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Freeman_NIH_NCI.pptx
1. How Nurses and “Non-IT” Factors Can Improve the
Health IT Experience
Rebecca Freeman, PhD, RN
Chief Nursing Officer
Office of the National Coordinator for Health IT || US Department of Health & Human Services
2. Overview of Key Takeaways
• Overview
» The Health IT Agenda and Hidden Barriers
• Understanding Workflows
» …and the need for formal assessment.
• Implementation Decisions
» Communication Pathways and Automation
• Clinical Decision Support
» Governance
• Nursing Roles
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8. The Reality of Primary Care
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Shared with permission of General Medicine, MUSC.
9. Implementation Decisions
• Training
» Too much, too little, too early, too late. Who is a Super User? SME?
• Documentation
» Inclusion/Exclusion, EBP, and Consolidation
• Informatics
» Use of Informatics Team (Is there an Informatics team?)
• Interdisciplinary Care and Communication
» Does the team work together?
– The system assumes it does.
» Are communication criteria and pathways established?
• Analytics, Culture, IT/Downtime
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10. Clinical Decision Support
“Clinical decision support (CDS) provides clinicians, staff, patients or other
individuals with knowledge and person-specific information, intelligently
filtered or presented at appropriate times, to enhance health and health care.
CDS encompasses a variety of tools to enhance decision-making in the clinical
workflow. These tools include computerized alerts and reminders to care
providers and patients; clinical guidelines; condition-specific order sets; focused
patient data reports and summaries; documentation templates; diagnostic
support, and contextually relevant reference information, among other tools.”
Governance is only one key component of CDS management. Ineffective
governance, however, can lead to significant safety and quality concerns.
https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds
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11. Nursing Roles
• Care Coordination: Registered Nurses (RNs) excel as care coordinators.
» If utilized to the full scope of their practice, aided by protocols, they can do an
incredible number of things!
– In the outpatient setting, under-utilization is common.
– Task-oriented work in the clinic vs. care coordination across settings
» Many have varied backgrounds that make them a consummate team player.
• Informatician: Nursing Informatics professionals can lead governance
initiatives, system requests, and help to clarify workflows. Nurses at the
bedside can serve as Subject Matter Experts and Super Users to better
inform the efficient use of health IT.
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12. ONC Resources
• SAFER Guides
» https://www.healthit.gov/safer/safer-guides
• Health IT Playbook
» https://www.healthit.gov/playbook/
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The non-technical topics I will briefly cover, that impact the use of health IT for care.
These are the things we talk about a lot! None of these terms are likely to be new to you.
These are the underlying barriers that can really cause trouble when you start trying to leverage health IT in the clinical world.
Let’s talk about workflow first, and I will use a quick set of slides as an example. These are used with permission of the General Medicine service at the Medical University of South Carolina (MUSC). This is what they signed off on = as the workflow for the Internal Medicine clinic.
A patient arrived.
More patients arrived.
A formal workflow analysis happened. This is ideally what you will work out BEFORE you implement a system or any piece of technology. [It is rare that the workflow work is actually done proactively.]
Some of the “non technical” implementation decisions that can significantly impact the use of health IT. Talk about communication and whether or not the EHR helps or hinders team communication. Also, talk about the integration of research into the EHR. Also talk about areas of research that could use some help, to make the system work more efficiently.
This is the definition used by ONC. If you perform a lit review, or talk to different experts, you will find a lack of continuity (although general agreement) about what CDS is. Testing is a HUGE deal with CDS. So is having the appropriate governance – a solidly interdisciplinary team who controls what goes into and out of the health IT screens.
Two key ways to use nurses and other allied health professionals to streamline care and the use of technology.
