Archive for the ‘health information technology (HIT)’ Category

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Health information Technology, EHRs, Meaningful Use, and Nursing

August 15, 2012

By Maureen Shawn Kennedy, MA, RN, AJN editor-in-chief

If you’re like most nurses working in a health care organization, you’ve been involved in a migration to electronic health records, computerized physician order entry (CPOE), or bar code medication administration.

If you’re lucky, nursing input was considered during the planning stages of all this health information technology (HIT). We’ve heard from many nurses (and have had a few submissions from nurses about their experiences—see for example the Reflections essay “Paper Chart Nurse”) who have had “issues” with the systems or who wonder, why the big push?

In the August issue of AJN, which is available online and on the iPad (download the app here), Susan McBride and colleagues John Delaney and Mari Tietze debut their three-part series on HIT. The first article, “Health Information Technology and Nursing,” examines the federal policies behind efforts to expand the use of this technology, the importance of meaningful use, and the implications for nurses. Subsequent articles upcoming in the fall will take a closer look at the use of HIT to improve patient safety and quality of care, and the important role nurses are playing—and could play—in this system-wide initiative.

It’s crucial for nurses to understand HIT. As the authors note,

“If HIT systems are going to truly improve care, nurses need a voice in their planning and development to ensure patient safety and system usability. The success of this technology depends on nurses informing the industry—at all levels, from influencing federal policy to providing feedback to their department and facility leaders—about what works best for the patient and the clinician. If wisely implemented, HIT may eventually free up more time for nurses to spend at the bedside . . . ”

We’d love to hear your experiences: Were nurses consulted and included in planning the implementation of HIT at your facility? Was there a thoughtful plan to “roll out” adoption? Do you see computerized health records as a help or hindrance? What would you change? Let us know how it is in your practice area.

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Posted in health information technology (HIT), nursing perspective, Shawn Kennedy, AJN editor-in-chief | Tagged , , , , , , | 1 Comment »

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AJN’s August Issue: A Metaphorical Prison, a Found Manuscript, a Nurse Carries the Torch, More

July 27, 2012

AJN’s August issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Nurses play a crucial role in inpatient programs for anorexia in adolescents, but how do the patients view them? Our Original Research article, “An Inpatient Program for Adolescents with Anorexia Experienced as a Metaphorical Prison,” describes the experience of adolescents in an Australian inpatient behavioral program and how both nurses’ and patients’ perception of the program as a metaphoric prison negatively affected the development of therapeutic relationships between them. This CE article is open access and can earn you 2.5 CE credits.

Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. But what does this really mean for nurses? “Health Information Technology and Nursing,”  the first article in a series of three on HIT and nursing, will examine the federal policies behind efforts to expand the use of this technology. This CE article is open access and can earn you 2.1 CE credits.

Accord­ing to the U.S. Department of Labor’s Bureau of Labor Statistics, more than 348,000 unlicensed as­sistive personnel were employed in the hospital set­ting in 2011. Our Cultivating Quality article, “Continuing Education for Patient Care Technicians: A Unit-Based, RN-Led Initiative,” explores how one teaching hospital in New York City implemented a hospital-wide upgrade of nursing attendants to patient care technicians.  

Tonight is the opening ceremony of the London Olympics, and one nurse helped get the torch to its destination. Debra A. Toney, the immediate past president of the National Black Nurses Association, was selected to carry the Olympic Flame with 22 other inspiring Americans by Coca-Cola, one of the relay’s sponsors, “in recognition of her personal and professional dedication to promoting healthy lifestyles and for empowering civic engagement in communities.” Read more in this month’s Profiles article, “Nurse Lights the Way at London Olympics.”

And if you’re a history buff, check out “My Grandfather’s Unpublished Manuscript,” by Greta Krapohl. After her grandfather’s death, Greta discovered a manuscript that he had written in the late 1960s, but was never published—until now. This manuscript provides the voice of a male nurse at a time when men in nursing were virtually silent.

There is plenty more in this issue, so stop by and have a look. Feel free to tell us what you think on Facebook or our blog.

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Posted in children's health, continuing education, health information technology (HIT), male nurses | Tagged , , , , , | 2 Comments »

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That Acute Attention to Detail, Bordering on Wariness…

November 21, 2011

via Wikimedia Commons

By Kinsey Morgan, RN. Kinsey is a new nurse who lives in Texas and currently works in the ICU in which she formerly spent three years as a CNA. Her last (and first) post at this blog can be found here.

It seems that nursing schools across the world subscribe to certain mantras regarding the correct way to do things. Different schools teach the same things with utmost urgency. Hand washing is one of the never-ending lessons that comes to mind. How many times do nursing students wash their hands while demonstrating the correct way to perform a procedure? I vividly remember actually having to be evaluated on the skill of hand washing itself.

Another of the regularly emphasized points of nursing school is double-checking. One of my first clinical courses required students to triple-check patient identification before giving medications. We were to look at the medication administration record, the patient’s wristband, and then actually have the patient state their name.

As a new nurse learning several new computer systems for charting, etc., I’ve noticed that the old attention to detail, ground into my soul during my school days, now seems easy to overlook, since computers do so much of the work. Of course, computer charting and electronic MARs* have simplified tasks and made time management much less daunting. But sometimes I worry about the hidden cost of such improvements.

I intend, vow, resolve to make an effort to remain aware of how easily errors can happen when we don’t double- and triple-check things. I want to always retain that astute attention to detail, bordering on wariness, so that I can practice as safely as possible, even with the advent of electronic methods.

*MARS = medication administration records

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Posted in health information technology (HIT), nursing students, patient safety | Tagged , , , , , | 2 Comments »

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AJN’s Top 10 Blog Posts for the Last Quarter

August 2, 2011

At this blog we’re not always devoted practitioners of the art of the list. Used too often and too cynically (some of the more mysterious nursing blogs consist entirely of lists of articles and excerpts from other blogs), lists can be just another form of journalistic cannibalism.

But it sometimes occurs to me, as I publish a new post that takes its place at the top of the home page and pushes all those below down another notch (until, after a few such nudges, they gradually fall off the page, entering the purgatory of the blog archives), that this isn’t entirely fair.

While blogs allow for quick reaction to a news story, a public health emergency or controversy, a new bit of published research, they are also places for writing that isn’t so narrowly tied to a specific date and event. Many thoughtful posts by excellent writers have been published here in the past couple of years. With this in mind, here’s a list of the 10 most read blog posts for the past 90 days. It doesn’t mean that these are necessarily the very best posts we published in that time, or that they were even published in the last 90 days . . . but it’s one way of measuring relevance.—Jacob Molyneux, senior editor/blog editor 

1. Dispatches from the Alabama Tornado Zone
This one is actually a page with links to a series of powerful and thought-provoking posts by Susan Hassmiller, the Robert Wood Johnson Foundation Senior Adviser for Nursing, who volunteered with the Red Cross after the devastating Alabama tornadoes in late April of this year.

2. Notes of a Student Nurse: A Dose of Reality
This honest account of a first semester of nursing school is by Jennifer-Clare Williams, a student at Cox College of Nursing and Health Sciences in Springfield, Missouri. We hope to have more of her posts in the future.

3. Bullying Wars: Theresa Brown vs. ‘the entire physician profession’
AJN‘s editor-in-chief Shawn Kennedy comes to the defense of nurse and author Theresa Brown, who dared to write about physicians who bully nurses.

4. New Nurses Face Reality Shock in Hospital Settings – So What Else is New?
We ran this one two years ago, but it’s as relevant as ever for nurses who’ve just graduated from school and are starting out in a new job—and for the nurses who work with them.

5. Don’t Cling to Tradition: A Nursing Student’s Call for Realism, Respect
By Medora McGinnis, a student at Bon Secours Memorial College of Nursing in Richmond, Virginia, this post got a lot of attention with its assertion that “nontraditional” nursing students may be the new normal.

6. What Is Meaningful Use? One Savvy Nurse’s Take
By Jared Sinclair, an ICU nurse in Nashville who has a blog about health care and technology, this post demystifies for nurses some of the issues associated with electronic health records.

7. Workplace Violence Against Nurses — Neither Inevitable Nor Acceptable
A look at some helpful articles that have addressed aspects of this perennially troubling issue. Read the rest of this entry ?

Posted in health information technology (HIT), nursing perspective, nursing students, public health nursing, social media | Tagged , , , | 1 Comment »

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Today’s Notes from the Nursosphere

December 7, 2010
Image of Japanese Attack - Pearl Harbor, Hawai...

Image via Wikipedia

As noted today by Joni Watson at Nursetopia, it’s Pearl Harbor Day, and nurses were (surprise) key players in that day’s awful events. Here’s how the post begins:

My heart was racing, the telephone was ringing, the chief nurse, Gertrude Arnest, was saying, “Girls, get into your uniforms at once, This is the real thing!”

Speaking of safety, “Top 10 Health Technology Hazards for 2011″ (pdf), from the ECRI Institute, gives us a list of hospital patient safety risks that, according to the authors, ”reflects our judgment about which risks should receive priority now, a judgment that is based on our review of recent recalls and other actions . . . , our analysis of information found in the literature and in the medical device reporting databases of ECRI Institute and other organizations, and our experience in investigating and consulting on device-related incidents.” These include “radiation overdose and other dose errors during radiation therapy,” “alarm hazards,” and eight others.

And now to electronic charting vs. doing it the old-fashioned way: we have a comment thread going on at AJN‘s Facebook page about whether or not EHRs save nurses time or not. Go there to comment, or leave a comment here.

Also noted: Stephen Ferrara at A Nurse Practitioner’s View wonders whether the preceptorship model is still adequate for training NPs. Or is it time for a residency model instead?

I’m not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people’s homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to handle scenarios encountered in Federally Qualified Health Centers (FQHCs). The residency lasts 1 year and appears to be a wonderfully structured program and setting.

Just a few items of interest. As always, we welcome your comments.—JM, senior editor/blog editor 

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Posted in combat nursing, electronic medical records, health information technology (HIT), nurse practitioners, nursing perspective | Tagged , , , , , , , | Leave a Comment »

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Finding a Job as a Nurse In a Digital Age — and Keeping It

October 26, 2010

Will at Drawing on Experience manages to post a new comic almost every day. A regular theme is the progress of his career—having finished his accelerated nursing program, he’s now looking for a job. To the left is a thumbnail of a recent drawing he did about one of the more annoying aspects of the process (click the image to visit his blog and see a larger version).

A nurse returns to work at age 68 and finds her biggest challenge is computers.Of course, this isn’t the first downturn we’ve had in the U.S. economy; as AJN clinical editor Christine Moffa wrote back in May, newly minted nurses have struggled to find work before. Once you actually do get a job as a nurse, there’s the small matter of doing it for the first time. Or for the second or third time—but as if it’s the first time, at least in some respects. The October Reflections essay, “Paper Chart Nurse,” gives another perspective on the ways computers have changed the lives of nurses. It’s by an oncology nurse who returned to practice two years ago, at age 66. Her struggles with adapting to using an electronic medical record system were at times profoundly discouraging; she just wasn’t as proficient as the younger nurses at computer use, despite all her skills and experience. Have a look and please, tell us what you think.—JM, senior editor

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Posted in electronic medical records, health information technology (HIT), nursing perspective, nursing students, professional identity | Tagged , , , | 5 Comments »

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What Is Meaningful Use? One Savvy Nurse’s Take

October 14, 2010

By Jared Sinclair, an ICU nurse in Nashville who has a blog about health care and technology

If you follow health care news regularly, and yet you still feel unsure what “meaningful use” means and how it will affect your job as a nurse, then you have something in common with even the most knowledgeable people on the subject. Despite the fact that discussion of meaningful use among health care IT and informatics folks has reached a fever pitch since the HITECH (Health Information Technology for Economic and Clinical Health) Act was passed last February, in many ways we are no closer to understanding how it will change health care than when discussion first began.

What do we know for sure? The HITECH Act promises incentive payments to providers and hospitals that use electronic health records in ways that meet a minimum set of requirements called “meaningful use.” That sounds simple enough; however, there isn’t just one set of requirements. The criteria for meaningful use will come in three stages, and the requirements for stages two and three have yet to be determined. This is why your local hospital’s nurse informaticists may be less than enthusiastic about the next five years of their jobs. They bear the responsibility for preparing their hospitals for huge changes—without the luxury of knowing what those changes will be.

We can get a glimpse of stages two and three by taking a closer look at the requirements for stage one. There are dozens of requirements, ranging from the use of computerized physician order entry (CPOE) to providing an electronic copy of a health record to a patient upon their request. To qualify for the incentive payments, hospitals must meet all of the requirements, but only to a specified degree. In the case of CPOE, for example, the Final Rule (see PDF link here) states:

More than 30% of unique patients with at least one medication in their medication list [must] have at least one medication order entered using CPOE.

In plain English, that means that a physician must order at least one drug for one third of his patients directly via a computer, and not with a handwritten order entered into a computer by a clerk.

The really worrisome issue. All of the meaningful use criteria merit discussion, but CPOE in particular stands out above the rest.  According to a comment made in the Final Rule (see PDF link above), CMS has received more concerned responses about CPOE than any of the other criteria. Stage one only requires a fraction of orders to be entered via CPOE, but the general opinion among industry leaders is that either stage two or three will require as much as 100% CPOE adoption. Consider what it would mean for a hospital to permanently do away with paper charts:

1. How would the transition be accomplished: all at once, or by one group of physicians at a time?

2. If a hospital physician can write an order via his office computer, how will the bedside nurse be alerted that an order has been written?

3. What if two physicians, one of whom has not been transitioned to CPOE, unknowingly order the same stat drug, one on paper and the other by the computer? Will the bedside nurse be able to manage keeping track of orders on two systems?

There have been some eyebrow-raising studies on the impact of CPOE on patient outcomes in the past several years, with stunning contrasts between their conclusions. Read the rest of this entry ?

Posted in electronic medical records, health information technology (HIT) | Tagged , , , , | 2 Comments »

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Supporting Nurse Practitioners as ‘Priority Primary Care Practitioners’

July 29, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing 

It’s important for nurses to understand the Medicare and Medicaid incentives to implement electronic health records (EMRs) and to move to their “meaningful use,” as well as the purpose of the Regional Extension Centers created to support nurse practitioners and other “priority primary care providers” in the implementation process.

Dr. Mari Tietze, John Delaney, and I are fortunate to be involved in two of the Regional Extension Centers in Texas. We believe that nursing professionals have many contributions to make in the evolving electronic highway in the U.S. We will blog later about our roles as nursing informaticists in the Regional Extension Center program.

What are ‘Regional Extension Centers’? Under the Office of the National Coordinator (ONC) Health Information Technology Initiative to support getting providers to meaningful use on electronic health records, the ONC has established Regional Extension Centers. There are 60 Regional Extension Centers that will furnish assistance to providers in specific geographic services areas covering virtually all of the U.S. A total of $643 million is devoted to these centers.

The purpose of the Regional Extension Centers is to support priority primary care practitioners in priority settings to implement and use EMRs according to the meaningful use requirements outlined in our previous post (below is a screenshot illustrating one example of how an EMR might align with meaningful use requirements; click image to enlarge). The goal of the program is to provide federally subsidized outreach and support services to over 100,000 priority primary care practitioners within the next two years. 

© 2010 e-MDs, Inc. All rights reserved. Product and company names are trademarks or trade names of their respective corporations.

Regional Extension Centers will provide the following support services to providers:

  • EHR implementation
  • education and training
  • project management
  • incentives
  • meaningful use

NPs as “priority primary care practitioners.” A priority primary care practitioner is defined by the ONC as a primary care provider  that is any doctor of medicine or osteopathy, any nurse practitioner, nurse midwife, or physician assistant with prescriptive privileges in the locality where she or he practices, who is actively practicing in one of the following specialties: family, internal, pediatric, or obstetrics and gynecology.

Priority settings. Many NPs work within priority settings identified by the ONC, including small group practices of 10 or fewer, public and critical access hospitals, federally qualified health care clinics, rural healthcare clinics, and other settings serving uninsured, underinsured, and medically underserved populations.

NPs are eligible for support services of the Regional Extension Centers. For more information on what services might be available to you, contact the Regional Extension Center within your geographic region. A table and map covering the 60 centers is available here.

Incentives program for EMR implementation. February 17, 2009, President Obama signed the American Recovery and Reinvestment Act (ARRA) and along with that Act $33 billion dedicated to Medicare and Medicaid incentives for providers and hospitals who adopt, implement, or upgrade an EMR system and meaningfully use that system. As we blogged previously, meaningful use of EMRs has many parameters that providers must meet—but with that comes financial incentives that eligible providers can receive.

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For Those Interested In Learning More, See Below….

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Posted in electronic medical records, health information technology (HIT), nurse practitioners | Tagged , , , , , , , | 1 Comment »

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‘Meaningful Use’: What’s It All About, And Why Should Nurses Care?

July 26, 2010

By Susan McBride, PhD, RN, professor at Texas Tech University Health Science Center School of Nursing. McBride and fellow nurse informaticists Mari Tietze and John Delaney will be blogging here on the intersection of nursing and informatics in the coming days. 

By DeclanTM, via Flickr.

Everyone knows by now that the Obama administration has made electronic health records (EHRs) a high priority and is providing financial incentives to health care providers (and yes, nurses are included in that group) to adopt them. But not everyone knows it’s not just about converting records from paper to digital—its much more than that.

On July 13, the Office of the National Coordinator (ONC) for Health Information Technology (HIT) released the final rules establishing definitions for the “meaningful use” of EHRs. The final rule is 864 pages and contains critical information for nurses to understand about how electronic records will change our lives. 

(No one expects every nurse to read the entire document. That’s why we’re going to be blogging about some important aspects of the topic. In the meantime, click here for a good overview of meaningful use and electronic medical records, as well as links to more exhaustive information. And for a short, useful table breaking down the rule by health outcomes policy priorities such as ”improving care coordination,” have a look at this PDF: Stage 1. Meaningful Use Objectives and Associated Measures Sorted by Core and Menu Set.)

Ongoing concerns. The idea behind these rules is to establish EHRs within a National Health Information Network that will allow us to exchange health care information regardless of where we are in the nation. There are many concerns about privacy and security related to this network, and these concerns are likely to be the most difficult component to address in establishing it. But there are definite clinical advantages. Read the rest of this entry ?

Posted in health information technology (HIT), patient safety | Tagged , , , , , , | 5 Comments »

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Thousands of Critical Care Nurses, a Helicopter, and More! AACN’s National Teaching Institute & Critical Care Exposition

May 19, 2010

By Shawn Kennedy, AJN interim editor-in-chief

 

NTI exhibit hall crowds.

I’m writing to you this morning from Washington, DC, where I’m attending the American Association of Critical-Care Nurses (AACN) 2010 National Teaching Institute & Critical Care Exposition (known simply as “the NTI”). I’m probably miscounting, but I think this might be my 15th visit to the NTI. I first attended when I was an ED staff nurse at Bellevue Hospital in New York City. I marveled at the hundreds of nurses who attended from all across the country. It was energizing and inspiring and overwhelming, and I learned a lot.

Now, it’s not just hundreds but thousands of nurses who attend the NTI, and they come not only from states across this country but also from around the globe. It’s still energizing, and there’s no doubt I can still learn a lot. Throngs of nurses have crowded the sessions, so much so that it’s hard to remember there’s a nursing shortage; but critical care nurses are still much in demand, and representatives from many hospitals—as well as from all branches of the military—are manning recruitment booths. The exhibit hall is still overwhelming: this year there are more than 500 exhibitors and the exhibits include a Life Flight helicopter, a couple of full-size buses equipped as classrooms or EDs, and a fully-equipped military emergency treatment tent.

I’ve attended some very good sessions and a couple of clunkers—a better ratio than I’ve found at most conferences. Now I’m off to interview the incoming and outgoing presidents of the AACN—look for that post, with a link to a podcast of the interview, in the next few days. I’ve got to get inside that helicopter . . .

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Posted in health information technology (HIT), international nursing, nursing innovations, nursing shortage, patient safety, Shawn Kennedy, AJN editor-in-chief | Tagged , , , | 1 Comment »

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