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CIN: Computers, Informatics, Nursing:
doi: 10.1097/CIN.0000000000000085

Elsevier Clinical Practice Model Achieves Milestone Successes to Advance Clinical Decision Support and Evidence-Based Practice

Troseth, Michelle R. MSN, RN, DPNAP, FAAN

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Executive Vice President and Chief Professional Practice Officer of Elsevier CPM

The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

One of the highlights of the Alliance for Nursing Informatics (ANI) is the sharing of members’ key activities and achievements. The vast experience and contributions of ANI member organizations are always impressive as we all work towards ANI’s vision to “transform health and healthcare through nursing informatics and innovation.” As an ANI affiliate member, Elsevier Clinical Practice Model (CPM), and its unique healthcare consortium, is celebrating some significant achievements: (1) for clinical decision support (CDS) with embedded care plans in the electronic health record (EHR) and (2) the publication of an advisory report based on a national survey and forum for nurse executives leveraging evidence-based practice (EBP).

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One of the biggest challenges of the EHR for healthcare organizations is designing, building, implementing, and sustaining a meaningful care plan. For nursing, in particular, the reality has been the challenge of breaking the old paradigm of the “nursing care plan,” where we check things off at the “end of the shift,” and shifting into a new paradigm of an “interprofessional plan of care” that supports collaborative practice, EBP, and is intentionally designed to “guide care” within the workflow of the EHR. The Institute of Medicine noted, “inconsistencies are exacerbated by variation in the scope of practice by setting of care,” and “care should not vary illogically from clinician to clinician or from place to place.” 1 The work of the Elsevier CPM Resource Center has been focused on understanding and optimizing care, at the point of care, which called for prioritizing CDS tools to support patients and clinicians by addressing standardization and creating evidence-based clinical practice guidelines (CPGs).2 Elsevier CPM, in collaboration with its consortium members, develops and maintains evidence-based CPGs that support the unique scope of practice of each discipline and are the basis of the care plan methodology embedded in EHRs across North America. An important distinction of evidence-based standardized CPGs, and related content, is the ability to map to the recommended terminology codes (SNOMED CT and LOINC) as national standards for the exchange of nursing information among disparate information systems.3

Elsevier CPM was recently named the Category Leader for the “CDS—Order Sets and Care Plans” category in the 2013 Best in KLAS: Software and Services Report,4 a research firm that specializes in monitoring and reporting the performance of healthcare vendors. A Category Leader designation identifies the top-rated vendor products in a specific market segment based on provider input. Elsevier CPM was placed at the top of the category with an overall score of 84.5, a 2% increase from last year. The award signifies that an evidence-based solution, integrated into several EHR systems, meets the needs of providers through content and ease of use. We believe the KLAS award also carries a broader message: nursing will achieve the goals of EBP only if it can tap into the power of an EHR-based solution that integrates evidence-based care planning and clinical documentation into day-to-day practice.

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Speaking of EBP, the second significant milestone this year was the publication of a landmark National Advisory Report: “A National Survey & Forum for Nurse Executives: Leveraging Evidence-Based Practice to Enhance Healthcare Quality, Reliability, Patient Outcomes and Cost Containment” (available at Evidence-based practice is a problem-solving approach to clinical decision making in healthcare, one that integrates the best evidence from well-designed studies with a clinician’s expertise, including internal evidence from patient assessments and practice data, and a patient’s preference and values.5,6

Chief nursing executives (CNEs) see EBP as a driver of higher-quality care, with safety and improved patient outcomes, yet only a small percentage of their budgets are allocated to EBP. This is just one of the findings presented in a landmark National Leadership Advisory Report, supported by Elsevier CPM in partnership with The Ohio State University College of Nursing, to better understand the current reality and perceptions of CNEs on EBP, findings, and outcomes. The report is the result of a quest to see evidence-based principles and practices understood, applied, lived, and sustained throughout the healthcare system.

Based on the key findings from the survey and their implications for nursing leadership, a national forum for CNEs took place during the annual national conference of the American Organization for Nurse Executives in 2014. During the conference, the study’s findings were shared with the approximately 150 nurse leaders/executives in attendance, and strategic action tactics for next steps were developed.

Among other key findings from the report are the following:

* Although CNEs’ beliefs in the value of EBP are strong, their implementation of EBP is relatively low.

* More than 50% of CNEs believe that EBP is practiced in their organization from “not at all” to “somewhat.”

* There is an inadequate amount of EBP mentors in healthcare systems to work on EBP with direct care staff and create sustainable EBP cultures/environments.

* Although CNEs reported top priorities are quality and safety, EBP is rated as a low priority.

The report also included several recommendations as priorities for a CNE action plan to create, support, promote, and sustain a culture of EBP. Among them are the following:

* align EBP as a cost-effective foundation for patient safety and quality, leveraging data for interprofessional evidence-based planning, decision making, and process improvements;

* establish a business case, budget, and resources to prioritize EBP as a strategic imperative;

* provide EBP mentor coaches and integrate EBP into orientation, continuing education, daily interprofessional proactive activities such as rounds, patient care conferences, councils, and communications; and

* provide evidence-based tools and resources to interprofessional team members in the EHR to keep EBP in the forefront of patient care processes.

The last recommendation is at the core of the role of nursing informatics, as we partner with CNEs to make evidence-based tools and resources a reality within the EHR. This contributes to the efforts to collectively and boldly advance EBP as standard for healthcare.

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1. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century Washington, DC: The National Academies Press; 2001.

2. Wesorick B, Doebbeling B. Lessons from the field: the essential elements for point-of-care transformation. Med Care. 2011;49(12):S1, S49–S58.

3. University of Minnesota, School of Nursing. Big Data Proceedings Capturing Nursing Information for Big Data Research—and Improved Health Outcomes. Conference Proceedings, August 12–13, 2013; Minneapolis, MN: University of Minnesota.

4. KLAS Enterprises, LLC. 2013 Best in KLAS: Software and Services, January 2014, Orem, UT. Available at:

5. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. Br Med J. 1996; 312( 7023): 71–72.

6. Melnyk BM, Fineout-Overholt E. Evidence-Based Practice in Nursing & Healthcare. A Guide to Best Practice. 2nd ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins; 2011.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.



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