Innovations in Nursing Informatics: Wired in Rural Washington
Mason General Hospital
(MGH) is a 25-bed critical access hospital located in Shelton, WA. Receiving the status of "Most Wired -Rural" hospital in 2008 and 2009, MGH in 2011 was named one of the nation's "Most Wired"
hospitals by Hospitals & Health Networks
magazine. Although a rural hospital, and perhaps "small" by big city standards, MGH has been successfully providing its staff, providers and clinicians with cutting edge, best practice technological tools for several years.
Perhaps one of the key's to MGH's success is the creation in 2006 of the role of director of clinical informatics. Originally the role reported jointly to the chief administrative officer (CAO), Eric Moll and the chief operations officer (COO), Eileen Branscome, MBA, RN.
When asked why the role was created, Kelly Nettle, RN, BSN, director of clinical informatics at MGH said: "To ensure that nursing has a voice in the technological aspects of the electronic medical record since their documentation is so critical to the patient's care." Nettle sees herself as a bridge between not just nursing but all departments within the hospital: health information management (HIM), the business office, providers, clinicians and IT. Being that "bridge" to successful tools for use by the end users.
Currently the director of clinical informatics' role reports to the chief information officer (CIO), Tom Hornburg whom Kelly reports as: "Recognizing that clinical informatics is a very strategic part of IT."
Nettle believes that the innovations and successes that the department of clinical informatics and MGH has experienced are also due to leadership acting as active agents of change. "Reasons why we are successful? Because the CAO, COO and the CIO believe in what we as bedside clinicians do. They have facilitated the changes by giving us the tools, provided us with the training resources, allowing clinicians and staff to evaluate what's out there in the market and taking our recommendations seriously. Four years later and I am still so excited about my role and to come to work!"
Nettle also points to the family orientated culture of MGH that translates to a "whole team" effort between non-clinical IT staff members and the clinical informatics staff. There is also a very high level of participation by and collaboration with the medical staff lead by Dean Gushee, MD, medical director.
Speaking of current innovations, Nettle reports: "We are using visual smart boards for not just nursing but multiple disciplines. Visually the boards help brings information to one place, increase staff efficiency and decrease the time it takes to find what the staff needs.
"We recently implemented a new nursing board that displays the most current vital signs, recent critical lab values - glucose, potassium and H&H. It gives our clinicians real-time data immediately. They don't have to thumb through a chart, just click on that data and see it immediately.
"The other boards we have are workflow specific - such as the one for the lab that let the lab staff know when a patient has a central line so that they don't waste valuable time going to that patient's room - because the nurses will draw the blood.
"Our HIM coders were having a difficult time finding exactly where nursing was documenting certain items. The department of clinical informatics said: ‘You tell us what it is you need to find and let us help you find it.' Then our team worked with the vendor to configure the smart board to display exactly the particular documentation needed to by the coders on the particular patient thereby eliminating unnecessary searching.
"Great thing about the smart boards is that they allow the information to display for 13hrs instead of making the clinician again have to log back on."
Having strong leadership, mandating clinical involvement, working collaboratively and giving staff real- time tools that streamline their workflows are examples of innovations in nursing informatics.
Too often, we hear about the challenges and failures occurring within healthcare informatics: resistance to change, failed implementations, scope creep, gaps in quality, silos of data, poorly designed systems - even clinical information applications that cause more harm than good. Beginning with this post, I will be focusing on the successes and innovations in nursing informatics that are occurring throughout the United States within clinical informatics and the healthcare information systems arena.