Charlotte A. Weaver

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.

Enabling technologies promise to revitalize the role of nursing in an era of patient safety

The application of information technology (IT) in health care has the potential to transform the delivery of care, as well as the health care work environment, by streamlining processes, making procedures more accurate and efficient, and reducing the risk of human error. For nurses, a major aspect of this transformation is the refocusing of their work on direct patient care and away from being a conduit of information and communication among departments. Several of the technologies discussed, such as physician order entry and bar code technology, have existed for years as standalone systems. Many others are just being developed and are being integrated into complex clinical information systems (CISs) with clinical decision support at their core. While early evaluation of these systems shows positive outcome measurements, financial, technical, and organizational hurdles to widespread implementation still remain. One major issue is defining the role nurses, themselves, will play in the selection and implementation of these systems as they become more steeped in the knowledge of nursing informatics. Other challenges revolve around issues of job satisfaction and the attraction and retention of nursing staff in the midst of a serious nursing shortage. Despite these concerns, it is expected that, in the long run, the creation of an electronic work environment with systems that integrate all functions of the health care team will positively impact cost-effectiveness, productivity, and patient safety while helping to revitalize nursing practice.

Report of the AMIA EHR 2020 task force on the status and future direction of EHRs

Over the last 5 years, stimulated by the changing healthcare environment and the Health Information Technology for Economic and Clinical Health (HITECH) Meaningful Use (MU) Electronic Health Record (EHR) Incentive program, EHR adoption has increased remarkably, and there is early evidence that such adoption has resulted in healthcare safety and quality benefits.1,2 However, with this broad adoption, many clinicians are voicing concerns that EHR use has had unintended clinical consequences, including reduced time for patient-clinician interaction,3 new and burdensome data entry tasks being transferred to front-line clinicians,4,5 and lengthened clinician workdays.6–8 Additionally, interoperability between different EHR systems has languished despite large efforts towards that goal.9,10 These challenges are contributing to physicians’ decreased satisfaction with their work lives.11–13 In professional journals,14 press reports,15–17 on wards, and in clinics, we have heard of the difficulties that the transition from paper records to EHRs has created.18 As a result, clinicians are seeking help to get through their work days, which often extend into evenings devoted to writing notes. Examples of comments we have received from clinicians and patients include: “Computers always make things faster and cheaper. Not this time,” and “My doctor pays more attention to the computer than to me.” Ultimately the healthcare systems goal is to create a robust, integrated, and interoperable healthcare system that includes patients, physician practices, public health, population management, and support for clinical and basic sciences research. This ecosystem has been referred to as the “learning health system.”19 EHRs are an important part of the learning health system, along with many other clinical systems, but future ways in which information is transformed into knowledge will likely require all parts of the system working together. Potentially every patient encounter could present an …

The future state of clinical data capture and documentation: a report from AMIA's 2011 Policy Meeting

Much of what is currently documented in the electronic health record is in response toincreasingly complex and prescriptive medicolegal, reimbursement, and regulatory requirements. These requirements often result in redundant data capture and cumbersome documentation processes. AMIAs 2011 Health Policy Meeting examined key issues in this arena and envisioned changes to help move toward an ideal future state of clinical data capture and documentation. The consensus of the meeting was that, in the move to a technology-enabled healthcare environment, the main purpose of documentation should be to support patient care and improved outcomes for individuals and populations and that documentation for other purposes should be generated as a byproduct of care delivery. This paper summarizes meeting deliberations, and highlights policy recommendations and research priorities. The authors recommend development of a national strategy to review and amend public policies to better support technology-enabled data capture and documentation practices.

AN ACADEMIC-BUSINESS PARTNERSHIP FOR Advancing Clinical Informatics

A jointly funded partnership between the school of nursing at a large midwestern university and a premier health care information technology supplier represents a pioneering event for education and for the health care information technology industry. The impetus for this partnership arose from Institute of Medicine reports published in late 1999 and early 2001 addressing the quality, error, and waste in the health care system in the United States. The Simulated E-hEalth Delivery System (SEEDS) provides opportunities based on best practices in education to learn and practice clinical skills in a state-of-the-art environment using a live-production, clinical information system designed for care delivery. A pilot project that began with a small cohort of baccalaureate nursing students has been implemented and extended. SEEDS will also be extended to other health professional programs.

Guideposts to the Future—An Agenda for Nursing Informatics

As new directions and priorities emerge in health care, nursing informatics leaders must prepare to guide the profession appropriately. To use an analogy, where a road bends or changes directions, guideposts indicate how drivers can stay on course. The AMIA Nursing Informatics Working Group (NIWG) produced this white paper as the product of a meeting convened: 1) to describe anticipated nationwide changes in demographics, health care quality, and health care informatics; 2) to assess the potential impact of genomic medicine and of new threats to society; 3) to align AMIA NIWG resources with emerging priorities; and 4) to identify guideposts in the form of an agenda to keep the NIWG on course in light of new opportunities. The anticipated societal changes provide opportunities for nursing informatics. Resources described below within the Department of Health and Human Services (HHS) and the National Committee for Health and Vital Statistics (NCVHS) can help to align AMIA NIWG with emerging priorities. The guideposts consist of priority areas for action in informatics, nursing education, and research. Nursing informatics professionals will collaborate as full participants in local, national, and international efforts related to the guideposts in order to make significant contributions that empower patients and providers for safer health care.

HIT plants SEEDS in healthcare education.

By incorporating a clinical information system in the education curriculum as a teaching platform, the University of Kansas School of Nursing teaches nurses and other health professional students how to assess, plan, document and manage care in an electronic medium that develops healthcare informatics competencies. The outcomes of this integrated technology curriculum brings hope for transforming health professional education for 21st century practice and graduating a workforce with the leadership and competencies for improving quality and safety in patient care. It results in IT savvy healthcare providers who will cross the quality chasm.

Toward a Central Repository for Sharing Nursing Informatics' Best Practices.

Building on prior work done by the Transforming Nursing DocumentationWorking Group 10, in 2015, the authors volunteered to explore the feasibility of creating a central repository for best practices in nursing informatics. In this report, we share what we discovered. We started our explorations by talking to several nurse leaders known to have faced the challenges of nursing documentation in their own settings and who could offer solutions that we hoped they might share. Obviously, there is no need for a best practices repository unless there are best practices to be shared and people willing to do so. We interviewed Dr Patricia Sengstack, who is chief nursing informatics officer at the Bon Secours Health System. Dr Sengstack had led an evaluation of the patient admission assessment nursing documentation in her health system, during which she found that completing every field in the electronic nursing admission assessment alone required 532 key clicks, including 14 different screening assessments. Overall, the admission assessment had been configured so that there were 153 “required fields” that must be completed. Further study led Sengstack to estimate that only 25% of the nursing data in the electronic health record (EHR) were actually useful to nurses. Bon Secours is now engaged in a streamlining process, identifying what is of little or no use—or simply a historical relic. She is also working with Bon Secours quality experts to assist in identifying if items in the assessment are truly required by Centers for Medicare &Medicaid Services or the Joint Commission or if the organization’s interpretation mandates the documentation. Sengstack was willing to share the streamlining process that Bon Secours used with other organizations via a central repository.

Big-Data Enabled Nursing: Future Possibilities

Possible futures for education, partnerships, research, and practice are presented as a result of our immersion in the world of big data and data science. We propose basic and sweeping changes in each of these areas, especially for nursing. Kuhn’s episodic model of scientific revolution where suddenly the discovery of a new path changes the way we view and live in the world may explain some of what we see and experience. This new paradigm asks questions of old data, proposes new ways to manage data, and hypothesizes where new data might be found. The paradigm shifts from “puzzle-solving” to changing the rules of the game and the mapping directing new operations and research (Kuhn, 1962, 2012).

Big Data-Enabled Nursing

Attention on “big data” spans nursing and the health sciences, and extends as well to engineering/computer sciences through to the liberal arts in professional literature. A current Google search (3 Nov 2016) of “big data” yields 288 million entries. A focused search of “big data and nursing” yields more than 3.9 million entries. Thus we ask, “Why big data? Why nursing?” The focus of this chapter is to provide an overview of why big data has emerged now and to make the case for how big data has the capacity to change health, healthcare systems, and nursing. This chapter lays a foundation for the chapters and case studies to follow that explore what data, knowledge, and transformation processes are needed to put information and knowledge into the hands of nursing wherever nurses are working. In this chapter we examine the big data sources within and beyond nursing and healthcare that can be collected and analyzed to improve nursing and patient, family and community health. This chapter entices the reader to examine “Why big data now?” and “Why big data in the future?” This chapter is meant to stir curiosity for “Why should I be knowledgeable?” Whether the reader’s role is in clinical practice, education, research, industry, or policy, the applied uses of big data analytics are empowering change at an exponential speed across all domains. Big data has the capacity to illuminate nursing’s discovery of new knowledge and best practices that are safe, effective and lead to improved outcomes including well-being of providers; it also can expand nursing’s vision and future possibilities through increasing awareness of what nursing doesn’t know. The importance of nursing’s lens on the new discoveries obtained through big data and data science is critical to the transformation of health and healthcare systems. This transformation completes the challenge of placing the person at the center of all care initiatives and actions. C.W. Delaney, PhD, RN, FAAN, FACMI (*) School of Nursing, University of Minnesota, Minneapolis, MN, USA e-mail: Delaney@umn.edu R.L. Simpson, DNP, RN, FAAN, FACMI, DPNAP Technology Management, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA