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Department: TECH NOTES

Clinical nurses lead the charge with EHR

Daly, Patricia DNP, MN, BSN, RN-BC

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doi: 10.1097/01.NURSE.0000471426.47075.d2
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THE ALARMING NUMBER of deaths due to preventable medical errors was highlighted in a report published by the Institute of Medicine over a decade ago.1 Since its release, To Err is Human: Building a Safer Health System has given rise to efforts to improve patient safety. However, the quality and safety of care in the United States remains mediocre at best: It ranked last among industrialized nations on indicators of efficiency, equity, and outcomes in a recent report by the Commonwealth Fund.2 Health information technology (HIT) has emerged as a key tool for making necessary improvements in healthcare quality, and cost.3 This article discusses the role of electronic health records (EHRs) in current safety initiatives. Given the current mandate requiring the use of EHRs, automated nursing documentation will affect the work of every nurse.

Providing incentives

To accelerate the use of HIT, in 2009 Congress passed and President Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act, which is part of the American Recovery and Reinvestment Act. HITECH makes incentive payments available to hospitals and healthcare professionals who adopt EHRs certified by the Office of the National Coordinator for Health Information Technology and use them effectively in the course of care.4 EHRs have been associated with reductions in medication administration errors and improved nursing documentation; nursing communication and workflow are enhanced as well.5,6 As of May 2015, more than $20.5 billion in Medicare EHR incentive program payments and $9.7 billion in Medicaid EHR incentive program payments have been made.7

Most healthcare organizations are implementing EHRs to take advantage of these incentives. The projects are often referred to as “Meaningful Use” projects and have become a major initiative in many healthcare organizations. A future phase of HITECH will include penalties if organizations don't meet the quality and safety initiatives identified.8

Selecting, designing, building, and implementing these projects require additional technical and clinical HIT staff. With the incentives driving this process, the successful implementation and support of an organization's EHR project is important from both a financial and clinical viewpoint.

Informatics in nursing

In 1992, the American Nurses Association (ANA) identified nursing informatics as a specialty “that integrates nursing science with multiple information and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice.”9 Nurse informatics professionals play a vital role in all aspects of the HIT lifecycle. The clinical information accumulated in EHRs is used in many secondary settings such as quality, legal, and regulatory venues, and the data are analyzed to produce new nursing knowledge. This creates an environment where clinical nurses interact with informatics nurses and informatics nurse specialists.9

The roles of the clinical nurse, informatics nurse, and informatics nurse specialist are complementary. This is supported by ANA's position, which states that clinical nurses must be involved in the selection, design, development, implementation, evaluation, and improvement of EHRs and electronic patient-care devices used in patient-care settings.10

Nurses at all levels of the organization—nurse executives, nurse managers, and clinical nurses—should be involved in HIT decisions. Chief nurse executives own the patient-care vision and the impact of HIT on the realization of that vision. They need an understanding of how HIT affects patient care so they can collaborate with other members of the executive team when HIT issues are discussed.11

Clinical nurses have many opportunities to get involved during the EHR selection and implementation process. In general, phases of the process include:

  • system selection
  • system design and development, including current and future state validation
  • testing
  • education
  • implementation or “go live”
  • ongoing maintenance and optimization.12

Most organizations engage clinical nurses throughout all the phases noted above. Typically, these nurses have demonstrated an interest in HIT projects. Organizations or hospitals will often identify nurses who are considered subject matter experts on each unit or specialty within the organization. These clinical nurses are experts in patient-care delivery and can articulate the needs of patients, families, and nurses to HIT professionals.

The design, development, and implementation of EHRs must support the needs of patients, nurses, and other clinicians delivering care. The clinical nurse has the responsibility to be this “voice” to the HIT department.

Working together to improve outcomes

All nursing professionals play a vital role in EHR implementation. Working with HIT professionals, clinical nurses play an essential role in integrating direct patient care with technology to transform data into wisdom.


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