Health information technology (IT) is at the tipping point. Last October, Health and Human Services announced four large infrastructure contracts as part of the national initiative to create electronic health records for all Americans in 10 years. Also in October, a new report from MarketResearch.com predicted that the U.S. market for clinical information systems will grow about 11 percent per year for the next five years, and pegged sales of products and services at more than $38 billion in 2009. Add to this the 2005 HIMSS Leadership Survey findings that identify implementing an electronic medical record (EMR) in the next two years as the top IT priority for more than half of the respondents (54.4 percent). Fewer than one in five organizations (17.20 percent) have not yet begun to plan for an EMR system.
All this activity presents healthcare institutions with unparalleled opportunities to transform how they deliver care. Still, we caution that success is no sure thing. From 50 to 70 percent of information system projects fail, not because the technology is flawed, but because human and organizational issues are given short shrift.
The Case for Nursing Involvement
It is possible to increase the likelihood of success, as national health IT coordinator David Brailer explained in an October interview with Nursing Management: "In the key success stories of hospitals that rolled out computerized physician order entry [CPOE] systems, IT worked with nurses and physicians to foster a smooth transition. Nurses can help organizations figure out how to lower the perceived risks." According to Brailer, nursing's input is an essential component in efforts to realize the nation's health IT goals.
Views from the Frontline
As nurse advocates, we have long been committed to the premise that nursing must be involved in such efforts-and that the best way to find out what nurses think is, quite simply, to ask a nurse. In addition to looking over the latest reports summarized above, we polled a handful of nursing professionals for their opinions and observations. [See box at right.]
Queried individually, these nurses agreed that IT teams should include nurses. In part this may reflect their experiences, but it goes deeper than that. Teresa McCaskey stated that the various levels of nursing need to be included, "not just the CNO [chief nursing officer] or nurse executive," and "you have to have bedside care givers involved in order to achieve adoption and success."
There were widely varying views as to how prepared nurses are to play key roles on IT teams. Most expressed partial agreement, as did Sheryl Taylor, who noted that "Experienced critical care nurses seem to gravitate to the IT department at their facilities and their exposure to high tech in critical care provides some preparation; nurses with informatics degrees are becoming more numerous and are prepared to participate on IT teams; new graduates of undergraduate nursing programs typically are not prepared to participate on IT teams."
All agreed that nursing representation on the IT team improves the probability of success.
According to Jo Ann Klein, this is due to the fact that nurses take a holistic view of the patient and the clinical picture, alternatively characterized by Donna Dulong as "a broader and more patient-centric view." All reported seeing nurses play key roles in successful implementations, while only a subset had seen systems fail for lack of nurse involvement.
As we expected, our respondents concurred that workflow analysis often pays too much attention to physicians and not enough to nurses. In discussing what can be done to persuade IT professionals and clinical leadership, Donna Dulong noted, "Nurses represent one of the largest stakeholders in the acute care setting that will be impacted by IT projects, and their role on the IT team will greatly facilitate gaining the trust and utilization of the project with nurse users." Having nurses participate, she continued, is vital to the "support, ongoing feedback, and continual improvement of the program." At the end of the day, cultural expectations, starting at the top, are critical. According to Tami Merryman, the willingness to share and exploit failures as well as successes is key.
Tips for Success
Because we are committed to moving theory into practice, we also asked our nurse colleagues to advise us on what skills nurses serving on IT teams need and what can be done to persuade IT professionals and clinical leadership that nurses are vital team members.
Their skills they described in response to an open-ended query involved problem solving and behavioral skills, rather than IT expertise. They include the following:
- Patience, vision, and commitment
- Understanding of cross-disciplinary workflow processes
- The ability to articulate the work of nursing
- Strong analytical and communication skills
- Creativity and curiosity
- Openness to change
- An understanding of team dynamics
- The ability to function as a mediator, facilitator, and liaison
- An understanding of technical concepts
- Experience in patient care in the area being automated
Suggestions on how to make the case that nurses are critical to the IT team ranged from having IT professionals and clinical leadership "spend one whole 12 hour shift on a unit with a nurse" (Van de Castle), to communicating the message via presentations and publications (Taylor), to telling them a story about the impact a nurse had on an IT project, either soft sell or "pain selling" (Barey).
In closing, we turn to one of our contributors, Teresa McCasky, who observed, "When nursing is an integral part of the team, the outcomes can be so powerful and have such a positive impact on patient care and nursing workflow."
Marion J. Ball is a member of the Healthcare Informatics Editorial Board (see page 10) and Walter Wieners is a healthcare consultant based in Sausalito, Calif.