Translation Of Nursing Practice Into The Electronic Healthcare Record Systems: Now & In Our Future
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TRANSLATION OF NURSING PRACTICE INTO ELECTRONIC HEALTHCARE RECORD SYSTEMS: NOW & IN OUR FUTURE Patricia Abbott, PhD, RN
Goals & Objectives
Discuss how healthcare information technology can be used to improve patient safety and outcomes through nursing research and evidence-based practice.
Examine the influence of the national health IT policy on nursing practice and patient care.
Discuss the key strategies to enhance adoption of electronic healthcare record systems in nursing practice
Describe the future use of healthcare information technology to influence patient outcomes.
We need to acknowledge that many nurses work in combat like settings y ng rsi inall u n g i r o els ve od tool pro m m g ian sin to i bat sic s u nes com y i w h O, “P rkflo Mar g of MI n dC y i o n w d b and Pa e r. V /08 us derst ns.” , S are 1 D , M thc un atio ide eal ers ur H u h t i c e t s Ke onh h ep Le B Jos dist . W tho Me
“PTS D in trau ma i Nurses: sd the p O rofe riving n n-the-jo ssio b urse n” s fro Thom m as S c hwa rz RN AJN , AJN Marc h 20 05
What Do Nurses Do? …walks 3.89 miles per day on the job …works 8.5 weeks of overtime each year …makes and receives 33 calls per shift1 Source: Van Slyck and Associates, Inc.; Shepley MM, et al., “Nursing Unit Configuration and Its Relationship to Noise and Nurse Walking Behavior: Nurses Must Enhance Image,” March 12, 2006”: excerpted from The Advisory Board Company “Unlocking the Power of Nursing IT, 2007
Informatics in Nursing & Healthcare
It is NOT about paper And, it is really not about the computer It is about the patient It is about the data It is about collaboration It is about knowledge sharing and knowledge exchange It is about competency to practice & LEAD It is about closing the “know-do” gap
Know-Do Gap – Bridging the Translational Latency Gap
James Grant declared that 80% of the children who died in Africa during his term as Executive Director of UNICEF could have been saved because the knowledge to save them existed. This knowledge simply was not available when and where it was needed.
We really are not that much different in the US
How Hazardous Is Health Care?
Total lives lost per year
100,000
DANGEROUS (>1/1000)
REGULATED
HealthCare
ULTRA-SAFE (<1/100K)
Driving
10,000 1,000
Scheduled Airlines
100
Mountain Climbing Bungee Jumping
10 1
1
10
100
1,000
Chemical Manufacturing Chartered Flights 10,000
European Railroads Nuclear Power
100,000 1,000,00010,000,000
Number of encounters for each fatality Death associated with medication error Source: Leape
The Value Proposition - What Goes Wrong in Healthcare Today
The Value Proposition - What Goes Wrong in Healthcare Today
Med errors found in one of every five doses given in typical US hospitals
Of those, 7% (more than 40 per day in a typical hospital) were potentially life threatening
US Health insurance has risen over 10% in last three years 17 to 49% of diagnostic lab tests performed needlessly in the US And on and on and on…………
What Facilitates Inefficiency and Error? `
Best decision-making in patient care thwarted ◦ ◦
` ` `
Missing data impacts quality of decisions Recording system relies on human interpretation Rapidly mutating knowledge bases ◦ ◦
`
Care givers cannot hold all patient info in memory Care givers cannot know all best practices
We don’t know what we don’t know We don’t know what we do know
Systems not designed for and by the user-base ◦
Misfit, does not match workflow, accelerates error
Modeling the User Base
Nurses are highly mobile workers Complex, stressful and safety critical environments Cognitive overload common Portability important
Physical space and movement restricted
The COW (computer on wheels), a dying breed
Collections of solutions is no solution
COW replaced by a LOL (Llama on Legs)
Tragic Example…………
Air France Disaster:
"This is a plane that is conceived by engineers for engineers and not always for pilots," Jean-Pierre Albran, a veteran pilot of Boeing 747s, told Le Parisien newspaper.
HIT-enabled Care- Improving Patient Safety & Outcomes
Doran & Sidani (2007) More effective than manual at improving practice1 75% success rate with automated clinical support1 Effectiveness in improving clinical care comes from systems that:
Provide DSS as part of clinical workflow Deliver DSS at moment and place of need Provide actionable recommendations
HIT-enabled Care
Reducing ADE in Inpatient Settings David Bates, Peter Pronovost, etc. Reduce ADE by 200,00 a year Save 1 Billion Protecting the elderly
Reducing ADE in Ambulatory Settings Not as well studied 8M events annually – 1/3 to ½ preventable Extrapolate nationally – 3.5 B savings
At The Same Time……
HIT has not always been beneficial Koppel
– CPOE strikingly increased med error risks1 Han – significant increase in infant mortality after CPOE2 1: JAMA. 2005 Mar 9;293(10):1197-203. 2: Pediatrics. 2005 Dec;116(6):1506-12.
Poor Usability
How Will/Can We Change This?
Let me tell you how we WON’T change………………………..
NURSES - This Will Not Work…..
You are either part of the future or you are history…….
Nurses with Informatics Competancies
Designated formal specialty by ANA 1993.
Certification Exam 1995 Mimicked by AMA/AAMC IOM “Reengineering the Health Professions” ARRA & HITECH Act
40,000 health informaticians needed Large scale funding in the wings for HIT education (2 levels)
Healthcare Reform
Scope & Standards of Practice (Version 3)
The elephant in the room
Changing nursing competencies
American Recovery & Reinvestment Act (ARRA) – Policy Impact on Nursing
Health Information Technology for Economic and Clinical Health Act – “HITECH”
Act within the Act Goal of an electronic health system by 2014 $20 Billion Allocated Places ONC in statute Most of money for incentives for EHR adoption ($18 Billion) Wide variety of programs addressing all components of strategic plan Major section on privacy and security 22
HITECH
Focus on “patient as partner” Rural health and care of the underserved
Avoiding “technological apartheid”
National Health Information Infrastructure (NHIN) 90 days from bill signing to have formal plans to disperse funds
EDUCATIONAL REFORM
“Education for the health professions is in need of a major overhaul. Clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectation, evolving practice requirements and staffing arrangements, new information, a focus on improving quality, or new technologies.”
Patti’s Grandmothers Words…….
“If you do not understand it, then don’t fix it”
“Insanity: Continuing to do the same thing and expecting different results.” - Albert Einstein
http://www.youtube.com/watch?v=9jAH9hdF0xk
What Did We Hear?
2.2 Trillion spent 700 Billion in waste 45 million uninsured 7000 medication errors Can’t find the chart My patient in ER 2 days ago, what happened to her? Who is taking Vioxx that just got recalled? I spend more time with paper than I do with the patient
What Did We Hear?
We did not make the problem – but it is our problem…………..
What is the Take Away? HIT is not a panacea ` Implementing HIT on top of a faulty process will just speed up screw ups ` New environments require new competencies for Nurses ` Will nurses be road-kill, hitchhikers, or builders of the information highway in healthcare? `
Reviewing the Objectives
Discuss how healthcare information technology can be used to improve patient safety and outcomes through nursing research and evidence-based practice.
Examine the influence of the national health IT policy on nursing practice and patient care.
Discuss the key strategies to enhance adoption of electronic healthcare record systems in nursing practice
Describe the future use of healthcare information technology to influence patient outcomes.
THANKS!!! Thanks!
[email protected]
Goals & Objectives
Discuss how healthcare information technology can be used to improve patient safety and outcomes through nursing research and evidence-based practice.
Examine the influence of the national health IT policy on nursing practice and patient care.
Discuss the key strategies to enhance adoption of electronic healthcare record systems in nursing practice
Describe the future use of healthcare information technology to influence patient outcomes.
We need to acknowledge that many nurses work in combat like settings y ng rsi inall u n g i r o els ve od tool pro m m g ian sin to i bat sic s u nes com y i w h O, “P rkflo Mar g of MI n dC y i o n w d b and Pa e r. V /08 us derst ns.” , S are 1 D , M thc un atio ide eal ers ur H u h t i c e t s Ke onh h ep Le B Jos dist . W tho Me
“PTS D in trau ma i Nurses: sd the p O rofe riving n n-the-jo ssio b urse n” s fro Thom m as S c hwa rz RN AJN , AJN Marc h 20 05
What Do Nurses Do? …walks 3.89 miles per day on the job …works 8.5 weeks of overtime each year …makes and receives 33 calls per shift1 Source: Van Slyck and Associates, Inc.; Shepley MM, et al., “Nursing Unit Configuration and Its Relationship to Noise and Nurse Walking Behavior: Nurses Must Enhance Image,” March 12, 2006”: excerpted from The Advisory Board Company “Unlocking the Power of Nursing IT, 2007
Informatics in Nursing & Healthcare
It is NOT about paper And, it is really not about the computer It is about the patient It is about the data It is about collaboration It is about knowledge sharing and knowledge exchange It is about competency to practice & LEAD It is about closing the “know-do” gap
Know-Do Gap – Bridging the Translational Latency Gap
James Grant declared that 80% of the children who died in Africa during his term as Executive Director of UNICEF could have been saved because the knowledge to save them existed. This knowledge simply was not available when and where it was needed.
We really are not that much different in the US
How Hazardous Is Health Care?
Total lives lost per year
100,000
DANGEROUS (>1/1000)
REGULATED
HealthCare
ULTRA-SAFE (<1/100K)
Driving
10,000 1,000
Scheduled Airlines
100
Mountain Climbing Bungee Jumping
10 1
1
10
100
1,000
Chemical Manufacturing Chartered Flights 10,000
European Railroads Nuclear Power
100,000 1,000,00010,000,000
Number of encounters for each fatality Death associated with medication error Source: Leape
The Value Proposition - What Goes Wrong in Healthcare Today
The Value Proposition - What Goes Wrong in Healthcare Today
Med errors found in one of every five doses given in typical US hospitals
Of those, 7% (more than 40 per day in a typical hospital) were potentially life threatening
US Health insurance has risen over 10% in last three years 17 to 49% of diagnostic lab tests performed needlessly in the US And on and on and on…………
What Facilitates Inefficiency and Error? `
Best decision-making in patient care thwarted ◦ ◦
` ` `
Missing data impacts quality of decisions Recording system relies on human interpretation Rapidly mutating knowledge bases ◦ ◦
`
Care givers cannot hold all patient info in memory Care givers cannot know all best practices
We don’t know what we don’t know We don’t know what we do know
Systems not designed for and by the user-base ◦
Misfit, does not match workflow, accelerates error
Modeling the User Base
Nurses are highly mobile workers Complex, stressful and safety critical environments Cognitive overload common Portability important
Physical space and movement restricted
The COW (computer on wheels), a dying breed
Collections of solutions is no solution
COW replaced by a LOL (Llama on Legs)
Tragic Example…………
Air France Disaster:
"This is a plane that is conceived by engineers for engineers and not always for pilots," Jean-Pierre Albran, a veteran pilot of Boeing 747s, told Le Parisien newspaper.
HIT-enabled Care- Improving Patient Safety & Outcomes
Doran & Sidani (2007) More effective than manual at improving practice1 75% success rate with automated clinical support1 Effectiveness in improving clinical care comes from systems that:
Provide DSS as part of clinical workflow Deliver DSS at moment and place of need Provide actionable recommendations
HIT-enabled Care
Reducing ADE in Inpatient Settings David Bates, Peter Pronovost, etc. Reduce ADE by 200,00 a year Save 1 Billion Protecting the elderly
Reducing ADE in Ambulatory Settings Not as well studied 8M events annually – 1/3 to ½ preventable Extrapolate nationally – 3.5 B savings
At The Same Time……
HIT has not always been beneficial Koppel
– CPOE strikingly increased med error risks1 Han – significant increase in infant mortality after CPOE2 1: JAMA. 2005 Mar 9;293(10):1197-203. 2: Pediatrics. 2005 Dec;116(6):1506-12.
Poor Usability
How Will/Can We Change This?
Let me tell you how we WON’T change………………………..
NURSES - This Will Not Work…..
You are either part of the future or you are history…….
Nurses with Informatics Competancies
Designated formal specialty by ANA 1993.
Certification Exam 1995 Mimicked by AMA/AAMC IOM “Reengineering the Health Professions” ARRA & HITECH Act
40,000 health informaticians needed Large scale funding in the wings for HIT education (2 levels)
Healthcare Reform
Scope & Standards of Practice (Version 3)
The elephant in the room
Changing nursing competencies
American Recovery & Reinvestment Act (ARRA) – Policy Impact on Nursing
Health Information Technology for Economic and Clinical Health Act – “HITECH”
Act within the Act Goal of an electronic health system by 2014 $20 Billion Allocated Places ONC in statute Most of money for incentives for EHR adoption ($18 Billion) Wide variety of programs addressing all components of strategic plan Major section on privacy and security 22
HITECH
Focus on “patient as partner” Rural health and care of the underserved
Avoiding “technological apartheid”
National Health Information Infrastructure (NHIN) 90 days from bill signing to have formal plans to disperse funds
EDUCATIONAL REFORM
“Education for the health professions is in need of a major overhaul. Clinical education simply has not kept pace with or been responsive enough to shifting patient demographics and desires, changing health system expectation, evolving practice requirements and staffing arrangements, new information, a focus on improving quality, or new technologies.”
Patti’s Grandmothers Words…….
“If you do not understand it, then don’t fix it”
“Insanity: Continuing to do the same thing and expecting different results.” - Albert Einstein
http://www.youtube.com/watch?v=9jAH9hdF0xk
What Did We Hear?
2.2 Trillion spent 700 Billion in waste 45 million uninsured 7000 medication errors Can’t find the chart My patient in ER 2 days ago, what happened to her? Who is taking Vioxx that just got recalled? I spend more time with paper than I do with the patient
What Did We Hear?
We did not make the problem – but it is our problem…………..
What is the Take Away? HIT is not a panacea ` Implementing HIT on top of a faulty process will just speed up screw ups ` New environments require new competencies for Nurses ` Will nurses be road-kill, hitchhikers, or builders of the information highway in healthcare? `
Reviewing the Objectives
Discuss how healthcare information technology can be used to improve patient safety and outcomes through nursing research and evidence-based practice.
Examine the influence of the national health IT policy on nursing practice and patient care.
Discuss the key strategies to enhance adoption of electronic healthcare record systems in nursing practice
Describe the future use of healthcare information technology to influence patient outcomes.
THANKS!!! Thanks!
[email protected]
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