Panama’s Health Tourism Boom

A new kind of tourism is sweeping into Panama, but these visitors are not just coming for sun and fun. Offering first-rate health care at cut-rate prices, Panama is attracting the latest kind of traveler: the medical tourist.

Medical tourism is a rapidly growing, multi-billion dollar worldwide industry. Countries like India and Thailand have long been attracting patients from developed countries looking to escape the high prices and long waits at home, providing high-quality health care at a fraction of the price.

Panama is one of the latest countries to emerge on the health tourism scene, offering US-trained doctors, state-of-the-art infrastructure and equipment, plus a distinct advantage — proximity to North America. With as many as 45 million Americans uninsured, and Canadians waiting up to two years for critical procedures, many are looking south for alternatives.

“The demand is very strong, and we haven’t even begun to scratch the surface,” says Rudy Rupak, president of Planet Hospital, a medical tourism agency researching qualified doctors and hospitals in countries around the world to perform procedures for clients who cannot afford, or wait, in their home countries.

His company recently added Panama to its list of destinations, thanks to the newly-opened Punta Pacifica hospital, an affiliate of the prestigious US hospital, John Hopkins Medicine International.

“We look for doctors who are educated in the USA, or other excellent institutions abroad such as in Canada, the UK or Europe,” explains Mr Rupak, “as well as peer review, publications over the years in their area of specialization, and patient interviews.”

“I see Panama as a strategic place, with a good location, just a five or six hour flight from the US. But the main factors are quality of doctors and the presence of a US hospital,” he says.

Add to that a beautiful setting for recovery, personalized care, short wait times and price tags 40% to 70% less than those in the US — and the allure is clear.

Dr Richard Ford, medical coordinator of Pana-Health, a group of doctors specializing in medical tourism to Panama, estimates tourists spent in approximately $5 million last year on procedures such as cosmetic surgery, in-vitro fertilization, orthopedic prostheses, dentistry and laser eye surgery.

Despite the growing trade, the Panamanian government is not yet tracking health tourism numbers, but Dr Ford says they are on the rise, pegging 2006 figures at more than one thousand, a sharp increase over previous years.

“[That] is about 35 per cent more than the previous year and 80 per cent more than the year before,” he estimates.

While these numbers might seem small, Rudy Rupak believes they are about to explode, with many health officials and policy makers in the US calling for Medicare to pay for procedures abroad, to relieve a soon-to-be overburdened health care system.

Debra Lipson, a senior health researcher speaking at an AARP (American Association of Retired Persons) forum, said outsourcing medical care could amount to big savings in the US.

According to one study, she said, “the US could save $1.4 billion annually if only one in ten US patients receives treatment for 15 low-risk medical procedures abroad.”

Many of those who migrated from Latin America are returning to their home countries to retire, she pointed out, also taking advantage of ‘more affordable aged care support and services’.

“My husband’s parents recently moved back to Panama, after spending 15 years in the US,” she recounted. “They are still among the “young-old” — not yet out of their sixties. But my mother-in-law has a neurological condition that requires constant vigilance and I sleep better at night knowing that she has reliable, affordable care.”

America’s Health/ Medical Care: Some Alternatives/ Options

For nearly a decade, politicians have seemingly, buried their heads, in the sand, and considered this nation’s approach to treating the health, and well – being of our citizens, and responded with bipartisan, politics – as – usual! Wouldn’t we be better served, if the response of some, was not, merely, articulating a message, about so – called, socialism, etc? It seems, many Republican opponents, to the Affordable Care Act, spent a disproportionate amount of time, merely opposing that law, rather than fixing its flaws, etc. While that law, certainly needs, tweaking, it attempted to address the fact, the richest country in the world (the United States of America), did not come, even close, to the best statistics, regarding morbidity, mortality, infant survival, and other, health – related items, as well as having the most expensive costs, for prescription drugs, in the world. Why are we, the only place, where citizens go bankrupt, trying to pay their medical bills? Why do we pay, so much more, for prescription drugs, than others pay for the exact medications? With that in mind, this article will attempt to consider, review, examine, and discuss, some of the alternatives, we might adopt, to improve upon, what we currently have.

1. The pre – ACA, status quo: Why was the Affordable Care Act, passed, during the early part of the Obama administration? What was its intent? Why was it needed? Prior to enactment, health care, in this nation, was often about, the haves, and have – nots! More and more, health insurance companies, appeared to be, wagging the dog, instead of health professionals! Individuals with pre – existing conditions were often, denied coverage, rates often accelerated, as we aged, and every year, quality medical/ health insurance, became more, and more expensive! Many millions had no, or very limited insurance coverage, and we often witnessed, people being forced to choose between quality care, and eating! Those supporting the act, seemed to believe, our citizens needed, and deserved, better care, and, quality treatment/ care. For many, they felt, medical/ health care, should be, a right and guarantee, rather than a possibility, only for the richest!

2. ACA passage: When the act, was passed, it was largely among party lines, and at the time, Democrats were the majority party. While the basic intent of the legislation, was well – intended, because of the nature of our political system, it was somewhat flawed, and many ramifications and contingencies, were not fully considered, etc. The costs did not decrease, as promoted, and while, they probably increased at a slower pace, it still hurt many of us! Instead of improving the details, and fixing it, properly, the Republicans devoted their time, and energy, to constantly, trying to repeal it, but, without offering any viable alternatives, and/ or solutions, to solve the challenges.

3. The Trump alternative/ strategy: When Donald Trump, ran for President, he articulated a message, declaring, he would fix the health care system, and it would be better, and less expensive. He promised, it would be easy, and created a slogan, Repeal and replace, as if, he had the secret formula! Rather than admitting the plan, his supporters proposed, was different, but worse, and was defeated, he reverted to his customary, blaming and complaining, and settled for subtle ways, to destroy it. One of these steps, was having the mandatory coverage, eliminated, which, made everyone’s insurance, more expensive, Another was reducing/ eliminating, subsidies, for the neediest, and creating an Affordable Care, alternative system. The ramifications of these steps, was hurting, rather than helping! Now, Trump’s Justice Department, is supporting, legal actions, to declare the entire act, unconstitutional, without seeming to realistically, consider, the potential negative ramifications, if they get, what they seek. It seems, a lot like, someone, who kills both his parents, and pleads for mercy, because he was an orphan!

4. Proposed Medicare – for – All: While, to some, this seems wonderful, the overall analysis, appears to be, over – simplified! Medicare, itself, is a flawed system, which taxpayers, contribute to, throughout their working lives, and, still requires over $1,600 additional contribution, per year, after we turn 65. In addition, it only covers about 80% of the Part B, part, and the supplemental insurance, which completely covers, most of these expenses, now costs over $3,600 per year. Even after these expenses, one needs, either additional policy, for a prescription plan, or, risks extreme, out – of – pocket costs. One further consideration is, believing doctors, will accept these reduced Medicare rates, for their entire patient base. Doesn’t it make sense, to tweak, and improve, rather than trying to re – invent, the wheel?

Is quality care, a right or a privilege? If, like most Americans (based on many polls), you feel it’s a right, demand your elected officials proceed, accordingly, rather than, in a politics – as – usual, manner!

Health Care Fraud – The Perfect Storm

Today, health care fraud is all over the news. There undoubtedly is fraud in health care. The same is true for every business or endeavor touched by human hands, e.g. banking, credit, insurance, politics, etc. There is no question that health care providers who abuse their position and our trust to steal are a problem. So are those from other professions who do the same.

Why does health care fraud appear to get the ‘lions-share’ of attention? Could it be that it is the perfect vehicle to drive agendas for divergent groups where taxpayers, health care consumers and health care providers are dupes in a health care fraud shell-game operated with ‘sleight-of-hand’ precision?

Take a closer look and one finds this is no game-of-chance. Taxpayers, consumers and providers always lose because the problem with health care fraud is not just the fraud, but it is that our government and insurers use the fraud problem to further agendas while at the same time fail to be accountable and take responsibility for a fraud problem they facilitate and allow to flourish.

1. Astronomical Cost Estimates

What better way to report on fraud then to tout fraud cost estimates, e.g.

– “Fraud perpetrated against both public and private health plans costs between $72 and $220 billion annually, increasing the cost of medical care and health insurance and undermining public trust in our health care system… It is no longer a secret that fraud represents one of the fastest growing and most costly forms of crime in America today… We pay these costs as taxpayers and through higher health insurance premiums… We must be proactive in combating health care fraud and abuse… We must also ensure that law enforcement has the tools that it needs to deter, detect, and punish health care fraud.” [Senator Ted Kaufman (D-DE), 10/28/09 press release]

– The General Accounting Office (GAO) estimates that fraud in healthcare ranges from $60 billion to $600 billion per year – or anywhere between 3% and 10% of the $2 trillion health care budget. [Health Care Finance News reports, 10/2/09] The GAO is the investigative arm of Congress.

– The National Health Care Anti-Fraud Association (NHCAA) reports over $54 billion is stolen every year in scams designed to stick us and our insurance companies with fraudulent and illegal medical charges. [NHCAA, web-site] NHCAA was created and is funded by health insurance companies.

Unfortunately, the reliability of the purported estimates is dubious at best. Insurers, state and federal agencies, and others may gather fraud data related to their own missions, where the kind, quality and volume of data compiled varies widely. David Hyman, professor of Law, University of Maryland, tells us that the widely-disseminated estimates of the incidence of health care fraud and abuse (assumed to be 10% of total spending) lacks any empirical foundation at all, the little we do know about health care fraud and abuse is dwarfed by what we don’t know and what we know that is not so. [The Cato Journal, 3/22/02]

2. Health Care Standards

The laws & rules governing health care – vary from state to state and from payor to payor – are extensive and very confusing for providers and others to understand as they are written in legalese and not plain speak.

Providers use specific codes to report conditions treated (ICD-9) and services rendered (CPT-4 and HCPCS). These codes are used when seeking compensation from payors for services rendered to patients. Although created to universally apply to facilitate accurate reporting to reflect providers’ services, many insurers instruct providers to report codes based on what the insurer’s computer editing programs recognize – not on what the provider rendered. Further, practice building consultants instruct providers on what codes to report to get paid – in some cases codes that do not accurately reflect the provider’s service.

Consumers know what services they receive from their doctor or other provider but may not have a clue as to what those billing codes or service descriptors mean on explanation of benefits received from insurers. This lack of understanding may result in consumers moving on without gaining clarification of what the codes mean, or may result in some believing they were improperly billed. The multitude of insurance plans available today, with varying levels of coverage, ad a wild card to the equation when services are denied for non-coverage – especially if it is Medicare that denotes non-covered services as not medically necessary.

3. Proactively addressing the health care fraud problem

The government and insurers do very little to proactively address the problem with tangible activities that will result in detecting inappropriate claims before they are paid. Indeed, payors of health care claims proclaim to operate a payment system based on trust that providers bill accurately for services rendered, as they can not review every claim before payment is made because the reimbursement system would shut down.

They claim to use sophisticated computer programs to look for errors and patterns in claims, have increased pre- and post-payment audits of selected providers to detect fraud, and have created consortiums and task forces consisting of law enforcers and insurance investigators to study the problem and share fraud information. However, this activity, for the most part, is dealing with activity after the claim is paid and has little bearing on the proactive detection of fraud.

4. Exorcise health care fraud with the creation of new laws

The government’s reports on the fraud problem are published in earnest in conjunction with efforts to reform our health care system, and our experience shows us that it ultimately results in the government introducing and enacting new laws – presuming new laws will result in more fraud detected, investigated and prosecuted – without establishing how new laws will accomplish this more effectively than existing laws that were not used to their full potential.

With such efforts in 1996, we got the Health Insurance Portability and Accountability Act (HIPAA). It was enacted by Congress to address insurance portability and accountability for patient privacy and health care fraud and abuse. HIPAA purportedly was to equip federal law enforcers and prosecutors with the tools to attack fraud, and resulted in the creation of a number of new health care fraud statutes, including: Health Care Fraud, Theft or Embezzlement in Health Care, Obstructing Criminal Investigation of Health Care, and False Statements Relating to Health Care Fraud Matters.

In 2009, the Health Care Fraud Enforcement Act appeared on the scene. This act has recently been introduced by Congress with promises that it will build on fraud prevention efforts and strengthen the governments’ capacity to investigate and prosecute waste, fraud and abuse in both government and private health insurance by sentencing increases; redefining health care fraud offense; improving whistleblower claims; creating common-sense mental state requirement for health care fraud offenses; and increasing funding in federal antifraud spending.

Undoubtedly, law enforcers and prosecutors MUST have the tools to effectively do their jobs. However, these actions alone, without inclusion of some tangible and significant before-the-claim-is-paid actions, will have little impact on reducing the occurrence of the problem.

What’s one person’s fraud (insurer alleging medically unnecessary services) is another person’s savior (provider administering tests to defend against potential lawsuits from legal sharks). Is tort reform a possibility from those pushing for health care reform? Unfortunately, it is not! Support for legislation placing new and onerous requirements on providers in the name of fighting fraud, however, does not appear to be a problem.

If Congress really wants to use its legislative powers to make a difference on the fraud problem they must think outside-the-box of what has already been done in some form or fashion. Focus on some front-end activity that deals with addressing the fraud before it happens. The following are illustrative of steps that could be taken in an effort to stem-the-tide on fraud and abuse:

– DEMAND all payors and providers, suppliers and others only use approved coding systems, where the codes are clearly defined for ALL to know and understand what the specific code means. Prohibit anyone from deviating from the defined meaning when reporting services rendered (providers, suppliers) and adjudicating claims for payment (payors and others). Make violations a strict liability issue.

– REQUIRE that all submitted claims to public and private insurers be signed or annotated in some fashion by the patient (or appropriate representative) affirming they received the reported and billed services. If such affirmation is not present claim isn’t paid. If the claim is later determined to be problematic investigators have the ability to talk with both the provider and the patient…

– REQUIRE that all claims-handlers (especially if they have authority to pay claims), consultants retained by insurers to assist on adjudicating claims, and fraud investigators be certified by a national accrediting company under the purview of the government to exhibit that they have the requisite understanding for recognizing health care fraud, and the knowledge to detect and investigate the fraud in health care claims. If such accreditation is not obtained, then neither the employee nor the consultant would be permitted to touch a health care claim or investigate suspected health care fraud.

– PROHIBIT public and private payors from asserting fraud on claims previously paid where it is established that the payor knew or should have known the claim was improper and should not have been paid. And, in those cases where fraud is established in paid claims any monies collected from providers and suppliers for overpayments be deposited into a national account to fund various fraud and abuse education programs for consumers, insurers, law enforcers, prosecutors, legislators and others; fund front-line investigators for state health care regulatory boards to investigate fraud in their respective jurisdictions; as well as funding other health care related activity.

– PROHIBIT insurers from raising premiums of policyholders based on estimates of the occurrence of fraud. Require insurers to establish a factual basis for purported losses attributed to fraud coupled with showing tangible proof of their efforts to detect and investigate fraud, as well as not paying fraudulent claims.

5. Insurers are victims of health care fraud

Insurers, as a regular course of business, offer reports on fraud to present themselves as victims of fraud by deviant providers and suppliers.

It is disingenuous for insurers to proclaim victim-status when they have the ability to review claims before they are paid, but choose not to because it would impact the flow of the reimbursement system that is under-staffed. Further, for years, insurers have operated within a culture where fraudulent claims were just a part of the cost of doing business. Then, because they were victims of the putative fraud, they pass these losses on to policyholders in the form of higher premiums (despite the duty and ability to review claims before they are paid). Do your premiums continue to rise?

Insurers make a ton of money, and under the cloak of fraud-fighting, are now keeping more of it by alleging fraud in claims to avoid paying legitimate claims, as well as going after monies paid on claims for services performed many years prior from providers too petrified to fight-back. Additionally, many insurers, believing a lack of responsiveness by law enforcers, file civil suits against providers and entities alleging fraud.

6. Increased investigations and prosecutions of health care fraud

Purportedly, the government (and insurers) have assigned more people to investigate fraud, are conducting more investigations, and are prosecuting more fraud offenders.

With the increase in the numbers of investigators, it is not uncommon for law enforcers assigned to work fraud cases to lack the knowledge and understanding for working these types of cases. It is also not uncommon that law enforcers from multiple agencies expend their investigative efforts and numerous man-hours by working on the same fraud case.

Law enforcers, especially at the federal level, may not actively investigate fraud cases unless they have the tacit approval of a prosecutor. Some law enforcers who do not want to work a case, no matter how good it may be, seek out a prosecutor for a declination on cases presented in the most negative light.

Health Care Regulatory Boards are often not seen as a viable member of the investigative team. Boards regularly investigate complaints of inappropriate conduct by licensees under their purview. The major consistency of these boards are licensed providers, typically in active practice, that have the pulse of what is going on in their state.

Insurers, at the insistence of state insurance regulators, created special investigative units to address suspicious claims to facilitate the payment of legitimate claims. Many insurers have recruited ex-law enforcers who have little or no experience on health care matters and/or nurses with no investigative experience to comprise these units.

Reliance is critical for establishing fraud, and often a major hindrance for law enforcers and prosecutors on moving fraud cases forward. Reliance refers to payors relying on information received from providers to be an accurate representation of what was provided in their determination to pay claims. Fraud issues arise when providers misrepresent material facts in submitted claims, e.g. services not rendered, misrepresenting the service provider, etc.

Increased fraud prosecutions and financial recoveries? In the various (federal) prosecutorial jurisdictions in the United States, there are differing loss- thresholds that must be exceeded before the (illegal) activity will be considered for prosecution, e.g. $200,000.00, $1 million. What does this tell fraudsters – steal up to a certain amount, stop and change jurisdictions?

In the end, the health care fraud shell-game is perfect for fringe care-givers and deviant providers and suppliers who jockey for unfettered-access to health care dollars from a payment system incapable or unwilling to employ necessary mechanisms to appropriately address fraud – on the front-end before the claims are paid! These deviant providers and suppliers know that every claim is not looked at before it is paid, and operate knowing that it is then impossible to detect, investigate and prosecute everyone who is committing fraud!

Lucky for us, there are countless experienced and dedicated professionals working in the trenches to combat fraud that persevere in the face of adversity, making a difference one claim/case at a time! These professionals include, but are not limited to: Providers of all disciplines; Regulatory Boards (Insurance and Health Care); Insurance Company Claims Handlers and Special Investigators; Local, State and Federal Law Enforcers; State and Federal Prosecutors; and others.

Technological Advancement in Health Communication in Less Developed Countries

Direct communication in health care can take place via forms of social media such as Skype, zoom and video conferencing. Traditional forms of communication such as telephone, notes and letters can continue to be used for information sharing between health providers and patients. For example, doctors and patients can text and send messages to one another. It is imperative that social media messaging be used to reduce the time taken to obtain knowledge on patient condition and general wellbeing.

The use of social media communication tools should not make indirect communication obsolete. In instances of technology resistance and lack of access to social media, health providers will be required to communicate face to face with patients and their relatives. Sometimes it may be easier and faster to communicate with patients via other media such as third parties. Doctors and patients can communicate via third parties such as nurses, personal caregivers, family and relatives of patients who may be unable to communicate. In other instances, it may be advantageous for family or caregivers to inform patients of their condition. A spouse or parent may be empathetic in conveying negative news to patients.

As a small island developing nation, Trinidad and Tobago faces serious health challenges that can be minimized by appropriate investment in social media technology. The major challenges include shortage of ambulances, bed shortages, and acute shortage of highly specialized medical knowledge and practice. Three additional acute problems are hospital overcrowding, limited availability of biomedical technology and drug shortages. These problems are exacerbated by traffic congestion that results from poor road infrastructure. Health and infrastructural challenges often combine to impact the quality of healthcare for patients with limited access to health facilities negatively.

This paper proposes that the quality of patient care for less critically ill patients can be enhanced by the adoption of social media tools that will enable doctors and other health providers to see and hear their patients in remote sites such as specialized care facilities and patient residences. The main intention of social media usage is to reduce overcrowding, improve access to healthcare, promote effective pain management and reduce patient death or mortality. Many patients can be released from hospital and be cared for at convalescent and private homes where providers can monitor and evaluate their progress via Skype, video conferencing, zoom or other appropriate technology.

The state can promote technological advancement and innovation to make social media tools widely accessible, highly reliable and very efficient. Investment in innovation should lead to the introduction of local media technology that can enhance the phenomenon of multiple users at the same time. For instance, doctors, pharmacists, nurses and other health providers should be able to interface simultaneously in order to ensure patients receive the best care. The doctor will maintain the primary provider role but should be able to take advice from other providers who may spend more communication time with patients. Finally after health providers have attained a position of consensus on the way forward, patients and their relatives can be brought in to ensure that the agreed treatment plan is explained and understood. The patient will become the biggest beneficiary of a collaborative approach among health providers. He will receive faster, more efficient care from a multidisciplinary team of healthcare providers.

Technology should enable patient surveillance in a virtual setting that should reduce the time and hazards of taking weak and incapacitated patients to a hospital or care facility. In addition, providers can give safe and efficient care to patients who are in remote locations. It also means that patients warded at hospital would benefit from more direct contact with health providers who would have more time to spend with them. One advantage that cannot be underscored is the learning that will accrue from evidence based practice. Health professionals can learn from one another and develop innovative collaborative approaches to healthcare. Patients will receive consistent instruction or advice from health professionals. Use of social media technology in health care will also enable patients to have sessions with health providers individually. The use of electronic health records will enhance patient care tremendously. Health providers will be able to access patient information faster and easier thus reducing the time taken to care for patients.

Technological advancement must be accompanied by cultural change. The biggest change, technology acceptance, should ensure that resistance to technology is reduced. Change must bring about significant gains in patient education in order that they become more responsible for their overall health. Patient empowerment programs must be implemented to provide greater patient self efficacy. In other words, patients must be able to diagnose partially, monitor and evaluate changes in their physical and mental health. They must be able to detect significant health changes and be able to relate them to factors such as diet, changes in their physical environment and general increases in emotional, mental and psychological stress. The overarching goal is to enable doctors to make faster, more accurate, diagnoses of patient health problems.

This paper recognizes the limitation of social media technology such as technological failure or malfunction,. However, this challenge can be overcome by putting the required personnel in place to respond quickly to it. More importantly, this paper purports that systemic problems such as bed and ambulance shortages will be reduced significantly by the use of social media technology to care for patients who do not require hospitalization or critical care.

Nursing Informatics – Integrating Health Care With Information Technology

What is Nursing Informatics?

Nursing Informatics is the integration of clinical nursing with information management and computer processes. It is a relatively new focus in health care that combines nursing skills with information technology expertise. Nurse informatics specialists manage and communicate nursing data and information to improve decision making by consumers, patients, nurses and other health care providers.

The nursing process has four main steps: planning, implementation, evaluation, and assessment. However, because information management is integrated into the nursing process and practice, some nursing communities identify a fifth step in the nursing process: documentation. Documentation and patient-centered care are the core components of the nursing process. Automated documentation is vitally important, not just for nursing, but for all patient care. Up-to-date, accurate information at each step of the nursing process is the key to safe, high quality patient-centered care.

The successful implementation of information systems in nursing and health care requires the following: First, it is necessary to have well designed systems that support the nursing process within the culture of an organization. The second requirement is having the acceptance and integration of information systems into the regular workflow of the nursing process and patient care. Finally, it is important to have resources that can support the previously mentioned factors. One of the most effective and valuable resources a healthcare organization can add is a Nurse informatics specialists.

Nursing Informatics Specialists

Nursing Informatics Specialists are expert clinicians with an extensive clinical practice background. These individuals have experience in utilizing and implementing the nursing process. These nurses have excellent analytical and critical thinking skills. They also understand the patient care delivery workflow and integration points for automated documentation. Having additional education and experience with information systems is also important for this occupation. Finally, Nursing Informaticists are excellent project managers because of the similarity between the project management process and the nursing process.

To be competitive in this field one should become familiar with relational databases by taking a class about database structure. They should also become competent and comfortable with MS Office, especially Excel, Access and Visio.

Why these jobs are Important to Healthcare?

Nurse and health informatics bring a great deal of value to patients and the health care system. Some examples of how they provide value include:

  • Provide Support to the nursing work processes using technology
  • Increasing the accuracy and completeness of nursing documentation
  • Improving the nurse's workflow
  • Automating the collection and reuse of nursing data
  • Facilitating analysis of clinical data
  • Providing nursing content to standardized languages

HIMSS and RHIO

To provide some background on the field of healthcare / nursing informatics, there are some governing bodies for this field. The Healthcare Information and Management Systems Society (HIMSS) is the main governing body for health care and nursing informatics professionals. This group, formed in 2004, has the following four goals: NI awareness, education, resources (including websites), and RHIO (Regional Health Information Organization).

RHIOs are also known as Community Health Information Networks (CHINs). These are the networks that connect physicians, hospitals, laboratories, radiology centers and insurance companies.They all share and transmit patient information electronically through a secure system. Those organizations that are a part of RHIOs have a business interest in improving the quality of healthcare being administered.

Steps to a Job in This Field

To enter into the nursing informatics field, typically you need a minimum of a four year degree. There are specific health informatics degrees available. Earning your Bachelor's of Science in Nursing (BSN) is also a requirement before sitting for the ANCC certifications test for Nursing Informatics. Some individuals start with just a two year degree or diploma, but continue on to earn their BSN before becoming certified. Although there are several different routes for getting into the field, the most favored manner is to earn a Master's in Nursing Informatics from the start, however, most individuals start their career prior to earning their master's degree.

Most nurses who are in the informatics field start in a specialty area, such as the Intensive Care Unit (ICU), Perioperative Services (OR), Med-Surg, Orthopedic Nursing, or Oncology, just to name a few, and work in that specialty field for an extended period. Working in a specialty area helps nurses get to know the normal working processes and routines as well as understand the patient care process in their specialty. They usually are experts at their specialty and then develop interests in computerized documentation or some other technological healthcare focus. They then tend to gradually move into an information systems clinical support role.

If you have an interest in nursing and technology, this might be a career that can match both of these skills into one rewarding job.