Early and Often: Engaging Nurses in Health IT
By Alison Rein, Director, AcademyHealth
An expanded role for nursing in the strategic planning and implementation of health information technology (health IT) efforts is warranted for many reasons – some pragmatic and others evidence-based. And, not to be overlooked is the basic fact that nurses are trusted by patients and play a significant role in their care1.
Major events (e.g., HITECH act; PPACA) have accelerated the pace and promise of health IT to support improvements in care delivery, efficiency, and population health. They have also raised concerns about the feasibility of moving forward, absent significant workforce re-alignment. Furthermore, the technical, policy, and workflow challenges associated with executing such large-scale health IT transformations are already causing strain – as evidenced by the general response to Phase 1 Meaningful Use requirements among the physician community2. Proceeding at all, let alone at the desired pace, will require the early and active involvement of nurses who can serve as leaders in this transformation.
Nurses are well qualified to assume this responsibility. They are intimately aware of the failings of paper records and spend far too much of their own time on clinical documentation – time that could be better spent on providing care to patients3. And, as key staff involved in patient intake and information management efforts, they also know that well-designed IT systems are essential to support their own workflows as well as those of other care providers. As noted by Chow and Fong in Connected for Health, their charge (and challenge) was to design an electronic documentation system that captured vital patient information as part of their work, while minimizing burden. They attribute much of their success to the continuous and meaningful engagement of nurses4.
Absent this level of up-front involvement and leadership by nurses, it is unlikely that resulting health IT solutions will be responsive to the needs of providers – let alone the patients in their care. In fact, there is evidence that nurse involvement in all stages of health IT development and implementation can improve the effective execution and use of health IT systems5.
There is also evidence supporting the critical role of nursing in surveillance and interception of medical errors – tasks that are more effectively and efficiently done with the assistance of well-designed technology solutions6. To the extent that nurses can be involved in the design and implementation of such systems, this likely will improve their ability to detect and avoid errors.
It is by now well understood that successful execution of health IT initiatives also involves significant community engagement and trust building. As trusted caregivers, nurses are well positioned to both elicit and convey information about the implications of using health IT to facilitate care processes, and to participate in efforts to support more patient-centered care. Aside from patients themselves – also critical to involve in such initiatives - who better than nurses to help guide health IT efforts with an eye toward what is most important to patients and consumers?
Many nurse leaders already have stepped into these roles, but many more will be required in future years as efforts to adopt and integrate take root and expand. This represents a welcome opportunity for nurses, and one that is supported by leading policy experts. In its 2010 report on the future of nursing, the Institute of Medicine recommended “expanded opportunities for nurses to lead and diffuse collaborative improvement efforts,” and also that we should “prepare and enable nurses to lead change to advance health.”7 Furthermore, a 2010 Gallup poll of national opinion leaders revealed that more than 75 percent would like to see nurses have greater influence in the planning, policy development and management of health IT related efforts8.
To be sure, more evidence on the impact of nurse involvement in health IT efforts is warranted. In the interim, evidence suggests it would be wise to leverage their skills, esteem, and front-line involvement with patients as we proceed toward a more connected, IT enabled healthcare system.
1According to a 1999 Harris Poll, 92 percent of the public said they trust information about health care provided by registered nurses, ranking nurses just 1 percentage point below physicians.
2American Medical Association. (2010). Submitted comments to the Centers for Medicare and Medicaid on the proposed rule for implementing the Medicare and Medicaid electronic health record (EHR) incentive programs. Available at: ww.ama-assn.org/ama1/pub/upload/mm/399/meaningful-use-comments-15mar2010.pdf.
3Hendrich et al. (2008). A 36-Hospital Time and Motion Study: How Do Medical Surgical Nurses Spend Their Time? Permanente Journal, 12(3): 25-34.
4Chow, M. and Fong, V. (2010). Nursing Leadership and Impact. In Louise Lang (ed.), Connected for Health: Using Electronic Health Records to Transform Care Delivery. San Francisco: Jossey-Bass.
5Waneka, R. and Spetz, J. (2010). Hospital information technology systems’ impact on nurses and nursing care. Journal of Nursing Administration, 40(12): 509-514.
6Institute of Medicine. (2004). Keeping Patients Safe: Transforming the Work Environment of Nurses. Available at: http://www.nap.edu/openbook.php?isbn=0309090679.
7Institute of Medicine. The future of nursing: leading change, advancing health. Washington (DC): National Academies Press; 2010.
8Blizzard, R., C. Khoury, and C, McMurray. (2010). Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions. Available at: http://thefutureofnursing.org/resource/detail/nursing-leadership-bedside-boardroom-opinion-leaders%E2%80%99-perceptions.