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Nursing Takes Center Stage

April 1, 2006
by Mark Hagland
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Hospitals are realizing that a singular focus on the needs of physicians can leave nurses out in the cold.

With an intensive industry focus on the computerized physician order entry (CPOE) components of electronic medical record (EMR) systems, nursing IT leaders and nurse executives and managers would be justified in having concerns. After all, both vendors and many hospital and health system IT leaders have been so focused on physicians’ needs that they haven’t always thought through the consequences of implementing systems that work for nursing as well.

But, say experts, things are starting to change for the better.

Vendors initially did not pay much attention to nursing and clinical documentation; they were focused on CPOE, focused on the physician,” confirms Eileen O’Donnell, R.N., a director in the clinical practice at Long Beach, Calif.-based First Consulting Group. “But,” says the Monmouth Beach, N.J.-based O’Donnell, “I think they’re changing because they’re starting to realize how the nursing documentation keys into the physician documentation — they’re very interdisciplinary now. The big thing right now is that we’re seeing nursing documentation feed into what the doctor sees and uses.”

Indeed, say many, the key advances beginning to be made by vendors are those around integration and interfacing of the CPOE piece of EMRs and nursing documentation.

“I would say there is an increased level of sophistication in linking information for the nurses,” says O’Donnell. For example, she says, “Tighter integration among the various functions” within an EMR is beginning to evolve, so that a system will present the clinician with more information “to support clinical decision-making.”

For example, she says, if during a patient assessment, it is determined that the patient meets the criteria to receive the flu vaccine, the system should present nurses with an alert that allows them her to accept the recommended action and place the vaccine order, or to override the alert.

Betsy Weiner, Ph.D., senior associate dean for educational information at the Vanderbilt University School of Nursing in Nashville, agrees. “I think the products have improved in their user functionality; the biggest challenge right now for vendors is to connect these tools to knowledge bases.”

Vanderbilt UniversityHospital uses San Francisco-based McKesson’s nursing documentation product, though it[c1] largely self-developed its own core EMR.

The advances experts are seeing in products and in integration are necessary for a variety of reasons, but most immediately because of nurses’ perpetual time crunches and the ongoing nationwide nurse staffing shortage.

“One of our key objectives,” says Ann Keillor, R.N., Ed.D., a senior manager at the Dallas-based ACS Healthcare Services, “is to maximize direct care time. It’s been well publicized that nurses spend only 40 percent of their time at the bedside and 60 percent doing administrative tasks, and we’ve got to reverse that proportion.”

Keillor is currently implementing a core EMR from Madison, Wis.-based Epic Systems Corporation, at CaliforniaPacificMedicalCenter in San Francisco, where she is based. “Vendors are progressing on this front,” she says, adding that more and more are making it possible to automatically upload data from patient monitoring equipment, which can reduce the documentation elements that nurses need to chart on by up to 68 percent.

Weiner adds, “The nursing shortage is now impacting us, as predicted,” with the result that absolute time-efficiency will be required in order to overcome severe staffing shortages in many markets and clinical subspecialties.

After a long period of slow progress, things are now moving forward quickly, says Teresa McCasky, R.N., McKesson Corporation’s chief nursing strategist.

“In the last two years, we’ve really seen an explosion in the adoption of nursing documentation tools,” says the Louisville, Colo.-based McCasky. “We’ve almost made more progress in the past two years than in the previous 20. And some of this involves the adoption of languages like SNOMED (Systematized Nomenclature of Medicine). Nursing managers and executives are becoming champions, even as systems are evolving beyond simple vital-sign capturing to become more expert, and to link to past patient and intervention history.”

Her advice to CIOs? “Get your clinicians involved in the selection process, in the implementation process, and in the ongoing implementation of these systems.”

Mark Hagland is a contributing writer based in Chicago.

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