Atlanta – Soon after The Centers for Medicare and Medicaid Services released its proposed rules for “meaningful use” of electronic health records (EHRs) on December 30, 2009, Siemens asked two prominent chief nursing officers (CNO) how the new guidelines support nurses’ commitment to quality patient care delivery, enhance their care documentation capabilities, and can spur further health IT use and acceptance among nurses.
Quality care delivery has always been a primary focus for nurses. How do the newly proposed Meaningful Use criteria tie into that focus and keep quality top of mind?
Lisa Colombo, Corporate VP and CNO for Massachusetts-based HealthAlliance Hosptial: The criteria provide us with a driver to achieve better quality across the healthcare continuum. Even in their earliest forms, they’re reaffirming for nurses that quality will remain top priority, and specifying for us how healthcare information technology must be increasingly leveraged to help us achieve our highest quality benchmarks. The rules also draw a clear line of sight for nurses between Electronic Health Records as a tool and quality clinical results as an outcome, underscoring our need to embrace technologies that help contribute towards better workflow efficiencies and quality.
Gail Latimer, VP and CNO, Siemens Healthcare: As clinicians, it remains our mission to provide safe, quality care for all patients. It is through the use of EHRs and the tools they provide that we can ensure accessibility to patient information across the care continuum, deliver evidence-based care while capturing key clinical data needed to monitor quality measures and clinical performance. Meaningful use will encourage the adoption and implementation of technology to support clinical practice and thus will advance our ability to monitor our quality of care and expected outcomes.
What is the role of nursing in supporting meaningful use and what are the impacts of the proposed rules on day-to-day clinical practice?
Colombo: Nurses are key stakeholders in this process and many have contributed significant input surrounding the implementation and utilization of EHR-focused technology. While quality-focused care was already a tenant for nurses, I do see the new rules significantly impacting how we practice our care delivery, share information across disciplines, and capture data moving forward on a daily basis. Yes, meaningful use rules propel our hand forward, but nurses are embracing this because they’re focused on improving care.
Latimer: As the most consistent and hands-on care delivery providers, nurses document the majority of patient care and help to drive adoption and consensus across stakeholder groups. It is anticipated that we will see accelerated IT adoption as a result of the defined government incentives and it is likely that organizations will ramp up their implementation efforts around nursing and clinical documentation as a means to achieve the defined measures. Nurses today recognize the benefit of IT in supporting their clinical practice and acknowledge that it is a critical tool.
While many nurses already use EHRs, greater adoption is still needed. What would you recommend to organizations that are still in the early stages of a clinical IT implementation?
Colombo: Prepare for this as a holistic implementation by sharing your EHR vision with your entire staff and communicating the plan and milestones consistently. Consider your current structure and process and how the IT initiative can be incorporated to ensure a clear vision for decision-making. Make any changes early in the process in an effort to minimize rework as the implementation continues. And then, stay committed. It’s an evolving process for us all.
Latimer: Collaboration with key stakeholders from across the organization to define a clear roadmap for implementation will facilitate success. Among nurses, be sure to include how aspects of the initiative will fit within your nursing structure and processes, and encourage nurses to actively participate in the project, fostering empowerment, shared success, and positive outcomes.
With the newly proposed criteria, we see greater emphasis on reporting clinical quality measures electronically. How will this impact nurses in providing day-to-day care delivery?
Colombo: Nurses have been reporting and collecting clinical data for years, but these requirements will push us to implement a system that gives us the ability to effectively capture data more accurately and efficiently. EHRs facilitate the execution of care, integrating evidence within a workflow, providing decision-support tools, and advanced workflow technology to assist providers with clinical decision making. As we all evolve toward a fully electronic health system, it will be through the daily use of technology by frontline clinicians that organizations will be able to address meaningful use and more effectively measure the quality of our care delivery.
Latimer: The new criteria will push organizations toward the use of electronic documentation where, as a by product of care delivery, information is captured, evidence-based guidelines are presented, and alerts and reminders support the nurse in delivering the quality care we all expect. Nurses will increasingly see the electronic health record as tool that is critical to their clinical practice and will become reliant on it as means for ensuring accurate and efficient documentation to support quality reporting initiatives.
How are health systems involving nurses in their discussions surrounding continued Health IT adoption and implementation? How can their expertise be leveraged further?
Colombo: More and more, nurses are being asked to participate in the preliminary planning and implementation of a health system’s EMR system. That’s because nurses can make or break the project through their acceptance or rejection of the plan and willingness to embrace daily usage of the system. They know how to indentify the workflows that are currently in place and which ones should be addressed through the use of an EHR. The inclusion of nursing and clinical care team members in the IT implementation is critical to the overall success of the project.
Latimer: Successful organizations have committed nursing leadership engagement that sees the IT initiative as a strategic priority. Their nurses are involved in multi-disciplinary steering committees and councils that make collective decisions about the use of IT and the implementation. The ability to leverage your nurses’ wealth of knowledge and expertise in this effort will most certainly be of a tremendous benefit.