By Suzi Birz, Principal, HiQ Analytics
For years, nurses have been advocating for patient information
at the point of care. Now, Helen Connors, RN, Ph.D., FAAN, executive
director of the Center for Healthcare Informatics at the University of Kansas
Medical Center, in Lawrence, Kansas, has introduced “information at the point of learning.”
At Johns Hopkins University School of Nursing, in Baltimore, Maryland, Patricia
Abbott, RN, Ph.D., FAAN, assistant professor and co-director of the World Health
Organization/Pan American Health Organization Center for Information Systems in
Nursing Care, concluded that “it is a crime to graduate nursing students who
don’t know how to interact in this complex and information intensive
In the wake of these realizations, working with their vendors,
both the University of Kansas School of Nursing (KUSON) and the Johns
Hopkins University School of Nursing (JHUSON), have integrated electronic health
records into the nursing curriculum.
In 2001, the University of Kansas School of Nursing and Cerner
Corporation announced a jointly funded partnership representing “a pioneering
event for education and for the health care information technology industry.”
According to Connors and her colleagues, the partnership marked “the first time
that a live-production, clinical information system designed for care delivery
is being used in a simulated way for teaching curriculum content to nursing
In September 2004, Eclipsys Corporation issued a press release
stating: “Underscoring the growing role that information technology plays in the
delivery of healthcare, the Johns Hopkins University School of Nursing and
Eclipsys Corporation have signed a letter of intent to launch a unique academic
partnership. The goals of the partnership are to increase the healthcare
information technology competence of nursing graduates and to design new ways of
delivering safe and efficient healthcare utilizing healthcare information
technology.” Implementation of this partnership will begin in summer 2005.
Integrating Electronic Health Records into the Curriculum
Both programs are embedding the electronic health record into
their nursing curriculum. The emphasis is not the competency of using the
technology, but rather “keeping the technology transparent and focusing on the
learning,” Connors explained.
KUSON uses the recent Institute of Medicine reports on patient
safety and education to guide curriculum development. Connors noted that nursing
students will get a better understanding of the nursing process while they are
learning to navigate an electronic health record, acquire information at
point-of-learning, find evidence-based practices and create a plan of care based
on data, information and knowledge. The integration is widespread throughout the
nursing curriculum, including the research course in which nursing students
learn how research fits into the plan of care.
KUSON has created a virtual health care delivery system
including longitudinal records that allow nursing students to care for a patient
in one setting during the first semester and encounter that same patient in
another setting the following semester. Students interact with the electronic
medical record in the various settings. This enhances the experience of having
the electronic medical record embedded in the curriculum and builds a skill set
required for clinical practice in the 21st century.
The use of the electronic health record during teaching is not
just about learning to use the tool, but rather about how to “identify when a
gap in understanding is present, how to find the information needed to fill the
gap and how to critically evaluate the information to provide the optimal care
for our patients,” Abbott explained.
“It also requires that we teach our students to support
patient-centered care, which means having an informed patient who actively
participates in healthcare decision making,” she added. “A patient who has been
taught by a nurse to access online information and interpret data from a
personal health record is a better patient.”
Abbott and colleagues have integrated informatics into nursing
education in two significant ways: basic computer competencies and informatics
“Many people do not understand that these two things are
vastly different,” Abbott said. “Basic computer competencies are focused upon
actions like using databases and telecommunications—in other words, ‘Thy hands
will touch the keyboard,’” she explained.
“Informatics competencies, on the other hand, are more complex
and involve critical thinking and application of informatics tools, such as
identifying best practices from compilations of data, using technology tools to
plan patient care and using technology to help our patients reach and maintain a
higher level of health.”
Since 2001, the faculty at KUSON has been enthusiastic about
the implementation of technology. After beginning with a pilot of five faculty
and 34 students, most all undergraduate faculty were using the integrated
teaching methods in 2002. Improvements, especially for the faculty, have come
along, including the capability for the faculty to evaluate the students’ work
The introduction of new technology into a nursing curriculum
represents a fundamental change in teaching methods. In many instances, the
faculty will be using technology for teaching that was not available when they
were practicing clinicians. This requires the faculty to “move out of the
comfort zone,” Abbott explained.
Abbott added that it is challenging for faculty to teach what
they themselves have just learned, especially as students move into increasingly
automated clinical environments.
“What we have found at Hopkins is that the faculty has really
risen to the occasion, and is actively incorporating informatics throughout our
innovative and dynamic curriculum,” she said.
When surveyed, the students at KUSON stated that they are
“better prepared for the work environment” and that they had “better
decision-making skills.” When asked if they would be able to document in a
hospital that did not have an electronic health record, they said that they did
learn those skills, however, they expressed a desire to work in a setting with
The students at JHUSON welcome the upcoming change as well.
Abbott reported that they need more practical hands-on experience. “Having
32 fully IT-outfitted simulation beds gives our students a wonderful opportunity
to learn in a supportive environment,” she said.
What the Future Holds
The integration of the electronic health record is serving as
an aid at integrating the medical school and nursing school curricula at KUSON.
A virtual health care delivery system allows the medical students and nursing
students to administer care to the same patients. It is envisioned that this
will move into an integrated lab setting with medical students and nursing
students simulating care together. Connors is now working with the allied health
professionals, including the schools for occupational therapy and physical
therapy, to further extend the care environment and the multi-disciplinary
approach to patient care.
JHUSON involves the Fellows from the NIH-supported BioMedical
Informatics training grant. “This means that we have physicians, librarians,
nurses, computer scientists and public health professionals interacting in our
simulation space. It makes for great study of team dynamics,” Abbott said.
Both Abbott and Connors agreed that there is a responsibility
to teach the new generation of nurses practical computer skills so that with
their mastery, computers serve nurses, rather than nurses serving the computers.
This integrated training technique will prepare the students to take positions
at hospitals, regardless of the presence or absence of an electronic health
record or the specific vendor product.
Connors stated that the training these students receive will
help transform their education to include the competencies required by the
Institute of Medicine report on health professional education.
In looking at the impact on recruitment and retention, Abbott
cited that “studies show that mismatch between educational preparation and
clinical reality impacts on job satisfaction and retention rates.”
Take Away Message for Nurses
Connors advised: “Recognize that information technology is an
area in which you have to focus. Understand the value of having this skill set.”
Abbott advised: “Teach the principles, but then apply them.
For example, to play the piano you must touch the keyboard, not just read the
Take Away Message for Nursing Students
Connors recommended: “Use the technology skill set you bring to
nursing education and apply it to improve the quality, safety, efficiency and
effectiveness of health care—you will make a difference.”
Abbott advised: “If you are not getting practical information
in your training program, you need to demand it. Information technology in
health care can no longer be avoided; it is not a matter of if, it’s a
matter of when.”
University of Kansas School of Nursing and Cerner announcement
Johns Hopkins and Eclipsys announcement
The Johns Hopkins University School of Nursing
Institute of Medicine
Eclipsys Declares 2004 the Year of the Nurse
© 2005. AMN Healthcare, Inc. All Rights Reserved.