Seeking to Learn More

In last week’s blog, I mentioned my struggle in watching an unsuccessful deployment of EHRs in a clinical setting. In that deployment, I looked forward to the implementation of what was supposed to be an improvement in our healthcare delivery. Actually, though, the deployment created unexpected workflow problems and, in some cases, exacerbated workflow issues that had already existed in our paper-based record system. I was dissatisfied and surprised by the failure of the EHR system to integrate into our work processes. The idea that technology could enhance work processes, for us was unrealized.  I was filled with many questions; more questions than I had answers to. I wondered what piece of this puzzle had I missed; why the failure? I faced two choices, to either: a) resist progress; refuse to change and give up on this idea that technology could improve healthcare delivery or b) seek to understand the new situation I was confronting and figure out the puzzle.

At the end of the day, I decided it was time to grow. I had always known that nursing was a lifelong learning profession, so I looked around and found a nursing informatics program within an hour’s commute. I returned to graduate school and began a post graduate program to learn how this technology could support healthcare delivery and to understand why what I had witnessed was such an unexpected failure. My commitment to continuous improvements was driving me to learn how technology-enabled health records would support my advocacy of process improvement.  Over three years of study, I learned about information and computer science theories, system design, system life cycles development model, workflow analysis techniques, usability concepts, user interface design strategies, database design and structure, and much more.  What I found was endless possibilities to improve healthcare delivery.  More importantly, I found that going forward with any activity needed to be deliberate and measured to achieve a meaningful outcome. 

The next step for me was to reinvent my personal approach to healthcare delivery.  So, I began to challenge myself by asking questions and seeking the answers.  How to use technology to enable safe and resilient healthcare delivery systems? I asked questions about how to identify, manage and address unintended consequences of technology deployment. These questions, I hoped, would help to guide my informatics journey, which was now underway.

Lesson Learned:  There is much to learn and many uncharted issues to explore. I believe that, despite my best efforts, some of my choices regarding new situations might not be the best and that other choices could be better.  It would be helpful for me to document my journey so that history will not repeat itself.

How I fell into Informatics Nursing

After working in nursing administrative roles for 25 years, jobs such as charge nurse, nursing supervisor, nurse manager, and director, I was captivated by the idea that the care process could always be re-evaluated and improved upon and that better care delivery and outcomes could be achieved.  I was never satisfied with the status quo and continuously looked for ways to improve clinical outcomes, improve staff efficiency and satisfaction, and engage patients and caregivers as self-care agents. The challenge to me was how to make systems easier to learn so as to increase the probability of adoption.  I was in search of techniques there were evidence based – techniques that yielded lower complication rates, raised patient satisfaction, improved staff attrition rates, and increased staff satisfaction. To me, the opportunities to improve were endless; yet, there were so many stakeholders to engage and so many issues to address.

At the same time I was watching my nonprofessional life improve, with access to mobile devices, smart TVs, on line banking, and best of all on line shopping.  So why was the healthcare delivery system so slow to embrace technology?  I wondered how technology could enhance care delivery processes, the same way it had my everyday life.  I was struck by this question and, although I did not know the answer, I did know there were IT professionals telling me that EHRs would improve healthcare delivery.  EHR software sales staff touted that the EHR would improve health care record keeping and support provider decision-making.   So, at first, I welcomed the computers being placed on the nursing units. As the computers were deployed by our technology staff, I came to view the computers as large heat generating devices that consumed space, which was once available for multiple charting functions and now supported only one.  I watched in horror as lines to access the computer formed. I observed and concluded that simply adding computers to the unit was not going to improve things.  In fact this approach actually created workflow problems and, in some cases, exacerbated workflow issues that had already existed in our paper-based record system.

Lesson Learned:  There are number of factors to be considered when deploying EHRs and some are not as obvious as others.

Nursing informatics sharing the journey

Nursing informatics is nursing science and practice integrating nursing information and knowledge, with computer science, information management and technologies to promote the health of people, families, communities and populations. More and more today, an informatics nurse specialist serves as a clinical informatics team member supporting enabled health information systems to function safely. We know that patient safety is not the happenstance of good intentions, but must be engineered to support the outcome we desire. Adding technology to the complex clinical environment may enhance and improve our systems or challenge and disrupt those systems if electronic health records (EHRs) are implemented without thought. We must remain vigilant to the safety and safe use of  EHRs.

In this blog, I will share my experiences and lessons learned as an informatics nurse specialist.  What is an informatics nurse specialist?  According to the ANA, an informatics nurse specialist (INS) is an RN who has been "formally prepared at the graduate level in informatics or a related field", (Parker, 2012). Just to be clear, my point of view is that of an INS and I acknowledge there are many points of view.