Week 5: Healthcare Technology & Nursing Leadership

Healthcare Technology & Nursing Leadership

The success in meeting the demands of an increasingly complex healthcare delivery system in the future of nursing will depend on the use of technology to capture nursing outcomes data. The value of being able to evaluate the success of nursing care is essential for nursing leaders. It is no surprise that nursing leaders are turning to technology in order to overcome some of the biggest demands of nursing documentation. Nursing Minimum Data Set (NMDS) and Nursing Management Minimum Data Set (NMMDS) were explored in week 1 of this Blog (Rutherford, 2008).
The value of nurse leaders capturing outcomes information for the purpose of describing outcomes is not only good for the patients, it's essential to the future of nursing care delivery.

Transforming HealthCARE

Through LEADership

Changing the Landscape of Healthcare

There have been a number of challenges that have presented within the last decade in regard to conforming to incentivized methods of healthcare reimbursement. The Pay-for-Performance initiatives of the Medicare Program have been geared toward driving quality of through the Value-Based Purchasing initiatives (nih.gov).
For more information on VBP and P4P please visit: 
National Institutes of Health (NIH) - Turning Discovery into Health

The continued value of recognizing the changing landscape from the American Recovery and Reinvestment Act with provision for the HITECH Act in 2009 leading to Meaningful Use (MU) initiatives (cdc.gov). The Progress of technology initiatives requires nurse leaders to provide extensive support and contact with nursing informatics within respective organizations. There are particular concerns surrounding the effectiveness of interoperability and EHR platforms. There have been a number of challenges presented with attesting Meaningful Use in it's stages shown in the image above. The Nurse Leader has to be engaged with the challenges of technology uptake in the clinical setting. Nurse Leaders are uniquely positioned to advance initiatives for organizational goals as well as promoting the value of nursing within the organization, while driving better outcomes for patients (Houston, 2013).

Leveraging Technology

The Nurse Leader absolutely has to be at the forefront of identifying the needs of the front-line staff in order to better understand the demands that are mounting in care-delivery. The focus needs to be in the order of satisfy the EHR aspects of Meaningful Use while recognizing that nursing professionals need to constantly be allowed platforms for feedback, dialogue, and improving documentation systems rather than having to use workarounds and dismiss Clinical Decision Support technology. The technology needs to be utilized in the interest of empowering nurses to be more efficient and effective in the everyday work of improving patient outcomes. The Nurse Leader needs to leverage resources in order to bridge the gap between financial leaders and technology that can be utilized to make technology more efficient and effective. Please watch the video below to better visualize ways in which technology is transforming healthcare.

Technology: Transforming Care

Capturing Care: Databases

The NDNQI serves to deliver evidence to uphold the importance of investments in nursing strategy. Nurse Leaders have the role of looking into the vast and growing power of nursing databases such as the National Database for Nursing Quality Indicators (NDNQI) to be able to contribute and benefit their organizations with the power of a repository information which serves to benchmark care in comparison to like-institutions and provide insight into various ways to improve the delivery of care (pressganey.com). The power of being able to express the importance of nursing interventions on the quality outcomes places the Nurse Leader in a position of appropriate empowerment to support nursing practice.
 

Nurse Leaders & Technology: The Future

The power of nursing will be best positioned when Nurse Leaders see the value of embracing technology that will promote the nursing profession by the nature of improving patient outcomes. The work of Nursing Informatics will continue to develop and the Nurse Leader is in the ideal position to develop teams of nurses who can be successful in integrating technology in patient care. This role will continue to be presented challenges just as there have been in the history of the profession. The future is bright with the added value of Nurse Leaders Leveraging technology for the betterment of patient outcomes and the nursing profession.  The power of new technology on nursing care on Nursing Leadership challenges in the integration of new technology; including the balance of the human element with technology, balancing cost and benefits, training a technology enabled Nursing 
professionals and ensuring ongoing competency of nursing using new technologies. There  are a host of challenges that present when the Nurse Leader encounters integration of technology but the challenge is rewarding when considering the benefit the outcome of patients, health of the organization and furthering of the nursing profession.
(OJIN: The Online Journal of Issues in Nursing)

  

References

Huston, C., (May 31, 2013) "The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead" OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 1.



Rutherford, M. A. (2008). Standardized Nursing Language: What Does it Mean for Nursing    Practice? American Nurses Association, 13(1). Retrieved February 1, 2016.

Retrieved from: http://www.cdc.gov/ehrmeaningfuluse/introduction.html

Retrieved from: http://www.nih.gov

Retrieved from: http://www.pressganey.com/solutions/clinical-quality/nursing-quality



Week 4: WORKFLOW SOLUTIONS: EHR MOBILITY

Workflows and Nursing Care Delivery

Challenges are faced when nurses have to alter effective workflows in order to accommodate technology not only impacting patient care but staff morale and particularly in relation to electronic health record. We know that the EHR is here to stay and that the need is to focus on improving workflows in the nursing care delivery environment...

A workflow is the sequence of processes through which a piece of work passes from initiation to completion. It is the set of tasks—grouped chronologically into processes—and the set of people or resources needed for those tasks, that are necessary to accomplish a given goal (NCBI). This can take shape in any number of ways in the healthcare setting. Nurses are faced with difficult scenarios in having to prioritize patient care, establish relationships and maintain high standards while technology platforms have faltered in keeping up with the demands of nursing workflow.

THE WORKFLOW PROBLEM

Not having proper access to EHR documentation platforms can be cause for serious safety concerns. When nurses cannot access health records in real-time, nurses report a litany of problems and barriers to timely documentation of interventions, care plans, and overall workflow (NCBI).

Many opportunities for development of HER documentation platforms have emerged in recent years. The initial concept of an ideal workflow in which the nurse had access to a stationary computer was quickly recognized in being insufficient (Heslop et al. 2011). The importance of having ready access to mobile devices has become a significant challenge in the ICU where I work.

The nurses have to log into multiple devices and loose information if pulled away. The ideal workflow is that the nurse has the time to carefully document each series of events and assessments. But the workflow for the day demands that the nurse has to pass all medications and assess patients early rather than late. By the time testing, transfers, admissions, discharges, and all manner of challenges present, the nurses cannot document in a timely manner. This is cause for concern. When information is not entered in a timely manner, important detail can be lost, increasing the risk of documenting on the wrong patient, and any number of other errors.

 

MORE ACCESS: BETTER CARE

 A BETTER WAY

Evidence reveals that nurses having to log into multiple devices is problematic and interrupts workflows. The solution is a personalized, wireless access device that can go anywhere with capability to access records, scan medications, and document patient care in the EHR. (Parker & Baldwin. 2008). The access to real-time electronic chart information and access decision-support mechanisms. Failure to comply with medication bar coding can be a major safety concern with work-arounds impeding safe processes. The introduction of a wireless device would allow the ICU nurses to seamlessly access EHRs and document care delivered. The Infographic below provides a description of the workflow.

THE NEW WORKFLOW: PLANNING AND PROCESS

ehr-infographic

References

Parker, C., & Baldwin, K. (2008). Mobile device improves documentation workflow and nurse satisfaction. CARING Newsletter, 23(2), 14-18 5p.

Heslop et al. (2011). Enhancing Clinical Nurse Workflow through Redesign of Networked Wireless Laptop Computers. Electronic Journal of Health Informatics, 6(3).

Patient Safety and Quality: An Evidence-Based Handbook for Nurses Organizational Workflow and Its Impact on Work Qualityhttp://www.ncbi.nlm.nih.gov/books/NBK2638/

Week 3 Nursing Leadership in Leveraging Technology

Nursing Leadership- Setting the Trajectory for Clinical Technology Integration for the Future of Care



Nurse Leaders are well-positioned to leverage technology in the health care setting. The improvement of quality of care, safety of patients, improved outcomes, and improved work environments has become the work of technology integration with Nurse Leaders in the position to influence change. The rapidly developing culture of change in healthcare reform has placed so much pressure on the traditional Health Information Management (HIM) Role with integration Health Information Technology (HIT).

Background for Informatics as a Specialty

This was clear as early as 1992 when the ANA defined the informatics role as a nurse which

"supports the nursing process by helping to integrate the data, information, and knowledge required for clinical decision making." The ANA went on to develop Nursing Informatics: Practice Scope and Standards of Practice. 

The Role of Health Informatics...

The Strategy for Nurse Leadership

The role of Nurse Leader in informatics is not unlike any other area of influence for the Nurse Leader, in that there needs to be a good understanding of the integration of technology in health delivery. The Nurse Leader must be informed of the trends in informatics in addition to the current systems in order to integrate the current systems with trajectory of future development.

The first position needs to be that of understanding and support of the resources for the role of the Informatics Nurse Specialist.

 

The American Organization of Nurse Executives' Guiding Principles to enhance clinical outcomes by leveraging technology has been established as a groundwork for Nurse Executives to support the value of informatics in Healthcare. Attributes of the Ideal System to Leverage Technology are as follows: 

• a well-defined governance model that defines strategic vision, roles, responsibilities and measures for success;
• a roadmap with iterative steps for adopting and integrating of enabling technologies; and
• a model to facilitate collaborative among the CNO, CIO and technology industry partners.

The Nurse Leader is in a unique position to be aware of the necessity and shoulder a great deal of responsibility to promote the role of nursing in technology integration. Having a voice to be able to impact the landscape of technology integration, having a relationship to unit-level and individual staff competencies places the nurse leader in a excellent position to ensure that initiatives have the best opportunity for success.

Allocation of resources is an essential part of the Nurse Leaders to avoid the "penny wise and pound foolish" mentality of limiting resources for proper preparation of technology initiatives that promise to improve quality of care, safety of patients, improved outcomes, and improved work environments. If the leader can have the vision, leverage resources, and have the follow-through to see that technology initiatives are given every opportunity for success.

 

TIGER Initiative

TIGER is an initiative focused on education reform and interprofessional community development. The spirit of TIGER is to maximize the integration of technology and informatics into seamless practice, education and research resource development.

This initiative is associated with the Healthcare Information and Management Systems Society (HIMSS), which provides resources and guidance to health leaders through a vision of "better health through information technology."

Further defined priorities for Chief Nurse Executives are provided below.

Top Priorities for the Chief Nurse  Executive (CNE) 

• Assure that there is a defined governance model that oversees technology initiatives. 
• Define roles, accountabilities and outcomes to achieve the strategic vision. 
• Align the overall technology and patient care strategic plans as the foundation for the governance model. 
• Define criteria for acceptance, initiation, midcourse correction and termination of the initiative.
• Define the communication and decision-making process and the rules of engagement for all participants.
• Engage the entire C-suite in the initiative.
• Define clear, measurable, clinical outcomes for each technology initiative/project. 
• Drive performance measurement based on evidence-based best practices using an adaptive model to synthesize new knowledge.
• Clearly link outcomes to the strategic plan and communicate outcomes to all working teams.
• Define a scalable and repeatable methodology to measure outcomes.
• Assure and advocate for adequate resources for data support and analytics.
• Align and integrate clinical outcomes with the quality improvement plan.
• Assume ownership of the process roadmap for future work redesign and the relationships that manage the process. 
• Articulate and define a transformational vision and a strategy to achieve the vision.
• Create an effective communication plan.
• Identify, name and empower a multidisciplinary team to drive the process to its initial end state.
• Do not underestimate the complexity of process work—it requires education at all levels to achieve the cultural change required.
• Support and champion cultural transformation as the foundation for process change.

 

The Future of Health Informatics..

The Nurse Leader needs to be aware of the need to partner with technology experts in the health care setting in order to anticipate the rapid change that will continue to be a force for varying technology frameworks. The future of technology will continue to develop along the lines of:

• Cloud Computing
• Big Data, analytics, meta-analytics
• Process Modeling and biomedical imaging
• Continue toward mobile device use and patient-centered care.
• Augmented Reality

 

  

Reference
http://www.himss.org/aboutHIMSS/
http://nursing.advanceweb.com/Article/ANA-Revises-Informatics-Scope-Standards.aspx

Week 2 Blog- Human-Technology Interface

Week 2 

Human-Technology Interface

What exactly is the Human/Technology Interface?

The human/technology interface is a topic for exploration in the present and future of healthcare. The Human Computer-Interaction, in particular, studies facets of how people complete design, proceed with implementation, and ultimately evaluate computer systems that are designed to interact with human tasks within workflows (Nelson & Staggers). 

The Impact of Human-Computer Interaction on Nursing Practice...

There has long been a challenge of an aging nursing workforce, according to the American Association of Colleges of Nursing (AACN) the current average age of nurses being 47 years, making it essential to make the human-computer interaction more integrated in order to avoid the loss of human closeness in nursing interactions with the risk of those not as familiar with computerized charting platforms. Nurse Leaders are well-positioned to have a significant impact on the successful integration of technology into nursing practice. Readily having access to the informatics nurse and the understanding the available resources in order to better support nursing practice. 

Explore more about the Human-Technology Interface Here


The Impact of the Human/Technology Interface on  Nursing Care

The experience of patient care in the Intensive Care Unit can be overwhelming for the patient and family. The nurse is positioned to connect the patient and family to a more informed understanding of the care being delivered. Without having a sense of what is being done for the patient, highly specialized interventions can be seen as mere busy interactions that interrupt time than can be spent with the critically ill patient. The human-technology interface allows for a deep connection with the patient and family at the bedside. In the ICU the bedside nurse can access Clinical Decision Support (CDS) to educate about medications with realistic understanding without ever leaving the room. This can build confidence with the family in the competence and informed nature of nursing, care.

The experience I have had with human technology interface focused on using my smartphone to help the spouse of a critically ill patient understand the illness of her husband. I was able to show her pictures and resources that helped her to better comprehend the nature of the sickness and how to better support her spouse. The challenges that accompany care delivery in the modern healthcare setting require cutting edge technology to be able to intertwine with clinician competencies and take on a more meaningful and comprehensive care-delivery model. 

Explore the Human-Technology Interface Here

References

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. St. Louis, MO: Elsevier.

http://www.nvnurses.org/Main-Menu-Category/NNA-Initiatives/Environmental-Health-Committee/Human-Technology-Interface-Computers-Vision-Health.html

 http://www.emersonprocessxperts.com/2012/07/are-human-technology-interactions-solving-or-causing-problems-part-2/

MSNE 605 Joshua R. Smith

Week 1

Nursing has long been plagued by lacking a standardized means of communication up until the North American Nursing Diagnosis (NANDA) was developed and released in 1973 (Rutherford, 2008). The American Nurses Association (ANA) has built on standards through the Committee for Nursing Practice Information Infrastructure (CNPII) that have recognized two minimum data sets which will be explored this week. These include the Nursing Minimum Data Set (NMDS), developed in 1988 and the Nursing Management Minimum Data Set (NMMDS), which was developed in 1989 (Rutherford, 2008). To provide some comparison to this nursing standardization, medicine recognized the need for standardization of medical diagnoses as far back as 1893 and has developed into what is know as the International Classification for Disease (ICD), now in it's 10th iteration (Rutherford, 2008).





Nursing Minimum Data Set (NMDS)

A term referring to a framework for collecting nursing care data with requirements including:

• Patient Demographics
• Nursing Process information  (Assessment- Diagnoses- Interventions- Outcomes)
• Elements of Service (Organization- Admission & Discharge Dates)     

These elements were developed in order to move toward developing a universally concise manner with which to describe the population, nursing interventions, and in order to assess the overall quality of nursing care delivered (Nelson & Staggers, 2014).

You can explore specific NMDS category elements by clicking here



Nursing Management Minimum Data Set (NMMDS)

This term refers to the collection of data associated with 18 variables concerned with supporting nursing administration in decision making. These variables are centered on:

• Nursing Environment
• Nursing Resources
• Financial Resources    (Nelson & Staggers, 2014)

The NMMDS is comprised of 18 elements organized into three categories which include the environment, nursing care, and financial resources. The 18 variables collected provide insight to assist in administrative analysis with which nurse executives can make informed decisions (Westra, et. al., 2010).


 You can explore specific NMMDS category elements by clicking here

Better Understanding a Dataset...



 Conclusion

In the interest of improving patient care through standardization of terminology it stands to reason that the American Nurses Association (ANA) would continue to move in the definitive direction of solidifying NMDS's and NMMDS's. The value of standardizing  nursing language will not only improve the consistency in care delivery, but also increase efficiency and promote the recognition of nursing care to the appropriate position. It is essential to nursing as a profession to move away from informal charting methods which have continued to dominate the profession's documentation methods (Rutherford, 2008).

The development of these standards will support the development of the nursing profession and build on the foundation of nursing practice. This will have implications for education, practice, and research in the future of nursing. There is continued need forth e development of EHR platform use to fully integrate this common terminology into practice.  

References:

Nelson, R., & Staggers, N. (2014). Health informatics: An interprofessional approach. St. Louis, MO: Elsevier.
 

Rutherford, M. A. (2008). Standardized Nursing Language: What Does it Mean for Nursing    Practice? American Nurses Association, 13(1). Retrieved February 1, 2016.

Westra, B., Subramanian, A., Hart, C., Matney, S., Wilson, P., Huff, S., & ... Delaney, C. (2010). Achieving 'meaningful use' of electronic health records through the integration of the Nursing Management Minimum Data Set. Journal Of Nursing Administration, 40(7/8), 336-343 8p. doi:10.1097/NNA.0b013e3181e93994