HealthMarch 01, 2016

Giving frontline nurses a voice in EHR design

Since frontline nurses are chief users of electronic health record (EHR) systems, it only makes sense they’d have a major say in their design and upgrades. Yet in many facilities, EHR optimization is left primarily to the informaticists, with just minor input from nursing. That divide, says Betty L. Blahna, MPM, BSN, RN, is less than ideal.

“While many informatics departments have extremely knowledgeable staff, these departments are still highly dependent on their subject matter experts. Traditionally, these are point-of-care clinicians who act as liaisons in their respective areas of expertise. These liaisons usually include representation from nursing, but they may not act as dedicated resources for the informatics department,” writes Blahna, nursing informatics officer at City of Hope, Duarte, CA, in the December issue of Nursing2015.

“If subject matter experts don’t have autonomy and responsibility within the design process, implementing EHRs can take longer because providers are distanced from the outcomes.”

Shared governance

To improve the situation at her hospital, Blahna proposed a different organizational framework: shared governance. She says shared governance empowers participants—in this case, point-of-care nurses and other clinicians—to voice their input and have it be heard.

“Additionally, and perhaps most important, it fosters a partnership among everyone involved in the care of our patients,” she explains.

Blahna’s vision for shared governance for EHR design at City of Hope resulted in the launch of two new teams within the nursing and patient care services departments. An informatics team reviews and makes recommendations on EHR system design and optimization. An innovation team, meanwhile, reviews and makes recommendations on new technologies to improve workflow.

Each team consists of unit-based council representatives from inpatient, ambulatory and outpatient settings who serve as the voices of their point-of-care colleagues. Information technology, lab and pharmacy representatives are also involved.

Idea to implementation

Under the set-up, team members bring ideas from their units to the team for consideration. Having ideas evaluated by point-of-care staff offers multiple benefits, in Blahna’s view.

“When the analysis of EHR requests comes from the frontline staff, it reinforces the notion that the clinical informatics team is listening to and supporting EHR enhancements for the personnel who actually use these systems,” she writes. “It also lets each request move into production more expediently.”

The team considers the idea’s efficacy and its supporting data, and then it provides a recommendation to the appropriate council within the hospital’s governance structure. If approved, the idea proceeds to IT for implementation.

Taking ownership

Shared governance allows nurses to invest in the EHR system that’s become such an integral part of their workday in recent years.

“Nurses at the bedside understand that they can continue to evolve and take ownership and design of their EHR and have input into the various technologies they wish to have at their disposal,” Blahna writes.

An idea currently undergoing team consideration is early-warning technology that provides real-time patient data to nurses. The predictive technology has the potential to improve patient outcomes through immediate interventions as well as improve reimbursement.

The idea, a result of shared governance, has the potential to produce a significant return on its investment and illustrates just how important nurse input is to truly optimizing EHR.

“We should take an interdisciplinary focus and not just see the optimization of an EHR system as one department’s job,” Blahna concludes. “Nurses can help drive and design what they need from an EHR system that supports top quality patient care. If anyone is going to make this paradigm shift happen, it will be frontline nurses and their counterparts in clinical informatics!” 

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