In one of the reading assignments this week you reviewed advance nurse practitioner (APN) roles and the application of project management concepts, one of the major elements of NI, but new to most nurses. Does this have an application to your practice? Why or why not? I am a Neonatal Intensive Care nurse. NICU
Information that may help
As we noted in Week 1, healthcare delivery is growing more complex, leading to more demands upon nurses. Consider the examples below.
An increasingly global society, which introduces healthcare problems not previously common to the United States
Advances in technology and drug therapies that enable us to keep sicker patients alive
Increased demands to use EBP to improve care and patient outcomes
Rapid turnover in knowledge
Expanding roles
Shorter patient stays
This complexity moves proficiency with technology and informatics skills from recommended to imperative in today's healthcare delivery system. Technology extends our capabilities to care for patients and provides access to information and knowledge beyond our individual abilities to "know." Technology also creates new information and knowledge needs and changes the way that we work. It can be an enabler or an obstacle, depending upon one's attitudes and skill sets. We will look at some of these tools and technologies here-namely, electronic health records (EHRs) and patient-care technologies-that are at our disposal now or promise to be available in the near future.
Electronic Health Records (EHRs)
EHR or EMR (electronic medical records) are used interchangeably as a generic term to refer to an electronic version of a record of a single treatment episode, or the information system in which it resides. The term has evolved to refer to a comprehensive, birth-to-death record of all health information and treatment encounters for an individual-something that has yet to be realized in a healthcare delivery system that still, in 2016, remains highly fragmented with separate records at hospitals, clinics, urgent-care centers, public-health offices, long-term care facilities, subacute care, and doctors' offices. The realization of a birth-to-death record promises many benefits, not the least of which is improved access to information, continuity, and quality of care. Both Presidents George W. Bush and Barack Obama called for the establishment of an EHR for every American as a means to improve care across the life continuum and to help transform healthcare delivery.
The target date of 2014 for that goal will not be met, although progress has been made.
Electronic record systems are built around large databases that allow input, storage, and retrieval of specific data for use in a meaningful way that can support other functions, such as decision support, results reporting, and order entry. Clinical documentation and clinical messaging are other basic functions. Use and reuse of data relies upon the collection of structured data that follows a format that supports manipulation.
Historically, automation started with a limited number of functions, such as patient registration; then, it expanded to include clinical systems, which grew to share laboratory, pharmacy, and radiology information. Clinical documentation began with simple elements, such as vital signs and intake and output, before the incorporation of "nurses' notes" and progress notes. Order entry first automated a paper process in which physicians wrote orders on paper charts for transcription into the computer by clerks and nurses-a process subject to errors until it was replaced by computerized provider order entry, or CPOE, a system in which providers enter their own orders. Realizing the benefits associated with the EHR requires structure provided through standardized languages and health-information exchange (HIE). As we discussed in Week 3, standardized languages support clinical decision support, research, communication, and information sharing.
Reflection
Have you ever wondered why a field on a computer screen only accepts certain characters or a limited number of characters? This is an example of screen design to force entry of structured data. Another example is providing predetermined choices rather than allowing users to enter free text. Can you see advantages or disadvantages with this approach? What might these be?
How Do EHRs Support the Information Needs of Nurses?
EHRs collect, store, and permit retrieval of clinical information in a legible format,often while supporting views customizable by each user. Additional support for direct-care providers can be seen with clinical alerts, decision support, and the integration of evidence-based guidelines for care. EHRs can also incorporate links to resource materials and databases that allow users to quickly and seamlessly view information about the patient's condition without exiting the EHR (Cimino, Jing, & Del Fiol, 2012). The bulk of users rely upon clinical data needed for the direct provision and documentation of care, but what other information might EHRs provide?
The creation and use of structured fields support legal, accreditation, reimbursement demands, the collection of core criteria for Meaningful Use, and disease and procedure code information,some of which can be tied to specific patients, while other data such as that collected for Meaningful Use is stripped of patient identifiers. Some of you use reports generated from your clinical systems and EHRs, either on demand, monthly, or on an annual basis using various criteria such as MRSA status, payer status, or a number of other criteria. While these reports can be very useful, they are not always easy to obtain or available when timely decisionmaking is needed.
Reflection
Can you think of information that you would find useful in a report that is not currently available to you? Is it information collected by your electronic record system? If not, could you see a way that it might be collected and made available? What is this information, and how could it better support your work and the care that you provide? How might you determine if you could access this information?
The healthcare sector is just beginning to realize the potential value of the large pools of de-identified data at its disposal. This aggregate data, also known as secondary or big data, can be used to improve care, discover patterns, reduce costs, support research, and identify and respond to consumer preferences. The process of tapping this data is known by many names-analytics, data mining, knowledge discovery in data bases, or business intelligence. The end result is that the analysis provided can support better and timelier decision making, decrease risks, and discover valuable insights as long as appropriate tools are used. Harper (2013) suggested improved staffing models based upon patient information as one potential application for nurses.