Nurses’ Vital Role in EMR Upgrades Creating Opportunities

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By Debra Wood, RN, contributor

April 18, 2014 - Just as nurses play key roles during hospitals’ implementation of electronic medical records, they are proving valuable as facilities seek to achieve the next stage of meaningful use and extract data from the records to improve patient care. That creates new opportunities for nurses.

Joyce Sensmeier: Nurse involvement vital to EMR system success.
Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, said nurses have to be involved if a hospital wants a successful EMR system.

“As we are refining the systems and getting closer to having them capture data that will lead to outcomes is an optimization issue,” said Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, vice president of informatics at HIMSS, a global, cause-based, not-for-profit organization focused on better health through information technology in Chicago. “Having nurses involved with the upgrade will enable the systems to be used to their best and optimal purpose.”

The HIMSS 2014 Nursing Informatics Workforce Survey found nurse informaticists are working more on electronic medical record (EMR)/electronic health record (EHR) upgrades, refining and optimizing the systems. Staff nurses also have great ideas about how to leverage the systems, she added, and they should be included in planning and discussions.

Master’s-prepared nurse informaticists at South Nassau Communities Hospital in Oceanside, N.Y., work in various capacities, including clinical documentation, core builds and training. They received additional education and can go in and change the configuration to customize the product to meet the facility’s needs.

“It’s very important to have nurses,” said Barbara B. Guy, RN-BC, MSN, director of the electronic medical record department at South Nassau. “They are strong patient advocates and are able to look at problems and workflows through the eyes of the different caregivers on the health team.”

Opportunities for staff and temporary nurses 

“Nurses can help to make sure EHR systems are fully functional and meeting the end-user requirements by playing a major role in the choice of the EHR,” said Catherine Fant, PhD, RN, a graduate faculty member with Kaplan University School of Nursing. “Unless nurses are at the table when EHRs are chosen, then the product will not meet their needs, which in turn can compromise patient care.”

Ed Simcox relies on nurses to design EHR upgrades.
Ed Simcox said nurses are his first source of guidance and information when retrofitting a floor with new technology.

Vendors also appreciate nurses’ feedback. Ed Simcox, healthcare practice leader at Logicalis US based in New York, said nurses are his first source of guidance and information when retrofitting a unit with new technology, because “they are masters at making the most efficient use of space and time within the hospital setting.” He recalled shadowing a neurological intensive care nurse at a large hospital and asking for her ideas for improving efficiency.

“In 10 minutes, she shared some highly valuable, yet very simple system modifications that could save the nurses hundreds of hours of unnecessary screen time just in that one unit,” Simcox said.

Beth Kilmover: More RNs becoming health informaticists.
Beth Kilmoyer, DNP, RN-BC, said opportunities for nurses in health informatics are growing.

Involving nurses increases efficiencies of the system by making it more user-friendly due to their first-hand experience, said Beth Kilmoyer, DNP, RN-BC, nursing informatics manager at Mercy Medical Center in Baltimore.

“Staff nurses are critical to defining the system design to complement the ideal workflows,” added Maureen Scanlan, RN, director of nursing informatics at Montefiore Medical Center in Bronx, N.Y. “In addition, and not less significant, is implementing a system that supports easy adoption by end users as well as engages the patient. This is best accomplished when staff nurses are involved from the start of the project.”

Once systems are in place, nurses help familiarize other clinicians on the team.

At Holy Cross Hospital in Fort Lauderdale, Fla., nurses also learned the provider portion of the system so that they could assist physicians and mid-level providers if needed.

“Nurses provide elbow-to-elbow support during go-live and are responsible for ongoing education and follow-up,” said Andrew C. Durkel, RN, working in clinical informatics at Holy Cross. “We take feedback from end-users to make changes and additions to improve satisfaction, communication, and patient outcomes.”

Trinity Mother Frances Hospitals and Clinics in Tyler, Texas, trained and deployed new nursing graduates as internal “super users” and contracted with AMN Healthcare’s EMR solutions team to implement their new electronic health record system. AMN brought in more than 80 temporary RNs across various specialties who were experienced and versed in the software the health care system had selected. Most of the EMR-trained nurses had been hired by NurseChoice, an AMN Healthcare company specializing in EMR conversions and other short-term assignments.

“Not only were the individual nurses competent and friendly, AMN’s support role was invaluable,” said Robert Rose, RN, MS, NEA-BC, senior vice president and chief nursing officer at Trinity Mother Frances in a case study.

With their clinical experience, nurses can help translate changes needed to the information technology people, Guy said.

The next steps for EHRs 

Bethany Jones: Nurses instrumental in optimizing electronic health records.
Bethany W. Jones, MS, BSN, RN, CPHIMS, said nurses are instrumental in optimizing and upgrading EHRs.

“Now as the focus moves from implementing to upgrading, we are seeing [nurses’] roles changing,” said Bethany W. Jones, MS, BSN, RN, CPHIMS, health information technology advisor at the Kentucky regional extension center (REC) housed at the University of Kentucky College of Medicine in Lexington.

Nurses have the clinical information and resourcefulness to facilitate electronic transitions of care, help patients access health records online, collaborate among teams and extract quality data, Jones said.

“Nurses are incredibly effective in navigating this terrain,” Jones said. “Nurses have always been able to think holistically.”

EHRs are about improving patient safety and care, added Barb Stout, DNP, RN-BC, health care information technologist at the Kentucky REC.

Barb Stout: Nurses play critical role in using EHRs to improve safety.
Barb Stout, DNP, RN-BC, said nurses play a critical role in using electronic health records to improve patient safety and care.

“Meaningful use Stage 2 is different from Stage 1, and facilities are making changes,” Stout said.

Nurses at Holy Cross design and implement tools to communicate to health care providers across the continuum of care and to work with the many different quality indicators that are looked at to stay compliant with accrediting and regulatory agencies, Durkel said.

“EHRs are producing tremendous amounts of data,” Fant reported. “Regardless of the role the nurse plays, whether as a manager, staff or any other position, the nurse will have to deal with these data. Data can be organized, interpreted and applied to guide the nursing process. The clinical decisions support systems that collect and process data and information enable the nurse to make the critical decisions regarding the health of their patients.”

Opportunities for the future 

Along with short-term assignments in EMR system implementations and upgrades with companies like NurseChoice, nurses can expect to find more long-term career opportunities in the area of health information technology.

“The need [for nurse informaticists] is on the increase,” Sensmeier said. “Their salaries are increasing and their roles are expanding and changing.”

Thirty percent of the HIMSS survey respondents said they were involved with analytics, pulling out meaningful information to improve quality outcomes and understanding what care activities make a difference. The survey found average salaries were $100,717, up from $98,703 in 2011 and $83,675 in 2007.

Kilmoyer agreed that the opportunities are growing.

“Nurses’ education and work experiences serve really well with technology implementation, because we are very analytical and systems organized,” Kilmoyer said.
Additionally, every time the government changes regulations, EHRs will need updating, creating opportunities for nurses to upgrade the systems, Guy said.

“It’s constantly evolving and will never stay static,” Guy added. “There is always a new challenge.”

Jones encouraged all nurses to stay informed about not only about what is happening on their units and within their hospitals but in the broader community in regards to technology--such as meaningful use, state health exchanges and local medical neighborhoods.

“Nurses can take roles on teams, boards and panels to improve care delivery through health IT and quality improvement,” Jones said. “Nurses can advocate for their patients and their fellow nurses.”

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