By Beth A. Coutts, RN, BSN, NurseZone
OK nurses, ready or not, the information age is
upon us and it’s here to stay. So what are you going to do about it?
This is the technological climate of your
industry: Hospitals and health care systems are working on getting up to speed,
some because they want to and others because they have to. You’ve no doubt
seen some of the latest technologies to improve how patient information is
captured and managed. Historically, hospitals invested in information systems to
manage patients’ financial information such as billing, insurance and
admitting, while clinical data–the patient record–has been managed almost
completely on paper in most facilities.
But today, health care providers are moving
toward electronic management of patient related clinical information. Why? There
are many factors influencing this migration, including regulatory agencies,
insurance companies, as well as providers and patients who are demanding large
quantities of clinical information that is easily accessible and portable.
Manual methods of collecting, managing and analyzing this type of information
are no longer sufficient to meet these demands.
With the technological monster knocking at the
door, the question remains: How will clinical information systems affect your
nursing practice and how can you be prepared?
Benefits of Clinical Information Systems
Let’s look at the big picture: Clinical
information systems can deliver many benefits to hospitals, providers and
patients. Data can be accessed using personal computers (PCs), handheld devices
(PDAs), and thin clients (a simplified version of the PC). Data can be entered
and viewed from the patients’ bedside or remotely from other locations within
a hospital or even outside of the actual care setting. Many systems provide
Web-based access so health care providers can access information from virtually
anywhere there is an Internet connection.
What’s more, when data are entered into an
electronic medical record, that information can be shared automatically among
all the appropriate fields throughout the patient record. Patients only have to
answer a question once and providers only have to ask it once. Clinical systems
also enhance decision-making with programs that can incorporate clinical
guidelines into the charting process. Rob Knodle, a manager with Information
Systems at Sharp HealthCare is working closely with providers to incorporate
their clinical guidelines into software called LastWord created by IDX Systems
Corporation. This system provides a module that applies expert rules to
automatically analyze orders and other triggers as they are entered into the
system. It also has the capability to "make suggestions" about tests,
treatments or other indications for the patient before executing an order.
Ideally, clinical information systems should
decrease the amount of time that providers spend documenting. According to Linda
Gibson, director of Health Informatics for IDX, systems can also "improve
revenue cycle management by increasing the efficiency of the clinicians."
How is this carried out? The systems would ideally assist facilities in meeting
regulatory demands regarding documentation by automating many aspects of the
process for functionality and accuracy. Data entered could also be mined for
quality initiatives and research.
Acceptance of Clinical Information Systems
There are many factors that influence the
acceptance and use of clinical information systems in the hospital setting.
According to Knodle, one of the most important variables in gaining end user
buy-in comes from involving the end user in the decision making process from the
selection process through to the implementation of a system. Involving end users
in this process provides them with a sense of ownership and motivates them
toward making it a success. All departments who will use the system should be
represented and have a voice in the decision making process. Gibson agreed and
added that it is imperative to have knowledgeable nurses and other executives
involved in the strategic design and vision of the system.
Another key component of success when choosing
and implementing clinical information systems is education. A comprehensive
training plan should be implemented. According to Knodle, at Sharp Healthcare
they will have "over 40 trainers to educate the end users on how to use the
system". Creating experts throughout the facility creates a network of
users who can assist one another on a daily basis.
As Nurses, You Should Be Prepared
Nurses are an integral part of the entire
process of implementing a clinical information system. They should partner with
other clinical providers as well as IT experts to select and implement the best
system for the hospital as a whole. Nurses providing direct care to patients as
well as management could participate.
If asked to participate in such a team, there
are several things that a nurse can do to prepare. Knodle suggested that nurses
"do some research into what these systems can and cannot do." Often,
vendors will provide product demos or you can attend a trade show and review
many vendors’ products side-by-side.
Also, analyze your current processes and
practices and know what you want the system to do. Be prepared to rethink your
processes and improve on them using this new technology. Gibson suggested that
nurses "begin to redesign their work processes/flows prior to selection of
a system and use them to drive selection. She also suggested that
"databases should be standardized" early on in the process.
Let’s face it, nurses are the experts on
clinical processes related to their practice. However, they must be willing to
compromise, working with other disciplines and groups to decide how to use the
system to everyone’s benefit.
Most importantly, be proactive and get
involved. Many implementations suffer from the perception that the system was
chosen by non-clinical people and implemented without their input. To mitigate
that, nursing professionals should get involved early and actively participate
in the implementation of the system. Contribute to the success of the system
rather than waiting for someone else to make decisions that will affect how you
practice. If clinical information systems are chosen wisely and implemented with
a solid plan and the involvement of key players, like you, the nurse, the
systems will significantly improve how patient care is delivered. Embrace the
change, one day you will find yourself wondering how you ever functioned without
Beth Coutts has more than eight years of
experience in the health care informatics field as an end user, account manager
and manager of clinical services.