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The Road to Technology-Enabled Quality Care

March 3, 2013
by Rajiv Leventhal
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Two nurse leaders from Oakland, Calif.-based integrated healthcare provider Kaiser Permanente revealed real-world lessons learned for transforming care to improve quality, safety, and efficiency in the clinical setting utilizing clinical decision support, data mining, and advanced analytics at the pre-conference nursing symposium at HIMSS13 in New Orleans.

Julie Vilardi, R.N., Kaiser executive director, strategic projects and clinical informatics and Ann O’Brien, R.N., Kaiser director of clinical informatics presented, “Leveraging Technology to Drive Transformational Change.” The pair aimed to explain how the industry could make better use of technology in healthcare. Better healthcare, said Vilardi, will lead to better health, which will lead to reduced costs. “Right now, we’re not getting the results for the money we’re putting in,” Vilardi claimed, adding that while meaningful use is working, the industry needs to continue to mine data to move forward, with an eye towards Stage 3. “By Stage 3, we better be showing the outcomes.”

Vilardi and O’Brien agreed that the industry is in the midst of a “technology explosion,” but providers need to ask themselves if they’re really getting the benefits of technology that they are using. They pointed to an Institute of Medicine (IOM) report from earlier this year that stressed safety is a property of a larger system—not just the hardware and software—but how clinicians use it.

O’Brien, who has more than 20 years of experience in nursing leadership, education, informatics and consulting, emphasized that leveraging technology is not just about implementing an electronic health record (EHR), noting that only one percent of U.S. hospitals have achieved HIMSS Analytics Stage 7 Award honors, which signifies that a hospital is truly paperless. It doesn’t help that currently, nurses’ documentation is not easy, but instead burdensome and overwhelming, said O’Brien.

Ann O'Brien

It is necessary to lead with clinical goals, not with technology solutions, she added, and to make it easier for nurses going forward, they need to be supported with knowledge, their path needs to be made easier, and their non-value added tasks need to be reduced.

This can be accomplished by first implementing a rapid sign-on to EHRs, said O’Brien. “Currently, most nurses log on to the EHR every few minutes, and will do so between 100-120 times per shift. Having an easy, tap-in, tap-out method will impact nurses’ motivation to document in real time. You can’t have the technology be more difficult than the problem you’re trying to solve.”

Workflow automation and mobility are two more issues which need to be managed more effectively, continued O’Brien. “Nurses need to manage tasks and schedule events efficiently. They need to know when things are happening and where everyone is. And in terms of mobility, nurses don’t want to have to carry heavy tablets. We need to make them more mobile.”

Going forward, O’Brien envisions a patient room of the future that is bigger than just the nurse. Nurses should be able to walk into a patient’s room and know all of his or her information instantly rather than after 27 clicks, she said. “It’s about giving the right care for a certain patient, and to do that, you need to know the pertinent information right away.”

Although nurses need the burden on them to be lessened through the use of technology, O’Brien ended the presentation by ultimately putting the onus on the nurses to lead. “As nurses, it's our obligation to be leaders of this transformational change."