Smart phones are the norm and fully integrated in our society today. In fact, it has been estimated by Pew Internet, that 53% of adults have them. Many of the most popular applications on smart phones are related in some form to healthcare. The most frequently used healthcare applications pertain to dieting, exercise, stress/relaxation, chronic conditions and smoking cessation. It's not surprising to learn that 52% of smart phone users seek health information especially after a health crisis. As well, women age 30-64 use smart phones for health text alerts. And it's not only the general public using a smart phone in their daily lives; it's also clinicians.
Research by CompTIA, showed that 81% of MDs use smart phones. And Manhattan Research estimated that 62% of MDs use tablets. Spyglass Consulting Group found that 62% of hospital nurses said they use their smart phones for personal and clinical communications while on the job.
So, what exactly are clinicians using smart phones for? Upon walking the hospital, I've found that smart phones are often used by clinicians to:
- Document patient visits
- Manage clinical workflows
- Conduct research on technical and clinical issues
- Receive alerts on patient's conditions
- Interactive grand rounds - access to x-rays, medication profiles, laboratory data
- Order prescriptions in CPOE
While this is a great advancement and a huge leap from static paper charts and outdated time-consuming inefficient workflows of the not so recent past, there are threats and vulnerabilities when using smart phones.
Lack of confidentiality is one of the greatest threats, as transmitted and stored data needs to be secure. This is of the utmost importance so confidential healthcare data cannot be read by an unauthorized party. Patients and providers do not want an unauthorized party to know about a recent hospital stay or outcome of a sensitive procedure or diagnosis. The integrity of data must also be examined, as it is crucial to detect unintentional and even intentional changes to transmitted and stored data.
For example, there needs to be a way to track and locate any malicious or mischievous addition/deletion of healthcare information. Availability of data must also be examined. This ensures users can access resources whenever needed and do so in a secure way.
Although smart phones are open to threats, they are definitely here to stay in healthcare. So, I cannot help to wonder how nurse informatics can assist with safeguarding the healthcare data utilized by smart phones. Perhaps, much of it has to do with creating the organizational policies/procedures related to smart phones and mobile devices. However, I think it also depends on education we can provide to staff. When rounding in the hospital, I often see clinicians texting and emailing at the bedside. I am often struck by how many clinicians do not fully understand the risks and ramifications of using smart phones inappropriately. So below are a few items I often educate clinicians on:
- Provide physical security controls to decrease the chance of a smart phone being stolen or lost. Lock it up when not in use; know where it is while working with a patient. Don't be careless and leave it unintended, as it may store private healthcare data.
- Do not connect to an external network while using your employer-owned smart phone. Assume that external networks are untrusted allowing for ease dropping of data.
- Do not use applications created by unknown parties, as these cannot be trusted and may contain malicious software.
- Do not attach an organizationally owned mobile device to a personal laptop and vice versa. Data from your employer-owned device should not be downloaded onto a personal computer.
- Turn off GPS services on mobile devices to decrease the risk of targeted security attacks.
- Be aware that your hospital may restrict installed applications on a hospital-owned device.
- Your employer-owned device may have user and device authentication which requires dual authentication: 1) into the device, and 2) before accessing organization resources. This is an added security feature aimed at preventing unauthorized use of your device.
- Attend to the patient first, not your mobile device. After all, your first priority is your patient, not your smart phone.
Let's continue the conversation...
Are you allowed to use a personal smart phone at work? For what and when? If you are provided an employer-owned device, what do you use it for?
What is the policy at your work that pertains to the use of smart phones? What are the ramifications if it is misused?
What safeguards are in place at your work to safeguard the use of healthcare data while utilizing a mobile device or smart phone?
How do you think smart phones can properly be used by clinicians?
Nurses are moving down new career paths, each of which will demand knowledge and skill in the planning, implementation and use of health information technology (HIT). To understand HIT's indispensable role in healthcare transformation, nurses need only glance at the careers of professionals who began their climb toward the C-suite with an RN credential.
Growing numbers of nurses now pursue the BSN, MSN and doctoral degrees required to land emerging career opportunities - from nurse practitioner, physician assistant, transitional care manager or educator, to executive (CIO, CNO, CNIO) within a hospital, health system, outpatient or subspecialty clinic, home health company or payer organization.
Thriving in these multifaceted roles will demand that nurses understand the function and scope of technologies like telehealth, remote patient monitoring, analytics, portals and electronic health records, as well as how technology contributes to patient safety, improved outcomes and value-based accountable care. Technology is also poised to play a critical role within high-demand nursing specialties like emergency, critical and intensive care, pediatrics, oncology, cardiology, gerontology and psychiatry.
Change has already occurred. Nurse informaticists - typically armed with MSN degrees in nursing informatics - manage security and strengthen patient engagement via patient portals. The Alliance for Nursing Informatics (ANI) has pledged its support of consumer e-health initiatives, including patient portals, while the American Nurses Association (ANA) has asked members to sign the ONC Consumer Campaign Pledge that commits nurses to using a personal health record (PHR).
Leading the vanguard are nurses who used the RN as a launch pad to a challenging, fulfilling career:
- Dee Cantrell, RN, came to Atlanta-based Emory Healthcare as a director of patient services information systems and emerged as CIO just six years later. In the past 19 years, she's implemented Emory's EMR, clinical data warehouse, filmless imaging, and systems to improve research of disease processes.
- Laura J. Wood, DNP, MS, RN, is Vice President and National Director, Clinical Solutions for Malvern, PA-based Siemens Healthcare. A 2012 Executive Nurse Fellow at the Robert Wood Johnson Foundation, she serves the nursing profession as a member of the Health Information and Management Systems Society (HIMSS) Nursing Informatics (NI) Committee.
- Susan Kosman, RN, BSN, MS, is Chief Nursing Officer at
Aetna Inc. where she enhances development programs and advancement opportunities for more than 3,000 Aetna nurses. In addition to fostering collaboration between nurses and Aetna's other business units Kosman managed dedicated patient management units and led national medical management operations.
Nurses who want to follow similar career paths or just become more tech savvy as they progress from RN and BSN to MSN and DNP should consider this advice:
Monitor HIT advances. Read news stories, commentaries, issue briefs and white papers to understand the role and value of HIT in accountable care, population health management, patient engagement, and quality, safety, efficiency and cost management.
Know HIT trends. Ask these questions: What is the trend or development? Why is it important? Who has already succeeded or failed in responding to the trend? What can we expect in short and long-term future? What should be done now?
Study emerging nursing career paths. Among the issues: How strong or prevalent is the career path or opportunity? What's required in terms of education, skill, experience and interpersonal presence? Who has already succeeded within this career path and why?
Step up and get involved. Be on the lookout for opportunities to participate in internal, HIT-focused task forces and committees. Also take part in activities sponsored by ANI, HIMSS and the American Nursing Informatics Association (ANIA).
Ask for insight. Appoint a board of advisors - a collection of mentors - to guide your nursing career, making sure there's at least one person with expertise and experience in HIT or nursing informatics.
It is no secret that government incentives are the reason so many healthcare organizations and hospitals are embracing EMR technology to obtain the goals needed for meaningful use objectives. The real question is this: will good clinical business intelligence emerge from these systems once the incentives have stopped and the smoke clears?
What is meant by good clinical business intelligence? The answer is found in what we as nurses accomplish each day. Lab results are returned and nurses review these results in order to better understand what the results tell them about the patients' health and likely problems on the horizon. Clinical intelligence is not just producing a result it can interpret these results, trend them, and then provide predictions for the likelihood of the patients continued improvement or decline. This information can give an immediate feel for the patients well-being and can alert to potential critical situations before they happen and provide correlation of unrelated events or results leading to inference and early preventive measures.
One trial of these emerging technologies is being conducted currently at Barnes-Jewish Hospital in St. Louis, MO. "The sepsis alert developed at Barnes-Jewish Hospital was shown to increase early therapeutic and diagnostic interventions among nonintensive care unit patients at risk for sepsis." (Sawyer et al., 2011, Critical Care Medicine).
The healthcare industry could be at the beginning of a revolution in how clinical practice is managed and also with setting new expectations for clinical outcomes and clinical business intelligence put in place by meaningful use could help drive that revolution. Other industries already rely on data mining to forecast consumer behavior for their target populations. Their technology tools are no longer incomplete, inaccurate systems of tape drives and archived data relating only to customers' names and telephone numbers. Instead, they are large data repositories containing information relating to every facet of what a known customer does in relation to the product offered. Hospitals are now installing systems capable of this level of data comparison and forecasting. Given that these systems are here is not without surety that nurses will come to rely on these systems to assist in caring for their patients on a daily basis. The time has come for nurses to be part of that goal.
The EMR and data mining
The new EMRs provide fields that all nurses can chart what is being assessed on their patients throughout their shift. This collected data is not only stored in a database but it is arranged by headings known as tables. These tables can be used as heading when data is needed to be retrieved for a report. An example would be scanning the database for all patients in a unit who acquired and infection. These reports are helpful but with advances in technology these computers can scan data that is not related to the item and draw a point of data that can produce profound effects. An example would be pulling that same report displaying all the patients of a unit who acquired an infection and then having the system display that these patients all had the same nurses, rooms. The reporting and analysis of nurse names and rooms were obtained through a retrieval process similar to a flowchart called an algorithm. This information can then be used to identify the source of infection and reoccurrence. Proactive discussion such as education for the nurses in infection control and terminal room cleaning protocols can be produced from this data improving quality and standards for the unit and hospital.
What does this mean for healthcare?
Healthcare is tooling up and could be poised in the next few years to begin leveraging this same pool of information that traditional businesses use for actionable insights and decision making. The appearance of nurse informaticists and the trend of higher education offering medical informatics programs and predictive analytics only display the likelihood that clinical utilization of these powerful tools will become a reality.
Health organizations will want to know how to maintain patient outcomes and quality standards and reduce costs. Those who are able to forecast patient trends and identify likely populations to target for service offerings can achieve higher profitability and stability.
Since all the facts are not in yet it is hard to make concrete statements as to how technology will unfold for healthcare in the coming years. There are some definites. The Centers for Medicare and Medicaid tighten requirements each year for reimbursements; this will produce leaner markets and tougher competition among healthcare providers and the race for better information will increase.
Clinical data and business intelligence will become synchronous with healthcare and the business of healthcare. Prevention and intervention with immediate bedside reporting on multiple pieces of data will empower nursing with information to improve the patients' health or prevent onset of a critical decline. This information will ultimately be the difference between who will and who will not have the ability to provide better nursing and hospital care and therefore continue to stay in the healthcare business.
HIMSS celebrates National Nurses Week with the following activities:
- May 6-10: Read inspiring nursing stories on the HIMSS Blog
- Tuesday, May 7: Participate in a HIMSS LinkedIn discussion
- Thursday, May 9: The HIMSS Nursing Informatics Community will present the Nursing Informatics 101 webinar. Register for this complimentary event.
- Friday, May 10: An Introduction to the TIGER Virtual Learning Environment will presented by Sally Schlak, RN, MBA, Senior Director, The TIGER Initiative Foundation. Register for this complimentary event.About HIMSS
HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of health and healthcare. To learn more about HIMSS go to http://www.himss.org/.
Even though we'd never turn our backs on the incredible technological and clinical breakthroughs we've experienced in healthcare, many professional caregivers lament that there's never enough time to provide the level of personal care patients truly require.
Effective clinician and patient relationships include warmth, familiarity and a personal touch. These are important functions that allow a nurse to properly attend to the patient's health and recovery. The more time we spend by the patient's bedside, the more we hear, see and sense about his or her needs. There's nothing that replaces the nurse's touch and attention, especially at a time of crisis. We answer questions that might otherwise go unasked, and we observe more subtle behaviors and symptoms. Some aspects of that coveted level of attention and care have been lost to the fast-paced and stressful environments we see in hospitals today.
The bar is being raised and we are challenged to conduct hourly rounds and have to quickly assess up to 45 patients or more. With such little time to spread across numerous patients, how can a healthy patient-nurse dynamic exist? And more important, how can we make sure patients are getting the proper attention and care, clinically and emotionally?
Ironically, technology is providing a way to get back to some of the positive aspects of the past; specifically, personalized care. Through technology solutions like interactive patient education and engagement solutions, patients can receive customized education in order to better understand symptoms, diagnoses and their recovery. A highly focused, proactive flow of information to patients can curb the nurses' time spent educating the patient and his or her family. This also encourages patients to take a greater role in understanding their condition and the elements necessary for a healthful recovery. And with today's interactive feedback systems, nurses can track what their patients watch, assess comprehension through a simple interactive quiz administered electronically, and then focus on areas that are confusing or unclear to their patients. With another nod to the past, the key portals for these capabilities are hospital room TVs.
So, with time freed up by technology, nurses are able to focus more on hands-on clinical interactions. This improves our chances of noticing symptoms that may have been missed due to less patient interaction. Also, patients are empowered to play a larger role in their recovery thanks to increased access to relevant and timely information that's been customized specifically for their illness or condition.
There's another benefit nurses would experience from this increased hands-on service. Nurses tell me all the time how they're feeling the effects of stress from increased workloads and pressure. The consequences manifest in various health issues including weight gain, problems sleeping, less patience at home, and less resistance to illness. As the saying goes, "to help others you must first help yourself." Caregivers in our hospitals must be able to care for themselves, too, so they can perform their jobs to the best of their abilities.
Only a few hospitals currently use advanced technology solutions for patient education, though the interest is growing rapidly and the incentives for implementation are growing. A more concerted focus on integrated patient-engagement systems is a win-win for nurses, for patients and their families, and for improving the entire hospital experience. Hospitals using these tools are demonstrating returns on investment in improved HCAHPs scores, patient satisfaction ratings and clinical outcomes, including a reduction in preventable readmissions. It's even had a positive impact on nurse retention. The increased one-on-one efforts made possible through improved workflows, time-saving electronic reporting, more focused education, and feedback systems contribute to the patients' sense that they are in good, caring hands. And from the nurses' perspective, that includes having the opportunity to get back to the best aspects of old-fashioned care and caring, which often is the magnet that draws us to this profession in the first place.
I recently watched Moneyball (the movie that stared Brad Bitt as Oakland Athletics general manager, Billy Beane). In the movie, Beane utilized the assistance of a genius-minded statistician to make a wining baseball team with one of the skimpiest payrolls in the major leagues. Beane embraced sabermetrics, a type of predictive analysis, to identify promising players who were undervalued in the Major Leagues. Today, many healthcare organizations are in a similar spot as the Oakland Athletics were in 2002. They are trying to improve performance at the same time their reimbursements are shrinking.
Predictive analytic techniques, which can range from basic statistical regression to sophisticated machine learning, help healthcare organizations pinpoint how they can get the most bang for their buck in terms of improving quality and reducing costs. Predicative analytics have been used for decades by health insurers to identify potential high uses of health services. The growing interest in business intelligence among healthcare providers correlates with the growing amount of financial risk they are assuming under healthcare reform. Now that Medicare payments are tied in part to hospital readmissions and other performance-based metrics, providers are motived to invest in reducing needless admissions, visits and costly adverse events.
One organization that has successfully utilized predictive analytics to reduce unnecessary utilization has been Allina Health (based throughout Minnesota and western Wisconsin). They have made a financial imperative to prevent unnecessary hospitalizations and emergency department visits. By utilizing a readmission predictive model, they have assigned inpatients a readmission risk score. Their algorithm uses 30 highly predictive variables, including patient utilization, medical history (for example history of diabetes) and various clinical data ( patient's weight, functional status, lab values and medications). Nursing assessments such as information related to a patient's social factors, financial concerns and mobility concerns are also included. Allina's readmission algorithm sorts thru EHR data on a daily basis, assigning readmission scores to all hospitalized patients. To make this information useful, it is uploaded onto the hospital's patient census dashboard, providing Allina staff with a one-stop place to obtain a list of inpatients with a high risk of readmission.
I'm interested to learn your thoughts on the use of predictive analytics in healthcare. Particularly, the role nurse informatics play in designing data capture sources to provide the information needed to run a staticalical analysis. For example, designing nursing assessments or other charting screens that capture this data. And I'd also like to hear your thoughts on how this information, once properly designed and collected, could be best utilized to help clinicians.
For years, organized medical groups have blocked efforts by advanced practice nurses (APNs) to expand their scope of practice. Even at the dawn of technology in hospitals transforming and expediting many processes, groups such as the American Medical Association believe that allowing nurse practitioners to care for patients, rather than primary care physicians, put patients' health at risk. Pointing to the dramatic gap in years of education, these physicians advocate physician-led teams. However, new solutions provided through technological advances show potential to fill this gap when properly taken advantage of by NPs; a factor requiring serious consideration.
Most importantly, nurses must embrace technology and the ways it is revolutionizing hospital systems. Processes such as computerized physician order entry (CPOE) reduce errors and contribute to quality and efficiency on the whole, thereby making their understanding and function extremely important to NPs. The use of telecommunications to collaborate with professionals and experts across the country gives nurses the resources to make the most informed decisions. But such options made available through advances in technology play a bigger part than potentially providing assistance to nurses' duties. The overall quality of performance that can be provided by a workforce of tech-savvy nurses may well ease the notion that physician involvement is required for the best care. So, NPs will always have to be extremely familiar with new technologies to fully realize the potential offered through these resources and channel them toward providing patients with same high-quality, reliable and efficient care they expect from physicians.
Nurses can also position the nursing profession as indispensable in the quest to facilitate smooth transitions in care, implement new care models, prevent costly readmissions, foster patient accountability and manage the health of populations, not just individuals. To that end, nurses will need clinical experiences that emphasize aggregate care, care transitions, process of care and the before and after of care.
"Change is the only constant in life." ~ Heraclitus
- Your 700-bed acute care facility will be implementing an organization-wide electronic medical record (EMR) with a go-live scheduled for next year.
- Computerized provider order entry (CPOE) is being rolled out to the medical intensive care unit over the next three months.
- A critical access hospital is converting its financial and supply chain management systems from one vendor to another.
Although many of the above change efforts have detailed budgets, resource management and education plans, few (if any) will have a structured approach to manage the change - a plan for change.
"It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change." ~ Charles Darwin
Who Moved My Cheese, by Spencer Johnson, is a motivational story that speaks to how to deal with change. The story centers around four characters that inhabit a maze filled with cheese. They are living the good life. They have plenty of "cheese" but one day the cheese disappears! Unable to move on and adapt to the loss of his "cheese" Hem (one of the characters) almost starves to death. Simply put - organizations that handle change well thrive, while those that do not may not survive.
"The key to change... is to let go of fear." ~ Rosanne Cash
Why have a plan for change? A comprehensive change management approach is needed whenever a project involves people, processes or technology. By far the most difficult aspect of any initiative is creating an environment for change to occur successfully. If there is potential for lack of clinician buy-in ambiguity barriers (to the change) or resistance you will want to utilize a change management methodology in conjunction with your project management approach.
"The secret of change is to focus all of your energy, not on fighting the old, but on building the new." ~ Socrates
A popular change management model utilized in diverse industries is Kurt Lewin's, three-step process of 1) Unfreeze, 2) Change, 3) Freeze (or Refreeze). Described as elegantly simple, the Lewin model can facilitate rapid change, minimize the disruption of and sustain the change as part of the permanent culture of the organization.
"Our dilemma is that we hate change and love it at the same time; what we really want is for things to remain the same but get better." ~Sydney J. Harris
The estimated annual cost of IT project failure in the U.S. is between $50 to 80 billion. Why is change management critical to an organization's success? Healthcare information technology projects represent significant financial investment and are triggers for other major organizational change.
Why is it that so many change efforts fail miserably and how can you make sure yours does not?
"Be the change you want to see in the world." ~ Mahatma Gandhi
Second only to Lewin is John Kotter's eight-step change model. Kotter maintains that successful change is a process of completely advancing through all of the eight steps. In Kotter's parable: Our Iceberg Is Melting: Changing and Succeeding Under Any Conditions about a colony of penguins struggle to manage the change necessary for survival.
"The only person who likes change is a wet baby." ~ Mark Twain
If people will need to learn new skills, do things differently or the change requires a shift in organizational culture, a plan for change is essential. Change in order to be successful, should not be chaotic and unstructured. Whether employing Rogers' Diffusion of Innovations or Six Sigma for change , there must a change management methodology used - a plan for change.
"God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." ~ Reinhold Niebuhr
The alignment of education and technology is on hospital administrators' radar screens nationally, especially with today's new health reforms and community health initiatives. There's enormous potential for innovative solutions that can help deliver customized patient care and improve outcomes and patient satisfaction. This merger of technology and hands-on care has always appealed to clinicians, but significant gaps existed between the vision of what could be and reality.
Anyone working in healthcare today is aware of the tremendous pace of advancing technologies. Innovations have become so commonplace that we've come to take for granted the many amazing breakthroughs in areas such as diagnostic science, where new tools have made tremendous strides in improving patient care and outcomes.
These advancements require significant investment, and the politics of competition, funding and government requirements permeate every buying decision. Like any successful enterprise, hospitals must quantify the value of new systems versus the cost benefit. One area that was often difficult to measure financially was patient education. Sure, it was widely recognized as an important component of patient care, but the time commitment and resource requirements needed to deliver effective patient education were cost prohibitive for many hospitals.
In today's healthcare landscape, new technologies have helped provide some answers to the cost challenges of patient education. Additionally, emerging mandates and reimbursement criteria have elevated the focus of maximizing patient outcomes and reducing readmissions. We now know for certain what we've long believed: That proactive, focused patient education can have a profound impact on measureable outcomes
Interactive technologies are able to blend the key concepts of a quality education plan like video-on-demand, prescriptive ordering, comprehension assessments and patient-specific education. In addition, these systems link with care coordination and electronic medical record systems (EMRs), providing not only the return-on-investment metrics for hospitals, but additional tools to maximize resource allocation, enhance patient engagement, and increase patient satisfaction. With new meaningful use mandates, federal compliance requirements, and new reimbursement criteria moving forward criteria cri, hospitals that are not looking into updating their patient education and community health strategies will fall behind.
The days of wheeling carts with VHS machines and monitors into patient rooms, and chasing the one videotape the hospital has on breastfeeding are waning. Today, every patient room has a television set, and increasingly they have access to multiple channels and customized health programming. New technologies deliver automated content to patients through customized triggers in the ADT or EMR systems, and additionally engage the patient and their network of family members and caregivers.
However, although the technology exists, in many cases we are just scratching the surface. Nurses continue to be burdened with antiquated workflows and time-consuming tasks associated with patient and caregiver education. Fortunately, that is changing. The link between EMRs, patient satisfaction and government reimbursement is redefining educational and budgetary priorities. Hospitals are discovering that investing in interactive patient education and engagement systems helps address new meaningful use mandates and leads to improved patient outcomes, reduced readmissions and increased reimbursements. As nurses, we can be powerful advocates for improving the patient experience and related clinical outcomes. These new technologies can streamline our workflows, help improve care, and close the chasm that exists between information collection, reporting, and the data and processes we need to truly empower the patient in their own care.
To help address this disconnect, our voices can help raise awareness among EMR providers regarding our challenges, and we can ask them to work with us to find the solutions we need to more effectively streamline our workflow efforts, enhance patient care and improve patient outcomes. We already play a key role in listening to patients, addressing their needs and providing care, and we have a lot to offer with regard to the technology solutions that can help us do our jobs better and with greater efficiency.
Right now there is a concentrated focus on patient engagement as part of Meaningful Use Stages 2 & 3, and many new models of care have developed as a result. These new models emphasize the need for patient satisfaction and patient engagement. Examples of these models include:
Patient engagement is particularly compelling with wide-ranging implications. How can we encourage patients to participate more fully in the healthcare process and to take greater ownership of their own outcomes and safety, both in the hospital and when back at home? How can we balance the requirements for ease of use (both by patients and by caregivers) with those for privacy and security? What are the proper roles - and constraints - for social media and for mobile devices and applications?
Now that many hospitals and providers have implemented EMRs, it is finally feasible for a significant number of patients to be able to see their records digitally. And as consumers increasingly use digital tools in other aspects of their lives, their expectations of the healthcare system will rise. Clearly patients and consumers are looking for tools and capabilities that will make the healthcare system work for them more effectively. Although there has been much work already done, many patient needs are not being met. For instance, a September 2012 Harris Interactive poll highlighted that:
- 65% of the surveyed population thought it was very important or important to have online access to doctor visits, prescriptions, test results, and history. Only 17% of the surveyed individuals currently had that access.
- 53% thought it was very important or important to have access to their providers. Only 12% currently had that access.
These statistics point to significant unmet needs and a significant opportunity for providers, hospitals, and outpatient services to differentiate themselves by the digital patient engagement capabilities they provide.
Patient engagement is a long-term journey and a new way of doing business. As with most new ways of doing things in healthcare, the most important part is taking the first step. Consumers want access to their healthcare records and no longer want to wait for the hospital or provider to divulge information. Research shows that the ability to view lab results online (in the context of education) and the ability to message their doctor securely are two features that are especially engaging for patients.
I am interested to hear what others think about this topic, as there are many discussion points within the topic of patient engagement:
- How is patient engagement being enacted in your work projects or your personal life?
- What do you think needs to be done better, what works well?
- What do you think the barriers are to patient engagement?
- What about issues related to security/privacy?
- What about the use of Social Media?
The Future of Nursing: Focus on Education, a 2011 policy brief from the Institute of Medicine, outlines the need for more highly educated nurses, a reformed education system, lifelong learning and the production of "enough nurses with the right skills." The conclusion: "If new nurses are to succeed in this complex and evolving health care system, nursing education needs to be transformed." More specifically, the report offers these recommendations:
- Produce more nurses educated at the BSN level
- Allow nurses to easily transition from an associate's degree to a BSN degree or higher
- Increase the percentage of the nursing workforce holding a BSN to 80 percent by 2020
Experts now realize that addressing the primary care needs of higher numbers of insured patients and sicker Medicare patients calls for a nursing workforce skilled in the newest technologies, problem solving, care management, and collaborative, team-based care. Armed with BSN, MSN, and DNP degrees, these nurses can help minimize the shortage of primary care providers and nurse educators, while making headway on healthcare organization (HCO) goals - from value-based, accountable care and population health management, to meaningful use and chronic disease management.
As the inevitable convergence of technology and hospitals continues, there is a surging growth in opportunities within nursing informatics. But with the boost in this area comes the need for professionals who are capable of effectively and efficiently performing new technological duties. It is becoming increasingly evident that a formal education that couples both nursing and new technology is necessary to produce the highly capable workforce needed in hospitals today.
Nurses must play critical roles in the always changing technological environments of current and future medical processes. Certainly, pre-licensure education at the associate, diploma, and baccalaureate levels must prepare students to effectively use technology in direct patient care. However, the use of informatics to evaluate care of groups and populations is a competency of the baccalaureate and master's degree nurse. The benefits of a baccalaureate education in nursing technologies include giving nursing students opportunities to arrive in the workforce better prepared in all aspects of their jobs. Through computer-based learning technologies and simulations, nurses are provided genuine insight into real-life situations, and come away with valuable experience. The emphasis on technology in this approach to nursing education results in increasingly capable, skilled and proficient nurses entering their careers and hitting the ground running.
The solution to a far more technologically advanced and well-educated nursing workforce is multi-faceted, requiring the involvement of nurse executives, educators, researchers and policy makers. Among the strategies:
- Reduce educational barriers by helping nurses manage school, work and family responsibilities. Solutions include increased use of online learning, tuition reimbursement, flexible scheduling and weekend classes. For example, the MSN program at Lucille Packard Children's Hospital in Palo Alto, CA, provides tuition reimbursement, onsite master's and bachelor's degree programs and a work-life balance office.
- Reconcile nursing education with compensation and promotion opportunities. Nurse salaries vary according to state, job title, work setting, and number of facility beds, facility type and level of unionization, according to 2012 salary survey data from Advance for Nurses. For example, in the South, nurses with BSNs make $61, 956 annually, while those with an MSN make $77,370 annually. Nurses deserve to know the value of education and extra technology training by hearing candid feedback on career paths, promotion opportunities and salary progression.
- Sell the C-suite and opinion leaders on the value of highly educated and technologically savvy nurses. CNOs in particular, can play an important role in positioning nurses as educated professionals who help improve quality and safety, build a culture of excellence and accountability, and offer low-cost, easy-access primary care through newly created models, according to the 2013 American Hospital Association Environmental Scan.
- Support college-directed standardization of educational requirements. To accommodate the projected nursing shortage, every nursing school must continue to produce graduates prepared to take the NCLEX licensure examination. However, to ensure that nurses continue their education after achieving initial licensure, requirements for further education must be clear, simple and easy to navigate, rather than posing a barrier to the nurse's future course work. For example, ADNN-prepared nurses who enroll in BSN programs often describe structural barriers to further education. The diversity of prerequisites and general education courses in both nursing and general education often require students to complete more courses than they expect. To address these issues, individual associate degree and baccalaureate nursing programs are partnering to standardize requirements through articulation agreements or dual enrollment programs. The new requirements must address the importance of training nurses in electronic medical records (EMRs) and data analysis using informatics that can be used to help improve care coordination.
- Champion national efforts to standardize requirements and advance nursing. In 2012, the Robert Wood Johnson Foundation (RWJF) announced grants totaling $2.7 million to nine states as part of its Academic Progression in Nursing (APIN), an initiative designed to create state and regional strategies to build a more educated nursing workforce. Under phase one, states received two-year grants of $300,000 to help nurses earn advanced degrees, improve patient care and fill faculty and advanced practice nursing roles.
- Address the ongoing shortage of nursing faculty. HCOs and nurse education programs must join forces to address the $40,000-$50,000 pay gap between nurse educators and nurse practitioners, while offering flexible schedules that permit nurses to both practice and teach.
- Make education relevant and practical. Offer unique and value-added educational experiences, including clinical training sites that build interdisciplinary team knowledge and skill, using the newest technology teaching tools, including Patient Simulators and EMR Simulation tools.
Are you thinking of starting a new program or attempting to resurrect a disbanded group from a previous project? One of the keys to a successful clinical system implementation (or conversion) will be your super users.
Historically a super user was an end user that possessed an interest in participating in the project; an experienced staff member who retained their normal role (RN, unit clerk, respiratory therapist, etc.) in addition to the role of super user. Super users were looked to as the go-to resource for that floor or unit. Depending on the organization, a super user might also participate in training other users.
Not long ago I was asked to explain the difference between a super user and a champion. In recent years the terms have been used interchangeably.
Webster defines a champion as:
- a warrior, fighter
- a militant advocate or defender
- one that does battle for another's rights or honor
- a winner of first prize or first place in competition; also: one who shows marked superiority
Physicians were one of the first clinician groups to embrace the champion model in regard to IT initiatives.
I like to describe a champion as a super user on steroids. Where the super user is interested in participating, the champion is an enthusiastic advocate. Champions are viewed by their peers as informal leaders. This is the person routinely sought out and consulted about solutions to clinical practice problems.
While it's best to intersperse the project teams with advocates as well as naysayers, your champions should whole heartedly evangelize the system and the benefits its implementation will bring to the organization. A champion without good people and communication skills, or who lacks the ability to listen, usually fails to inspire others.
Tasks performed by a champion may include: system design, build and testing; policy and procedure drafting; hardware evaluation and selection; streamlining work flow processes; develop and delivery of end user training.
As we implement more complex and sophisticated systems there is a need to move from a super-user to a champion model and recognize the marked superiority of a champion.
Nursing Informatics: A Career on the Rise
First he won on Jeopardy, now he's diagnosing patients. Watson, the IMB supercomputer has been programmed to assess information presented by patients, caregivers and technology and to come back - very quickly (processing up to 60 million pages of text per second) - with a diagnosis and treatment recommendation. The computer is not just full of statistics and facts. It actually listens and learns, just like it did on Jeopardy.
Jonathan Cohn wrote about the advancement in the March 2013 cover story of The Atlantic. (Cohn is senior editor at The New Republic and the author of Sick: The Untold Story of America's Health Care Crisis-and the People Who Pay the Price.) He explains: "It can sit in on patient examinations, silently listening. And over time, it can learn ... so it gets better at figuring out medical problems and ways of treating them the more it interacts with real cases. Watson even has the ability to convey doubt. When it makes diagnoses and recommends treatments, it usually issues a series of possibilities, each with its own level of confidence attached."
So where does this leave caregivers - namely physicians? In the unemployment line, according to some. Cohn reports that Vinod Khosla, a venture capitalist and co-founder of Sun Microsystems, said in a 2012 TechCrunch article titled "Do We Need Doctors or Algorithms?": "A world mostly without doctors (at least average ones) is not only reasonable, but also more likely than not." Khosla predicts computers and robots would replace four out of five physicians in the United States.
Cohn envisions a different scenario, one where physicians are still employed, but depend on supercomputers like Watson. "Think Dr. McCoy using his tricorder to diagnose a phaser injury on Star Trek, not the droid fitting Luke Skywalker with a robotic hand in Star Wars," Cohn clarifies.
And nurses? "Physicians wouldn't need to do as much, and each class of professionals beneath them could take on greater responsibility," Cohn writes.
Sounds like a good future for nurses, and patients ... and nursing informatics.
The Nursing Informatics blog on ADVANCE for Nurses is back! Look for new, weekly updates beginning in March.
Read more on nursing informatics:
HIMSS, in collaboration with the American Nurses Association and the 29 members of the Alliance for Nursing Informatics, http://www.allianceni.org/members.asp are seeking your story!
About: We are collecting personal stories that demonstrate the impact of nursing and informatics. The stories should be personal experiences that illustrate how: nurses and nursing informatics are advancing better care, affordable care and healthier communities! Our goal is to collect 50 vignettes and have 50 individuals join us as we meet with members of the US Congressional Nursing Caucus on September 11, 2012 in Washington, DC, as we share these stories. Further details about the event will be made available at www.himss.org/niimpact
ACTION: Please submit your vignette in a word document to Jennifer Roniger at firstname.lastname@example.org
Time frame: Vignettes will be collected throughout the year but those that are received by August 1 will be incorporated in the "leave-behind" document for our event on September 11, during National Health IT Week.
Join us: Plan to join us on the Hill as we share these stories on September 11, 2012 (further details forthcoming). This will be a complimentary event and Registration thru the HIMSS Policy Summit is required: http://www.himss.org/policy/policysummit/registration.aspx Please note, Registration will NOT be open until mid-July.
The first 15-month Fellowship in Innovation Leadership for executive healthcare leaders will begin September 2012. The program is designed to prepare the most innovative leaders to positively impact the future of healthcare.
The Fellowship is:
- Focused on building innovation as a process and a capability, both personally and organizationally;
- A phased approach to innovation that allows Fellows to reflect and learn (in immersion sessions and webinars) and to accelerate realization of results through $1,000,000 projects;
- Rich learning and networking through diverse views, experiences and disciplines of Fellows;
- Learning that is shared by Fellows to strengthen their organization's capability to innovate and improve outcomes.
- The investment for the Fellowship program is $20,000 (the Fellowship program fee will be discounted for members of partner organizations), plus travel costs;
- Program fee is both an investment in your organization and your career;
- Application deadline is July 16.
Participants will be mentored by a group of nationally recognized leaders including: Barbara Balik, EdD, RN; Jack Gilbert, EdD, FACHE; Kathy Malloch, PhD, MBA, RN, FAAN; Tim Porter-O'Grady, DM, EdD, FAAN; Barry Silbaugh, MD, MS, FACPE; Donna Sollenberger, EVP and CEO University of Texas Medical Branch; and David Webster, partner, IDEO.
For more information and to apply, visit the Transdisciplinary Consortium for Innovation Leadership in Healthcare website or contact Jack Gilbert at email@example.com.