How Nurses and “Non-IT” Factors Can Improve the Health IT Experience

Rebecca Freeman, PhD, RN, PMP | May 10, 2016

Happy National Nurses Week!

As ONC’s Chief Nursing Officer, I spend a lot of time talking about the functionality and usability of electronic health records (EHRs) with the incredible nurses across the healthcare system. Many of us have had bad experiences using information technology (IT), and gotten frustrated with the system itself. But one thing I’ve learned in my conversations with nurses from all over is that there are many, many issues that aren’t technology or system issues at all, but rather process, workflow, or implementation challenges.

The Challenge and How Nurses Are a Key Part of the Solution

Last year, I had a fabulous chat with the husband of a home health nurse about the substantial burden that her organization’s EHR was causing her. We talked for nearly an hour and we realized that, from ambiguous workflows to insufficient training, the most pressing challenges she faced had less to do with the technology itself and more to do with policies and processes involving the implementation and use of the technology. It’s these policies and processes that are critical for an EHR to make a nurse’s life easier, rather than more difficult.

And nurses are often a major part of the solution: working in an interdisciplinary, team-based way to shape workflows, trainings, implementation plans, and documentation policies and processes to ensure that health IT helps rather than hinders the delivery of care. And I’m not just talking about nurses who are informatics professionals!

  • Bedside nurses are true experts when it comes to coordinating care and identifying pain points in workflows or processes, and can serve as “super users” to help an entire facility or practice get the most of its health IT.
  • Advanced Practice Registered Nurses (NPs, CRNAs, CNMs, CNSs) provide key input as ground-level providers who have a unique perspective on the role of health IT in the care of their patients.
  • Members of the nursing leadership team know the data needed for their operational tasks and play a critical role in the development of analytics tools, such as dashboards and reports. They play a key role in the engagement of all nurses through super user programs and training opportunities. The nursing leadership is also critical to helping a practice or facility discern when it has specialized or unique needs vs. when it can leverage more standard templates and approaches.
  • Nurse educators have long focused on clinical education, but there is now a crossover between clinical and health IT proficiency and training. In other words, nurses not only need to know how to execute a procedure, they need to be able to document it appropriately to avoid inaccurate dashboards, reports and measures of outcomes that can affect care, coordination and billing.
  • Nursing informaticists can ideally analyze workflows, apply technical principles and knowledge, discuss and evaluate evidence-based practice, and identify training needs in order to help lead the development of health IT that makes sense for the organization and the end users who depend on the system for their daily work. They also serve a critical role in translating clinician “asks” into actionable build requests for the IT team; when the build is complete, they serve a critical role in testing and ensuring that the build functions as intended, often in conjunction with the clinical end users.
  • Clinical analysts are often nurses who are working in an IT setting: building the system, creating reports, managing databases, etc. Many of them are longtime health IT experts. Their clinical knowledge is an irreplaceable safety net when it comes to build design, quality and testing.

All of these nurses – and many others working in important roles and locations – are critical to the success or failure of health IT across the nation’s delivery system. Practices and facilities – including, but not limited to the acute care and ambulatory settings – must integrate them into careful planning for pre-implementation, implementation, and post-implementation operations of EHR systems.

Health IT is More Than IT

In short, we all need to remember the many factors that contribute to the success or failure of health IT in practice. Success is often less about the “IT” itself and more about implementation, documentation, culture, analytics, training, workflows, and interdisciplinary engagement. This can be a major shift from paper records or a proprietary, standalone system, where changes could be “implemented” in quick, informal ways. Yet, the increased complexity of using an enterprise EHR system also comes with great promise for enhancing care for individuals, making practices and facilities run more efficiently, and allowing us to better track and address population health trends. It’s my mission to help ensure nurses in particular have the tools they need to achieve these “digital dividends.”

Continuing the Discussion

In honor of National Nurses Week, join me for a Twitter chat on May 12 at 1 p.m. ET to continue the discussion using #ONCNurse. ONC and I want to hear from you!

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