In some ways, the future of care delivery has arrived at Kaiser Permanente, a nonprofit integrated health care delivery system on the vanguard of health information technology (HIT).
At Kaiser Permanente, nurses utilize real-time electronic dashboards to monitor patient status and track needed interventions, which gives them more time and energy for direct patient care. Kaiser Permanente has also implemented a system that enables nurses to log on to electronic health records (EHRs) in seconds each time they see a patient, which saves time. Barcoded medications help ensure that patients get the right dose of the right medication at the right time.
New health technologies like these are streamlining workflow, lightening nurse workloads, and helping to prevent the kind of medical errors that claim hundreds of thousands of lives every year, according to Ann O’Brien, MSN, RN, national senior director of clinical informatics at Kaiser Permanente and an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program.
HITECH Act Ushered in a New Era
New health technologies began to take root decades ago, but they flourished in the wake of the 2009 HITECH Act—a law known as the “big bang” in the HIT world because it authorized the federal government to fund health care organizations to implement HIT and EHRs.
But technologies have thorns, too—particularly for nurses, the heaviest users of HIT and EHRs. That’s partly because systems were initially designed around physician rather than nurse workflow, says Bonnie Westra, PhD, RN, FAAN, associate professor at the University of Minnesota School of Nursing and an alumna of the RWJF Executive Nurse Fellows program. In addition, many devices and systems are not yet able to communicate seamlessly with each other, which can add to—rather than alleviate—nurse workloads.
These problems persist; a Harris poll of more than 500 nurses released in March found widespread frustration with HIT and, in particular, the lack of interoperability among devices. Nine in 10 nurses said they would be able to spend more time with patients if they could spend less time managing electronic devices. More than half said they had witnessed a medical error resulting from a lack of coordination among medical devices.
“We are now in the phase of optimization, evaluating the workflow of nurses and other clinicians and redesigning systems to reduce the burden of redundant and inconsistent documentation,” Westra said.
Linda Burnes Bolton, DrPH, RN, FAAN, vice president for nursing, chief nursing officer, and director of nursing research at Cedars-Sinai Medical Center in Los Angeles, and a member of the RWJF board of trustees, is a strong believer in the promise of technology to improve health and health care. “Through technology, we’ve been able to save lives by improving nurses’ ability to assess patients, implement interventions, and reduce the amount of time they spend documenting care,” she said. “This gives them more time to spend with patients.”
“Working together with infusion device and EHR organizations, Cedars-Sinai implemented a product last year that has improved medication safety,” Burnes Bolton added. It resulted from an American Academy of Nursing Workforce Commission project, funded by RWJF. Nurses and other providers identified the need for device integration and other technological solutions to workflow problems during a series of two-day “Technology Drill Downs” at 25 hospitals. Project leaders then asked technology companies to create solutions, and they did. Cedars-Sinai’s electronic infusion pump streamlines data and catches potential medication errors. “All of that came from nurses and physicians who asked for these kinds of products,” Burnes Bolton said.
Progress on the Horizon
Although nurses and other health professionals still experience frustrations with HIT and EHRs, the tide is beginning to turn, O’Brien said. Westra agreed: “Any time you start something new, there are going to be hiccups. But over time, we’ll have an increasing ability to optimize efficiency and tackle priority problems.”
She cites new tools like “smartphrases” and autocomplete texting, which are standardizing and streamlining data input; new systems that communicate better across platforms and settings; smartphones that allow nurses to communicate with patients and other providers in real time; and tools that allow consumers to monitor their health and access care from home.
Government, nonprofit, and other sectors are studying ways to overcome problems and push health technology forward. In January, the Office of the National Coordinator for Health Information Technology released a “roadmap” to guide the country toward more interoperable HIT systems.
The future holds special promise for nurses who specialize in informatics, said RWJF Executive Nurse Fellows program alumna Janie Gawrys, MSN, RN, CPHQ, chief operating officer at Access Community Health Network in Chicago. “It’s a great time for nurses,” she said. “Nurses can lead in this area because they really understand the patient population and how information systems can help manage populations and provide linkages to care.”
O’Brien agreed. “What’s so exciting is that we are able to move from something that’s very data-flat to more knowledge-based care and predictive analysis. It’s the most exciting time for nursing, and I’ve been in nursing for over 30 years.”