Heath Care Technology and Nursing Leadership

            The look of healthcare has changed since the introduction of Health Care Reform and the Affordable Care Act which afforded the opportunity for many American to have health insurance coverage.  There was also a large focus on primary and preventative care, focusing on population health.  Population health refers to the many healthcare entities working together to improve health outcomes in the communities in which they live (Academy Health 2013). In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act was introduced as a means to support and facilitated the adoption of EHR. With this advance of the Electronic Health Record, information can now be collected and that data can be stored. These vast amounts and types of data collected is so large and thus unable to be analyzed using traditional methods. Data mining then becomes increasingly important as a way to look at these large volume of data and discover patterns and trends that will allow for improved decision making in the world of health care (Koh & Tan, 2011). This collected data is now capable of effecting the way that care is delivered and performed. Benefits of the EHR include (Health IT):

·         Improving patient outcomes

·         Improving care coordination

·         Increase in practice efficiencies and cost savings

·         Improving patient participation in health care prevention

Nurse leaders must embrace the technology and facilitate and encourage its use with all clinical staff members.  Nursing Informatics is a powerful field and one that must continue advanced the profession.  This role combines nursing science with information management to realize and analyze data that will effect nursing practice (HIMSS, 2011).  Nurses can be key drivers of incorporating technology with patient care.  Positioning nurses in key positions such as nurse informatics, allows for a body of knowledge that incorporates both nursing practice as well as technology.  This leadership position will be critical as we continue to advance in the world of IT, as well as strive for population health management.  Nursing leaders across all domains will need to support and advocate for such positions in organizations, and engage staff members at all levels.

References

HIMSS Position Statement on Transforming Nursing Practice through Technology &
     Informatics. (2011). Critical Care Nursing Quarterly, 34(4), 367-376. 

Koh, H. C., & Tan, G. (2011). Data mining applications in healthcare. Journal of 
Healthcare Information Management, 19(2), 64-72.

Retrieved from:www.academyhealth.org/files/AH2013pophealth.pdf. August 11, 2015

Retrieved from: http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs  August 11, 2015

Workflow: Helping to Improve the Process

          In healthcare today, hospitals are being asked to do more with less.  Workflow is the execution and automation of a process where tasks and information are passed from one person to another for action, according to a set of rules (Emanuele & Koetter, 2007).  Business process management (BPM) involves delivering the right work, to the right person, at the right time.  In healthcare, using an efficient and successful workflow will result in favorable patient outcomes (Emanuele & Koetter, 2007).  The healthcare industry is a challenging environment in which to introduce BPM.  This slow adoption is due mostly in part to the technology constraints noted in the healthcare environment.  The healthcare industry is just now beginning to be able to capture all of the necessary data needed to improve workflow processes.  The advent of the electronic health record has made this opportunity to collect and analyze the necessary data a reality.

            One of the most critical challenges in the hospitals today is the management of the patient admission and discharge process in the acute care setting (BioMed Central, 2012).  Institutions not able to effectively manage this process face increased staff time in planning and assigning patients to beds and increased costs through alternative placement of patients when beds are not ready and available when needed. Applying technology at Highland hospital has addressed many of these workflow issues, but one continues to torment the bedside nurse and this involves assigning the pending discharge beds to incoming patients prior to the actual patient being physically discharged from the room.  This practice causes confusion and chaos for each nurse involved in the admitting and discharging of patients.  Once an admission is pended to a room, the charge nurse will then assign that patient to a particular nurse.  The responsibility of the nurse is to then review the patient’s history in the EHR, allowing the nurse to be understand the goals of care for that assigned patient.  The problems arise when the admitting department changes plans.  Often what will occur is that there will be a decision to place a different patient in that bed, adding additional work for the admitting nurse in the form of having to review a different patient’s record.  Waste also occurred in the form of time and effort because the originally assigned patient’s chart was reviewed prior by the same nurse. This change is done the admitting staff and causes time wasted and extra work for staff on the unit when new rooms must be set up for patient arrivals.

            A key challenge in bed management is to make sure that the process of assigning beds is done in a way that makes sense and is efficient (Interfaces, 2013)  There must be an overall understanding of the process from both sides of this equation; the admitting department is managing patient flow and time to bed metric.  The nursing units are managing nurse workflows and patient satisfaction metric.  Each must be able to look at the big picture in order to decide upon a workflow that will be able to meet the goals of all concerned.  Care must also be taken understand the workflow processes done at the unit level.  When this is done, there is a better understanding of what the impact is for the units at the bedside in terms of managing the admission data and chart review. Communication is key, and all stakeholders must be prepared to understand and provide the necessary feedback when necessary.

                                                                               

References

Workflow Opportunities and Challenges in Healthcare. Retrieved August 4, 2015 from: http://www.researchgate.net/profile/Laura_Koetter/publication/252065707_Workflow_Opportunities_and_Challenges_in_Healthcare/links/552290170cf2f9c13052e464.pdf  

Standardizing Admission and Discharge Processes to Improve Patient Flow: A Cross Sectional Study. Retrieved August 4, 2015 from: http://www.biomedcentral.com/1472-6963/12/180/

Retrieved August 4, 2015 from: http://pubsonline.informs.org/doi/abs/10.1287/inte.2013.0701

Embracing Technology: The Role of the Nurse Leader

  

 In the current world of health care reform, nursing leadership at all levels must be ready to embrace and encourage health information technology as a means of improving the quality of nursing practice.   Nursing informatics leaders are innovative and are considered to be both educators and practitioners of nursing care.  They understand nursing workflow and assist in the development, integration and communication of technology that will assist and support nurses at the bedside.    Nursing leaders must embrace HIT, communicate, support and challenge the visions that are created so as to optimize the development of new heath care delivery models (Daly, Speedy, & Jackson, 2015). 

            It is crucial that nursing leaders at all levels partner with and support HIT.  Leaders in nursing informatics can facilitate and help to educate other levels of nursing leadership to achieve competency and true understanding of the technology available.  Included in this understanding must be the realization of the data available and how nurse leaders at all levels can transform and innovate the findings into improved clinical practice and outcomes (Daly, Speedy, & Jackson). 

References

Daly, J., Speedy, S., & Jackson, D. (2015). Leadership and nursing: Contemporary 
     perspectives (2nd ed.). Chatswood, NSW: Elsevier Australia. 

Human Technology Interface: Where human and computer communications meet

             Human technology interface is the communication and connection between the computer and the human end-user.  This technology is essential in healthcare and in nursing practice.  The quality and safety opportunities that are generated through the use of technology are necessary as we strive to succeed in the world of healthcare reform and in the improvement of population health.

         
             Examples of Human technology interface are seen in many care settings.  The EHR is certainly a classic and important example of such an interface, and one that provides patient’ access to their records.  This access will improve communication between patients and providers, along with assisting in the decisions surrounding appropriate care management.  The current goal of such technology is to improve the quality of patient care, decrease health care costs, and focus on the quality and compliance of population health.

            When it comes to patient engagement and the promotion of health,  telemedicine provides the technology to improve such a relationship between provider and patient (Gephart & Effken, 2013).  While there is not much family education needed for this technology, the improved care behaviors and trusting relationship between patient and providers with the sharing of information, improves the patient experience and improves engagement.  This patient monitoring system can be used in the patients with chronic conditions such as CHF, and that require continued communication and reinforcements from providers and members of the healthcare team.  With the new technology, alerts can be deployed and instructions given to patients.  This technology can help in reducing the numbers of readmissions to the acute care hospital settings, decrease costs, and improve patient communication and engagement.

 Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Impact-of-Emerging-Technology.html July 21, 2015

Retrieved from: http://www.nursezone.com/nursing-news-events/devices-and-technology/Top-Technology-Trends-in-Patient-Safety_33668.aspx  July 21, 2015

Gephart, S. & Effken, J. (2013). Using Health Information Technology to Engage Patients in their Care. Online Journal of Nursing Informatics (OJNI), 17 (3), Available at http://ojni.org/issues/?p=2848

            The arrival of the EHR has made the use of a common nursing language a requirement.  Having a standardized nursing language will allow for improved communication not only between nurses, but other health team providers (Rutherford, 2008).  With the now mandated use of the EHR in many countries, this seems a perfect time to integrate this language into the EHR.  By standardizing nursing technologies, not only would communication improve, but the vital components of nursing care would be known and recognized.  These include diagnoses, interventions, and outcomes (Tastan et al., 2014).  The use of a consistent language will improve patient outcomes, enrich data collection and allow for the stricter adherence to nursing standards of care.  This creation has also been used in nursing education to develop and evaluate nursing competencies (Rutherford, 2008).

            The use of the Nursing Intervention Classification (NIC) and the Nursing Outcomes Classification (NOC) are consistent arrangement and grouping of patient interventions and outcomes, and examples of this standardized nursing language (Moorhead, Johnson, Maas, Swanson, 2013).    The NIC and NOC were developed as companion languages.  Recognized by the American Nurses Association (ANA), the NIC consists of 554 interventions and the NOC, 490 outcomes. Both of these classification systems are recognized by many other countries and translation to the individual languages continues.

References

Moorhead, S., Johnson, M., & Maas, M. (2013). Nursing outcomes 
     classification (NOC) (5th ed.) (E. Swanson, Ed.). St. Louis, MO:
     Elsevier. 

Rutherford, M. A. (2008). Standardized nursing language: What does it mean for
     nursing practice? The Online Journal of Issues in Nursing, 13(1).
     http://dx.doi.org/10.3912/OJIN.Vol13No01PPT05 

Tastan, S., Finch, G. C.F., Lopez, G. M., Stifter, J., McKinney, D., Fahey, L.,
     . . . Wilkie, D. J. (2014). Evidence for the existing american nurses
     association-recognized standardized nursing terminologies: A systematic
     review. International Journal of Nursing Studies, 51, 1160-1170.
     http://dx.doi.org/10.1016/j.ijnurstu.2013.12.004