Amy J. Barton

Using the patient engagement framework to develop an institutional mobile health strategy.

An increasing number of patients with chronic conditions present a challenge to the health care system in the United States and around the globe. The numbers of chronically ill patients who have mobile phones are also on the rise. Mobile phones present an opportunity for the clinical nurse specialist to reach large numbers of patients with chronic conditions as well as their caregivers, including minorities and those of lower socioeconomic status. Although the latest research evidence does not yet support the widespread adoption of mobile technologies for care provision, health care institutions can start forming a step-by-step plan to engage with patients and their families through mobile technologies. The modified Patient Engagement Framework offers steps to adoption of mobile health applications.

Why clinical change leadership is essential for project success.

This is the first in a 4-part series where we will explore the role of the clinical nurse specialist (CNS) in the project lifecycle for effective technology adoption. The CNS is often called upon during major projects, such as the implementation of a new electronic health record, to play a key role in the project team. The CNS brings clinical knowledge and skills to the project team, with a particular focus on patient-centered workflows and the maintenance or improvement of the quality of care. However, CNSs may find it challenging to balance their role as members of the leadership group with the role they play in staff development and support.

Decision support and the clinical nurse specialist.

I nformation technology is becoming increasingly available at the point of care. Electronic health records, barcode medication administration, and computerized provider order entry are a few of the innovations found in most healthcare facilities. Simply automating a process, however, does not contribute to patient care quality. The true value-added component of automation is derived from being able to use collected information in a new and different way, especially to facilitate the decision making of nurses and other healthcare professionals. The purpose of this article is to describe decision support systems (DSSs), explore their relevance to nursing, and identify ways the clinical nurse specialist (CNS) can be integral in their design and implementation.

Knowledge management and the clinical nurse specialist.

1. The knowledge worker’s question is BWhat is the task?[ 2. Knowledge workers have to manage themselves and have autonomy. 3. Continuing innovation has to be part of the work, the task, and the responsibility of knowledge workers. 4. Knowledge work requires continuous learning and continuous teaching by the knowledge worker. 5. Productivity of the knowledge worker is not primarily a matter of quantity of output. Quality is at least as important. 6. Knowledge workersmust be treated as Bassets[ rather than a Bcosts.[ They must prefer to work for the organization, over all other opportunities.

The emergence of a learning healthcare system.

A learning healthcare system has emerged as a means of addressing the need to move evidence to the bedside in a manner that is meaningful and efficacious. The advent of electronic healthcare records has translated to massive quantities of clinical data; a learning healthcare system coupled with locally derived clinical rules will push practice-based evidence to the point of care where its application will mean improved quality and patient outcomes.

The electronic health record and "meaningful use": implications for the clinical nurse specialist.

The Health Information Technology for Economic and Clinical Health Act was designed to provide health care systems and providers an opportunity to more rapidly adopt the use of electronic health records (EHRs) to support clinical care. The goal of this legislation is to create a sustainable data infrastructure that will substantially contribute to achievement of quality patient care outcomes. The legislation encouraged not only the adoption of EHRs, but also the ‘‘meaningful use’’ of health data among both providers and patients. The purpose of this article was to provide the clinical nurse specialist (CNS)with an overview of ‘‘meaningful use’’ criteria and identify implications for CNS practice within health care systems. It is important to note that the meaningful use provisions are designed to incentivize a system that will use electronic data to improve patient care quality and not simply to build an information superhighway for patient care. As a result, themeaningful use provisions are aligned with the following 5 patient safety goals: n Improve quality, safety, and efficiency and reduce health disparities n Engage patients and families n Improve care coordination n Improve population and public health n Ensure adequate privacy and security provisions for personal health information Clinical nurse specialists have a role in all of the goals identified above. Thus, developing an understanding of the requirements of meaningful use criteria is important for the CNS in the provision of quality patient care. In July 2010, the Centers for Medicare & Medicaid Services (CMS), as well as the Office of the National Coordinator for Health Information Technology, published the final rules that will govern how providers and hospitals use EHRs in a manner that is meaningful to patient care. Per statute, a provider must demonstrate meaningful use by (1) use of certified EHR technology in a meaningful manner such as e-prescribing; (2) that the certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of care; and (3) in using this technology, the provider submits to the secretary information on clinical quality measures and such other measures selected by the secretary. Three stages for implementation ofmeaningful use have been delineated. Staging is important because it allows hospitals and providers some time to implement EHRs as well as provides financial incentives for early adoption. Eligible providers must decide if they will obtain incentives throughMedicaid or Medicare services. The decision is driven by the patient population. For the Medicaid program, eligible providers include physicians, nurse practitioners, certified nurse midwives, and physician assistants who work in federally qualified health centers or rural health centers, as well as acute care hospitals and children’s hospitals. To be eligible, a specific proportion of patients within each type of practice must meet a minimum proportion of Medicaid patients, ranging from 20% (for pediatricians) to more than 50% at federally qualified health centers/rural health centers. Stage 1 begins in 2011 with an emphasis on data capture and sharing. Early adopters can earn as much as

Workflow optimization: essential in the electronic health record journey.

63 750 in incentives from Medicaid over 6 years if meaningful use criteria are met in 2011. Stage 2 begins in 2013 with a focus on advanced clinical processes and decision support. Incentives during this stage are between

Helping patients improve their health through the use of technology.

24 000 and

The use of smartphones in hospitals.

39 000. Stage 3 Author Affiliations: College of Nursing, University of Colorado Denver Correspondence: Amy J. Barton, PhD, RN, 7983 S Trenton St, Centennial, CO 80112 (Amy.barton@ucdenver.edu). DOI: 10.1097/NUR.0b013e3182011f14

Social Bookmarking: What Every Clinical Nurse Specialist Should Know

This article is the second in a series that highlights the role of the clinical nurse specialist in electronic health record implementation. Analyzing clinical workflows and processes is a critical step in the successful implementation of information technology. This article highlights the expertise of the clinical nurse specialist in this process and provides an example to illustrate the process.