event log data and time-motion observations. Annals of Family Medicine, 15(5), 419-426. https://doi.org/10.1370/afm.2121

Braunstein, M. L. (2014). Contemporary health informatics. AHIMA Press.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Hariyati, R. T. S., Handiyani, H., Wildani, A. A., Afriani, T., Nuraini, T., & Amiruddin, M. H. (2024). Disparate digital literacy levels of nursing manager and staff, specifically in nursing informatics competencies and their causes: A cross-sectional study. Journal of Healthcare Leadership, 16, 415-425. https://doi.org/10.2147/JHL.S470456

Holmgren, A. J., Apathy, N. C., Mehrotra, A., & Chernew, M. E. (2026). The uneven distribution of patient portal messages across patients and physicians. Health Affairs, 45(8), 862-870. https://doi.org/10.1377/hlthaff.2025.01416

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. Elsevier Mosby.