One-on-One with Children's Hospital Boston SVP/CIO Daniel Nigrin, M.D. and CMO Eileen Sporing, Part I

KG: I’m sure it makes a difference when it comes to adopting technologies if the nurses have been able to provide input on which solutions are chosen.

DN: When you hear about EMR systems implementation, the focus is always on the physician. For example, the physician is the one who has to do CPOE. As a physician, I feel comfortable saying that while that’s important and it’s obviously a big impact on the workflow of physicians, I think many institutions don’t recognize the impact it has on nursing workflows and nursing processes, and it’s absolutely critical that you involve the nursing organization when you do these things if you’re hoping for success. And I think it’s a mistake that a lot of organizations make; they concentrate so much on the physicians and the political battles that they forget about involving the nurses as much as they ought to.

ES: I think the real emphasis on that point has to do with workflow. Physicians and nurses have different workflows, and unless both clinical perspectives are at the table, you’re doomed to failure, either with the physician adoption and integration of the technology, or with the nursing acceptance and driving to solution.

KG: In terms of your IT goals at Children’s, what are the biggest issues you’re trying to solve? Is improving communication a priority?

ES: I think that workflow and patient safety are the biggest issues we’re trying to solve. I think we have pretty robust communication across and within clinical disciplines in this institution, and we’ve implemented technology to support that all along — well before we implemented our EMR. The communication devices we’ve used include PDAs, BlackBerry devices, and telephone technology to support real-time communications. If you were to ask our clinical staff if they’re burdened by not being able to access their colleagues, I think they would say no.

On the other hand, the challenges in implementing electronic medical records for nursing are real because most EMR solutions call for linear processing and that’s not the nursing workflow for the most part. Nurses are managing a panel of patients at any one point in time and are multitasking around all of those patients, and the technology doesn’t really support that kind of work as we wish it all did. So we’re constantly trying to solve that problem.

KG: Do you have a patient flow or bed management system in place at Children’s?

ES: We do. We’ve implemented a bed management system, and some of the nurses and other staff in support services are very accustomed to working with that technology. And I do believe that has improved a lot of our patient care processes. But again, we did that in collaboration with our medical staff colleagues as well, so there’s very little that we do where a partnership is not involved.

KG: Have you found that it has helped improve efficiency among the staff?

ES: Absolutely; we’ve taken a lot of time wasters out of the process, and were able to feed back data to people so that we know exactly how long it takes to identify where capacity is and how we can get patients moved as quickly as possible. So I think there’s a high level of satisfaction, and that the system is an enabler of improved process.

KG: When did the system go live — was it recent?

ES: Yes, it was in the last year. We took a lot of manual process away, from the nurse having to make five phone calls and wait and not know when, for example, the housekeeper would be available to clean a bed. Or getting calls from the ED for a patient needing to move or from the recovery room for a patient needing to move. So we’ve eliminated all of those processes and that’s been enormously satisfying.

We have not implemented all of the capacity in our patient management system, so we’re looking forward to continuing to look at how to leverage that technology to support workflow as well.

Part II coming soon