translation of nursing practice into the electronic healthcare record systems: now & in our future

8/14/2019 Translation of Nursing Practice into the Electronic Healthcare Record Systems: Now & In Our Future

1/17

TRANSLATION OF NURSING PRACTICE INTO

ELECTRONIC HEALTHCARE RECORD SYSTEMS:

NOW & IN OUR FUTURE

Patricia Abbott, PhD, RN

Goals & Objectives Discuss how healthcare information technology can be

used to improve patient safety and outcomes throughnursing research and evidence-based practice.

Examine the influence of the national health IT policy onnursing practice and patient care.

Discuss the key strategies to enhance adoption of

electronic healthcare record systems in nursing practice

Describe the future use of healthcare informationtechnology to influence patient outcomes.


2/17

We need to acknowledge that many

nurses work in combat like settings

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/08

PTSDinNurses:On-the-job

traumaisdrivingnursesfrom

theprofessionThomasSchwarzRN AJN,AJNMarch2005

What Do Nurses Do?

walks 3.89 milesper day on the job

works 8.5 weeks ofovertime each year

makes and receives33 calls per shift1

Source:VanSlyck andAssociates,Inc.;Shepley MM,etal.,NursingUnitConfigurationandItsRelationshiptoNoiseandNurseWalkingBehavior:NursesMustEnhanceImage, March12,2006:excerptedfromTheAdvisoryBoardCompanyUnlockingthePowerofNursingIT,2007


3/17

Informatics in Nursing & Healthcare

It is NOT about paper

And, it is really not about the computer

It is about the patient

It is about the data

It is about collaboration

It is about knowledge sharing and knowledgeexchange

It is about competency to practice & LEAD It is about closing the know-do gap

Know-Do Gap Bridging the

Translational Latency Gap

James Grant declared that 80% of the childrenwho died in Africa during his term as Executive

Director of UNICEF could have been saved because

the knowledge to save them existed. This

knowledge simply was not available when and

where it was needed.

We really are not that muchdifferent in the US


4/17

110

100

1,000

10,000

100,000

1 10 100 1,000 10,000 100,000 1,000,00010,000,000Number of encounters for each fatality

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REGULATEDANGEROUS(>1/1000) ULTRA-SAFE(


5/17

The Value Proposition - What

Goes Wrong in Healthcare Today

Med errors found in one of every five doses given in

typical US hospitals

Of those, 7% (more than 40 per day in a typical hospital)

were potentially life threatening

US Health insurance has risen over 10% in last three

years

17 to 49% of diagnostic lab tests performedneedlessly in the US

And on and on and on

The Value Proposition - What

Goes Wrong in Healthcare Today


6/17

What Facilitates Inefficiency

and Error?

Best decision-making in patient care thwarted Care givers cannot hold all patient info in memory

Care givers cannot know all best practices

Missing data impacts quality of decisions

Recording system relies on human interpretation

Rapidly mutating knowledge bases We dont know what we dont know

We dont know what we do know

Systems not designed for and by the user-base Misfit, does not match workflow, accelerates error

Modeling the User Base

Nurses are highly mobile workers Complex, stressful and safety critical environments

Cognitive overload common

Portability important

Physical space and movement restricted

Collections of solutions is no solution

The COW (computer onwheels), a dying breed

COW replaced by a LOL

(Llama on Legs)


7/17

Tragic Example

Air France Disaster:

"This is a plane that is conceived byengineers for engineers and not alwaysfor pilots," Jean-Pierre Albran, a veteranpilot of Boeing 747s, told Le Parisiennewspaper.

HIT-enabled Care- Improving

Patient Safety & Outcomes

Doran & Sidani (2007)

More effective than manual at improving practice1

75% success rate with automated clinical support1

Effectiveness in improving clinical care comes from

systems that:

Provide DSS as part of clinical workflow

Deliver DSS at moment and place of need

Provide actionable recommendations


8/17

HIT-enabled Care

Reducing ADE in Inpatient Settings David Bates, Peter Pronovost, etc.

Reduce ADE by 200,00 a year

Save 1 Billion

Protecting the elderly

Reducing ADE in Ambulatory Settings Not as well studied

8M events annually 1/3 to preventable

Extrapolate nationally 3.5 B savings

At The Same Time

HIT has not always been beneficial

Koppel CPOE strikingly increased med

error risks1

Han significant increase in infant mortality

after CPOE2

1:JAMA. 2005 Mar 9;293(10):1197-203.2: Pediatrics. 2005 Dec;116(6):1506-12.


9/17

Poor Usability

How Will/Can We Change This?

Let me tell you how we WONTchange..


10/17

NURSES - This Will Not Work..

You are either part of the futureor you are history.

Nurses with Informatics Competancies

Designated formal specialty by ANA 1993. Scope & Standards of Practice (Version 3)

Certification Exam 1995

Mimicked by AMA/AAMC

IOM Reengineering the Health Professions

ARRA & HITECH Act

40,000 health informaticians needed

Large scale funding in the wings for HIT education (2 levels)

Healthcare Reform The elephant in the room

Changing nursing competencies


11/17

American Recovery & Reinvestment Act

(ARRA) Policy Impact on Nursing

Health Information Technology for

Economic and Clinical Health Act

HITECH

22

Act within the Act

Goal of an electronic health system by 2014

$20 Billion Allocated

Places ONC in statute

Most of money for incentives for EHR adoption ($18

Billion) Wide variety of programs addressing all components

of strategic plan

Major section on privacy and security


12/17

HITECH

Focus on patient as partner

Rural health and care of the underserved

Avoiding technological apartheid

National Health Information Infrastructure (NHIN)

90 days from bill signing to have formal plans to

disperse funds

EDUCATIONAL

REFORM


13/17

Education for the health professions is inneed of a major overhaul. Clinical educationsimply has not kept pace with or beenresponsive enough to shifting patientdemographics and desires, changing healthsystem expectation, evolving practicerequirements and staffing arrangements, newinformation, a focus on improving quality, ornew technologies.

Pattis Grandmothers Words.

If you do not understand it,

then dont fix it


14/17

Insanity:Continuing to do thesame thing and expectingdifferent results.

- Albert Einstein


15/17

http://www.youtube.com/watch?v=9jAH9hdF0xk

What Did We Hear?

2.2 Trillion spent

700 Billion in waste

45 million uninsured

7000 medication errors

Cant find the chart

My patient in ER 2 days ago, what happened to her?

Who is taking Vioxx that just got recalled? I spend more time with paper than I do with the patient


16/17

What Did We Hear?

We did not make the problem but it is ourproblem..

What is the Take Away?

HIT is not a panacea Implementing HIT on top of a faultyprocess will just speed up screw ups

New environments require newcompetencies for Nurses

Will nurses be road-kill, hitchhikers,or builders of the informationhighway inhealthcare?


17/17

Reviewing the

Objectives

Discuss how healthcare information technology can beused to improve patient safety and outcomes throughnursing research and evidence-based practice.

Examine the influence of the national health IT policy onnursing practice and patient care.

Discuss the key strategies to enhance adoption ofelectronic healthcare record systems in nursing practice

Describe the future use of healthcare informationtechnology to influence patient outcomes.

Thanks!Thanks!

[email protected]

THANKS!!!

translation of nursing practice into the electronic healthcare record systems: now & in our future

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