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Nurses Are Critical to Success of Health IT, ONC Chief Nursing Officer Says

May 12, 2016
by Heather Landi
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Nurses play a critical role in the success or failure of health IT across the healthcare delivery system and should be integrated into planning before, during and after implementation of electronic health record (EHR) systems, according to a recent blog post from Rebecca Freeman, Ph.D., R.N., chief nursing officer for the Office for the National Coordinator for Health IT (ONC).

The blog post coincides with National Nurses Week, which began May 6.

According to Freeman in her many conversations with nurses about EHRs and health IT, many of the challenges and issues with using health IT are not technology or system issues, but rather process, workflow and implementation challenges. Often, she wrote, the most pressing challenges nurses face when having problems with EHRs have to do with policies and processes involving the implementation and use of the technology.

“It’s these policies and processes that are critical for an EHR to make a nurse’s life easier, rather than more difficult. And nurses are often a major part of the solution: working in an interdisciplinary, team-based way to shape workflows, trainings, implementation plans, and documentation policies and processes to ensure that health IT helps rather than hinders the delivery of care,” Freeman wrote.

Bedside nurses, for example, have an expertise in coordinating care and identifying pain points in workflows and processes and can serve as “super users” to help an entire facility or practice get the most of its health IT, Freeman wrote.

“Advanced practice registered nurses (NPs, CRNAs, CNM, CNSs) provide key input as ground-level providers who have a unique perspective on the role of health IT in the care of their patients,” she wrote.

In addition, members of the nursing leadership team often know the data for their operational tasks and play a critical role in the development of analytics tools, such as dashboards and reports, and play a key role in the engagement of all nurses through super user programs and training opportunities.

“Nurse educators have long focused on clinical education, but there is now a crossover between clinical and health IT proficiency and training. In other words, nurses not only need to know how to execute a procedure, they need to be able to document it appropriately to avoid inaccurate dashboards, reports and measures of outcomes that can affect care, coordination and billing,” Freeman wrote.

The nursing team might also include nursing informaticists “who can ideally analyze workflows, apply technical principles and knowledge, discuss and evaluate evidence-based practice and identify training needs in order to help lead the development of health IT that makes sense for the organization and the end users who depend on the system for their daily work.”

What’s more, clinical analysts are often nurses who are working on an IT setting: “building the system, creating reports, managing database, etc.” “Many of them are longtime health IT experts. Their clinical knowledge is an irreplaceable safety net when it comes to build design, quality and testing,” Freeman wrote.

For these reasons, Freeman wrote, “practices and facilities—including, but not limited to the acute care and ambulatory settings – must integrate them into careful planning for pre-implementation, implementation, and post-implementation operations of EHR systems.”

“Success is often less about the ‘IT’ itself and more about implementation, documentation, culture, analytics, training, workflows, and interdisciplinary engagement,” Freeman stated.

Yet, using an enterprise EHR system also comes with great promise for enhancing care for individuals, making practices and facilities run more efficiently, and enabling healthcare providers to better track and address population health trends. “It’s my mission to help ensure nurses in particular have the tools they need to achieve these ‘digital dividends’,” Freeman wrote.

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