Electronic Medical Record Implementation Creates Opportunities for Nurses

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By Megan M. Krischke, contributor

July 22, 2011 - With the push to obtain the full incentive payout for meaningful use of electronic medical records (EMR)/electronic health records (EHR) created by the American Recovery and Reinvestment Act of 2009, many hospitals are in the early stages of developing and implementing their EMR. These organizations need the assistance of nurses, both with and without technical backgrounds, to make the implementation and ongoing use of these new systems a success.

EMR Nursing
Jan Zachry, RN, BSN, MBA, vice president of nursing and operations at Scripps Memorial Hospital says nurses with informatics backgrounds are needed to translate between EMR programmers and nursing staff.

“In terms of EMR, health care as a industry has been a little late to the table in working with vendors,” stated Jan Zachry, RN, BSN, MBA, vice president of nursing and operations at Scripps Memorial Hospital in Encinitas, Calif.

“Most organizations do not have a fully integrated EMR,” she continued. “They may have certain areas working with an EMR or they might be working under a hybrid mode. Capital funds were very scarce prior to the availability of federal funding. So now there is a sudden movement of health care organizations working closely with vendors to expand ideas of what is possible, and to customize products that weren’t originally designed for health care.”

“There are roles for nurses—in fact it is critical to have their participation—in creating an EMR that makes logical sense with their workflow and which is user-friendly,” explained Zachry. “There are also long-term roles for nurses with technical experience or master’s degrees in nursing informatics. These nurses are a critical member of the health care team from the beginning phases of creation of the EMR, to implementation—and the impact that that will have—to the continual updating and upgrading from the original design.”

Nurses serving as super users or who work exclusively in informatics often serve as translators between the technical world and the clinical world.

EMR Nursing
Jan Hooten, RN, BSN, says that having EMR experience opens up new job possibilities.

Jan Hooten, RN, BSN, an ER registry nurse, served as a super user when the hospital where she was working transitioned to using an electronic medical record.

“I had experience working in a hospital as a travel nurse during their conversion to an EMR, so it made sense to serve as a super user when my home hospital made the transition,” Hooten said of how she became involved in the implementation process.

“Depending on the need, some weeks working with the EMR was my full-time job and other weeks I was with patients. I spent days and days checking the system to make sure words were spelled correctly and that the programmers had included everything we needed in our charts,” she remarked.

Hooten advises nurses who have an opportunity to participate in EMR implementation to jump at the chance.

“It is one more skill set you can develop to make yourself a better job candidate,” Hooten stated. “There is so much happening with computers right now, I would encourage nurses to take every chance they have to receive more education and training.”

“You do, however, need to be a good teacher and have patience for people who are not computer literate and who are intimidated by learning a new system,” she continued. “You also need to be aware that if you become a super user, even after the system is up and running and you have returned to your normal job responsibilities, that people are going to call you when they get stuck.”

EMR Nursing
Kim Martini, senior director of Nurse Choice, says that participating in and EMR implementation allows nurses to be part of a positive change with health care reform.

As hospitals roll out their EMRs over the next several years, there is a great need for travel nurses to assist with both quality patient care and to serve as super users during the implementation phase, explained Kim Martini, senior director of NurseChoice, an AMN Healthcare company focused on providing short-term staffing solutions, including during EMR implementations.

“One of the needs is for travel nurses to backfill for the core staff and provide quality patient care during the period the hospital is training its core nurses on the new system. Then, once the system goes live, a travel nurse might fill one of several roles, depending on the hospital’s strategy,” Martini said.

“He or she might provide patient care while being shadowed by a core nurse who is entering information into the EMR,” she explained. “A second role would be to serve primarily as a super user and coach. And finally, in some situations, the travel nurse would be doing work identical to that of the core staff—providing patient care and entering information into the EMR—but their presence helps improve the nurse-to-patient ratio and makes up for lost efficiency during the learning period.”

“In all scenarios, the EMR travel nurse is available to provide coaching to the core staff who are learning the system,” she said.

Nurses who come in to assist during the “go live” stage need to have strong computer charting skills, but don’t necessarily need to have previous experience with the exact system. Martini likens it to learning to play one stringed instrument after you already have experience and are comfortable with another—there will be differences, but the basic skills are similar.  Additionally, nurses are typically supplied with an online tutorial of the EMR system in advance.

For Jennifer Smith, RN, operating room nurse with NurseChoice, one of the highlights of working on an EMR conversion was getting to focus so much on the patient while the core nurse did the EMR charting.

“It was also an exciting assignment because there were 200 other travelers on site; it is easy to form fast friendships because the other travelers understand your lifestyle,” Smith noted.

Catherine Beaman, recruiter for NurseChoice, emphasized, “Working on an EMR conversion is a great opportunity for a travel nurse, because once you have worked on one, it opens the door to work on future conversions.”

© 2011. AMN Healthcare, Inc. All Rights Reserved.