Posts Tagged ‘health information technology’

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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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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 ?

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Hospital Execs Assert They’re ‘Scared to Death’ by Reform Measures

April 26, 2010

By Shawn Kennedy, AJN interim editor-in-chief

On Friday, at the Association of Health Care Journalists (AHCJ) meeting in Chicago, I attended a session in which a panel of hospital executives discussed how their facilities would be affected by health care reform. They weren’t really sure of anything except that they’d probably lose money.

The panel included Richard Gamelli of Stritch School of Medicine and the Loyola University Health System, Jeffrey Hillebrand from NorthShore University HealthSystem, and Jim Skogsbergh from Advocate Health Care.

Skogsbergh was the most dire: “I’m scared to death about health care reform and I’m not sure how it will all shake out. The only thing I do expect is to that I’m going to get paid a lot less.” An attendee asked if hospitals would do better now that patients they cared for as charity patients would have health insurance under the new law. Gamelli answered that that depended on the insurance. Currently, he said, his facility is only reimbursed for 90% of costs incurred by Medicaid patients and 50% of those incurred by Medicare patients.

Where’s the innovation? The session was disappointing in that it was mostly about how these megahospital systems would deal with the financial implications. It would have been interesting to have a perspective from a small community hospital. And other than a program mentioned by Hillebrand to try to reduce hospital readmissions among patients with chronic disease, there seemed to be little focus on finding new approaches to cutting costs through improving quality.

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