Nurses Often Left Out of Health IT Initiatives

[rninformatics, DNP, RN]

This is an awesome article that hits on several of the major factors related to this topic. Enjoy!

Angela

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iHealthBeat, December 14, 2007

Nurses Often Left Out of Health IT Initiatives

by Bryn Lansdowne

For years, health IT has been touted as a means to improve documentation, ease the administration of medication and generally boost patient care delivery and coordination. Yet for many nurses, the adoption of health IT in hospitals is not a smooth road to improved efficiency.

Federal incentives for IT adoption have mostly been aimed at hospitals and physicians, not nurses. Also, most health care facilities direct their IT adoption efforts toward physicians because nurses are almost always employed by the institution where they practice, whereas most physicians are not. Many hospital administrators fear that if they force IT adoption on physicians, those physicians may take their business elsewhere.

But however slowly, the health care industry is shifting its focus to assisting nurses in the implementation of health IT. Of 150 CIOs surveyed by Health Data Management this year, 55% agreed and 29% strongly agreed that providing nurses with IT is an increasing focus of their IT initiatives. Further, the Joint Commission, the Institute for Healthcare Improvement and the Institute of Medicine all have issued patient safety mandates that call for enhanced nurse involvement with IT.

Working With Vendors

Experts have suggested that health IT vendors solicit feedback directly from nurses and work with them during the initial design process.

Pam Cipriano, chief clinical officer of the University of Virginia Health System and chair of the American Academy of Nurses Workforce Commission's Workforce Commission, has said that involving nurses in the IT development process can reduce the potential for error and ensure that vendors' products are user friendly.

Many vendors already consider real-world implications during the design phase of IT development, according to Reed Gelzer, COO of Advocates for Documentation Integrity and Compliance. According to Gelzer, "Vendors often make a valiant effort to improve their" products by soliciting input from the users themselves, "but then they discover that the message was coming from only a subset of users," leaving the vendor to ask, "'Who do I listen to?'"

Gelzer recommended that vendors make a more concerted effort to incorporate nurses' suggestions into their offerings, but only after they first develop an input plan that will ensure the recommendations are valid and transparent to designers. Further, Gelzer said that suggestions can't come from just one component of users; instead, they have to represent all potential operators of the technology: physicians, administrators and ambulatory care workers, among others.

Avoiding 'Duplicative' Systems

Joy Grossman, a senior health researcher for the Center for Studying Health System Change, said that while she can't speak to how vendors should design IT, she does recommend that they aim to strike a balance between nursing input and quality goals by designing IT that helps nurses achieve the highest possible level of care quality, rather than developing technology that simply complements nurses' current workflow habits.

According to Grossman, nurses' problems with health IT might not stem from the technology itself, but rather "from how it's implemented, and to what degree." In many cases, hospitals operate with a "piecemeal system" of paperwork and IT; seldom is an IT solution implemented across an entire institution -- or even department -- Grossman said.

"Sometimes this kind of mix is complementary," Grossman said, "but often times it ends up being duplicative."

In some cases, nurses abandon IT that they see as obstructive, which Grossman said could be related to the immediate nature of health care delivery. She commented, "I would speculate that for nurses in particular, who do bedside care and so much paperwork, who are performing multiple tasks at once and have to get it done one way or another." She added that nurses often have to work around IT that gets in their way.

Bypassing IT presents its own problems: handwritten notes can be difficult for nurses to read when they're entering them in the computer sometimes hours after the notes were taken. In addition, sometimes nurses' delays in entering notes into electronic charts can mean they have to work -- and get paid for -- overtime. Delays also can prevent physicians and other clinicians from accessing up-to-date patient data.

Boosting Nurse Training

Gelzer said that the nursing industry could boost IT efficiency by making IT training a regular part of the nursing curriculum.

One-quarter of nurses receive no IT training whatsoever, while 56% receive between one and eight hours of training each year, according to a 2006 study by the health IT provider CDW Healthcare.

"The most important thing is to make sure that nursing training programs utilize these [iT] systems so that people coming out see them as normal -- even straight out of nursing school," Gelzer says.

Grossman echoed the call for enhanced education, adding that nurses, like physicians, are under immense pressure when new IT is introduced because there is no room for error in patient care.

"I think that it's putting a lot of pressure on providers to learn how to use IT well at the same time they're delivering care, Grossman said, adding, "Learning in real-time really ups the ante. It's not like learning Excel in an office."

Seeking More Solutions

This month, AAN's Commission on Workforce released a study identifying more than 1,200 technology products that would let nurses spend more time with patients. The commission also released more than 300 workflow issues that it believes could be improved through the use of technology.

According to AAN President Linda Burnes Bolton, nurses are able to spend only 30% of their time on direct patient care because of inefficient work processes and environments. "We'd like to get [nurses] to spend at least 70% of their time on direct patient care," Bolton said, adding, "Technology can help. But it has to be the right kind of technology."

In coming months, AAN plans to send informational packets to hospitals nationwide to help guide them through the process of engaging staff members in medical IT adoption and soliciting their feedback. That way, hospitals can tell the vendor community what IT would best suit their workplace.

Ultimately, AAN hopes its commission will lead hospital executives to understand how important it is that they achieve a return on their investment. "If hospitals keep deploying technology that their staff doesn't use, that's just pouring money down the drain," Bolton said.

Bolton said the commission also hopes to put pressure on the government and the health care industry to come up with standards that promote interoperability and to engage consumers in the health IT debate.

"We very much support the adoption of health IT, but to support the adoption one must engage in a product that is user friendly to nurses and other care providers that are going to use it," Bolton said.