“IT professionals are great at coming up with nifty tools for bringing clinical data to clinicians – as long as nurses are willing to memorize lots of byzantine paths to that information.”
“Nurses are dedicated to providing direct care for their patients and advocating for them in every way – as long as it doesn’t mean having to adapt to ever-changing computer systems,” says author John Rossheim.
In a great recent article, John delved into the relationship between healthcare and IT and how implementing better technology can support patient centered care. It’s a great message, so we’ve included excerpts from his article below. Catheter management is a huge issue where IT has made an impact through catheter removal reminders and by encouraging nurses to look at other options like Men’s Liberty.
There are some great ideas in there – take a look and share your thoughts!!
Stereotypes have helped perpetuate the notion that there’s a culture clash between clinicians and IT folks, a conflict that can scuttle the implementation of an electronic records system or at least reduce its effectiveness. But with careful planning and execution, this clash can be reframed to create a working coalition of healers and technologists. Here are some principles for increasing the odds of a successful collaboration.
Time Savings Come, with Time.
Let’s start with one perceived clash that any healthcare IT implementation team must address: that a new or upgraded electronic system will take direct-care time away from clinicians, at least in the early going. “Nurses have a way of viewing anything that comes between them and the patient as a threat,” says Mary Cothron, RN, a clinical trainer and implementation specialist at Informatics Corporation of America in Nashville.
Given nurses’ heavy record-keeping burden, their concern is understandable. Among the major tasks in an average shift, nurses spent 55.7 percent of their time on indirect care tasks such as documentation, versus just 32.8 percent of each shift on direct patient care, according to a 2008 study appearing in Nursing Leadership. So it’s reasonable for clinicians to push hard for an IT implementation that on balance will give them more time with patients. “When you add something to nurses’ workload, you also have to look at what you can take away,” says Harry Jacobson, M.D., CEO of Vanderbilt University Medical Center. “Nurses already have too many tasks.”
While navigating an online recordkeeping system may initially take longer than pen and paper, a digital records system has clear-cut time-saving features, and these should be highlighted. “When you bring in electronic records, you go from not being able to find the chart 20 percent of the time to always being able to find it,” says Chris Wood, M.D., Medical Director of Information systems at Intermountain Healthcare, a nonprofit system based in Salt Lake City. “You have to remind people again and again why you’re bringing in the technology.”
Efficiencies Come with an Increased Comfort Level.
For some nurses, an even greater fear is that the simple and transparent, if inefficient, information structure of a paper chart becomes opaque when reincarnated in electronic form. If you’re having trouble locating a test result in a paper chart, you simply leaf through every page; in an electronic health record, with its nonlinear structure, clinicians worry they could run circles around that test result without ever finding it.
“Clinicians are really making a leap of faith that the same kinds of information are being communicated” through a new electronic records system, says Claire McCarthy, Director of Change Management at Kaiser Permanente in Oakland, Calif. Or, as Cothron puts it, “As a nurse I’ve wondered: Do I have it all, am I missing any piece of the picture?”
Success Arrives when Clinical Insight Informs Technology.
Clinicians are the best advocates for their own usability requirements. They can, for example, insist that screens are configurable for individual patients, while key information is presented consistently throughout the system, Cothron says. Electronic dashboards can help nurses track all the requirements of a protocol in a unified view, says Dr. Jacobson, whether the patient is on an IV catheter, a ventilator or a complex regimen of medications.
Basic patient information such as allergies, fall risk and height and weight should be visible on the nurse’s screen at all times, says Cothron, perhaps on a static banner.
Screens can also be optimized to meet the specialized needs of nurses, therapists and other clinical professionals. “Our respiratory therapists suggested that to streamline their work, we modify the documentation flow sheets so that they could consolidate their entries in one area and not have to skip around,” says Ann Filz, RN, a floor nurse and designated super user at a medical center in Clackamas, Ore. “We’re trying to limit the number of clicks that a clinician has to make in a record.”
Proof of Patient Safety Brings Instant Gratification.
Perhaps the best way to bridge the culture gap is to demonstrate to clinicians that many aspects of automation improve patient safety. Bar-coding of medications is one innovation that does just that.
Reconciling the medications of a patient who is moving between units is complex and stressful for nurses, even when the transfer is within a hospital, Cothron says. “This scares nurses to death when they don’t know what the electronic record is going to look like when viewed from the other department.”
The solution? “We use bar-code scanning for medication,” says Filz. “So if a nurse had the wrong medication and scanned the patient’s wristband, the medication administration screen will open with the alert: ‘This medication has not been ordered for this patient.’ ”
As always, the perceived risks and clear wins of automation should be presented in tandem to clinicians, to show that a system implementation will yield a net gain for the patient. “There were concerns that our implementation might pose a risk, but in fact one of the big reasons to use electronic records is that they truly enhance patient safety,” says Filz.
Ultimately the culture clash can be tempered if technologists begin to understand the clinicians’ perspective, and if clinicians learn to appreciate how the IT implementation improves patient care, especially in the long run.
Says Dr. Wood: “When clinicians have experienced time after time that IT brings an increase in functionality or efficiency, even though there’s pain in the change, they’ll work with it.”