Healthcare Technology and Nursing Leadership

Healthcare Technology and Nursing Leadership

"The United States has the opportunity to transform its healthcare system, and nurses can and should play a fundamental role in this transformation."

The goal of health care is to provide higher quality, cost-eeffective care using electronic information exchange among healthcare providers and patients. Data management supports informed decision-making. The goal of technology is to have the right information always available at the right time. Achievement of these goals requires facilitating electronic exchange of health information while preserving privacy and security, increasing interoperable exchange of information, and promoting nationwide adoption of EHRs and personal health records. 

 Advantages to Using Technology in Healthcare:

1. Delivering higher quality healthcare to patients

2. Reduction of medical errors

3. Quick assessment/Monitor patient status

4. Communication between providers for consults

5. Improved information availability

6. Quick access to patient information (necessary in emergency situations)

7. Support provider decision making

Nurse leaders have a large impact and critical contribution in facilitating successful integration and maximization of technology to improve patient safety. In successful integration, the nurse leader needs to create a shared vision for the priority of health information technology use, facilitate open communication between nurses and IT departments, provided advocacy for clinical recommendations, and uses systematic problem solving skills for integrating technology with patient care.

A leader can enhance creativity by building an environment of trust and interpersonal relationships, along with promoting a willingness to listen and spirit of cooperation. In addition, a key is providing a wealth of useful information to staff and creatively educating nurses on technology in healthcare. Health information systems provide leaders and managers with day-to-day information on patient flow and acuity, resource use, and staffing levels.  

Here is a link for some information on : The Impact of Emerging Technology on Nursing Care

References:

Healthcare environment: Innovation, technology and legal issues in nursing.  Nurse Executive Review and Resource Manual, 2nd Edition. Retrieved February 28, 2015 from http://www.

nursecredentialing.org/documents/certification/reviewmanuals/nurseexecchapter.aspx

Benefits of EHRs. (2015). Health IT.gov Retrieved February 28, 2015 from http://healthit.gov/providers-professionals/electronic-medical-records-emr

Vogelsmeier, A.,  & Scott-Cawiezell, J. (2009). The role of nursing leadership in successful technology implementation. Journal of Nursing Administration, 37(7/8), 313-314.

A Workflow Solution

Standardized Hand off Report Between the Emergency Department and Inpatient Nursing Units

As healthcare becomes more specialized, with an increased use of technology and more healthcare clinicians involved in patients care there is a greater chance of ineffective hand offs. The transfer of necessary patient information regarding care is essential. When shift changes occur or a patient is transferred to another unit, nurses are expected to complete a hand off of patient information (Halm, 2013). The emergency department transfers a large number of patients to inpatient nursing units. Unfortunately there are a high number of nurses working in an ED often with different ways of handing off patients. A workflow issue exists when Information for patient hand off between units is not standardized, inconsistent or incomplete. This workflow issue creates gaps in care and greatly effects patient safety. Inadequate information jeopardizes patient care. There is a potential for adverse medication events or harmful care to patients (Patterson & Wears, 2010). The solution to the issue is a standardized report such as SBAR that can be incorporated into the EMR used by the facility for nursing hand off. Each SBAR report would offer the same information pieces. Some examples include important patient identifiers, diagnoses, history, assessments, treatments and medications. Nurses can add or edit important information about the patient that the oncoming nurse can use as a reference. The impact of this resolution on patient workflow is that patient safety and continuity of patient care are ensured. There is a safe passage of information for the next nurse to increase effectiveness of patient care. There are fewer errors and increased patient satisfaction. Overall, it is a more effective use of of the nurse's time (Friesen, White, & Byers, 2008).

 

Here are a few strategies to improve patient hand-offs!!!

Besides SBAR, another tool that available for paient hand-offs is SHARE. Solving Handoff Problems with SHARE


References:

Friesen, M. A., White, S. V., & Byers, J. F. (2008). Handoffs: Implications for nurses. Patient Quality and Safety: An Evidence-Based Handbook for Nurses. Retrieved February 17, 2015 from http://www.ncbi.nlm.nih.gov/books/NBK2649/?report=printable

Halm, M. (2013). Nursing handoffs: Ensuring safe passage for patients. American Journal of Critical Care, 22(2), 158-162.

Patterson, E. S., & Wears, R. L. (2010). Patient handoffs: Standardized and reliable measurement tools remain elusive. The Joint Commission on Accrediation of Healthcare Organizations, 36(2), 52-61. 

Nursing Leadership and Technology

Integrating Technology with Nursing Leadership  

How Technology is Improving Healthcare:

* Improved patient care and clinician efficiency

* Allows for telemedicine- doctors are easier to reach

* Standardized way to transmit information between providers/systems/multidisciplinary teams

* Increased communication between providers

* Disease management and prevention- data identify early risk factors

* Patients/families are encouraged to become active participants in care

- Link to some of the biggest new healthcare technology

Why EMRs?

The HITECH Act has compelled healthcare institutions and eligible providers to hastily implement electronic medical records with the anticipation of receiving incentive payments from Medicare and Medicaid.

Nursing involvement with EHRs includes- hospital leadership, defining clinical standards and governance, participating in clinical advisory teams and training and support.

The Case For The Need For Nurse Leaders To Embrace Technology

Technology is not an additional cost to service but rather a mechanism to enhance care. Nursing leadership plays a critical role in how an organization chooses, implements and adopts technology.

Nurse leaders must CONNECT THE DOTS between nurses,  IT and organization executives. Nurses communicate IT’s decisions to front line nursing staff, as well as what technology is needed for the goals that nurses are trying to achieve at the bedside. Nurse leadership help executives understand why nursing outcomes matter as they are key to achieving overall organizational goals.

Nursing leadership can influence IT department decisions and then encourage nurses to learn and develop the skills in utilizing the many new technologies being instituted in the healthcare world.

 The successful implement of technology is done by the nurse leader’s skills to guide the implementation process, to work to facilitate a team setting, create an environment for open communication for information sharing, and helping all to work towards a common goal.

Nurse leaders should be pushing continuing education of staff and themselves. Staying up to date with new technologies and best practices encourages implementation of the technology into the clinical setting. Education of nursing staff on unit can occur from the nurse leader.

References:

Moorman, L. P. (2010). Nurse leaders discuss the nurse’s role in driving technology decisions. American Nurse Today, 5(1), 1-5.

Johnson, L., DuSold, D. I. (2013). How nurses drive rapid electronic records implementation. American Nurse Today, 8(11).

Vogelsmier, A.,  Scott-Cawiezell, J. (2009). The role of nursing leadership in successful technology implementation. Journal of Nursing Administration, 39(7), 313-314.

The Human-Technology Interface and Nursing

      The Human- Technology Interface

The implementation of information technology systems into healthcare is inevitable. Health information technology is a way to create the free exchange of health information to improve the efficacy, quality and safety of care while still protecting patient confidentiality. EHRs offer a solution to the challenge of the large amount of people in the population with out healthcare access but also cuts the costs resulting from the over utilization of healthcare. EHRs reduce the duplication of tests, improve the use of interventions and clinicians can easily access information to complete a health assessment or compile patient history of care and medications.  

Patient engagement in their health has is the root of implementation of health information technology. The goals for the technology design have been to improve the availability of health information through electronic records and to integrate it in a meaningful way for patients. These efforts progress the need to achieve quality care while reducing costs. Giving patients access to EHR allows patients to view their appointments and medications, to input physiologic data such as blood pressure, weight or blood glucose values to promote health and disease awareness. Nurses are able to help create and educate patients in using these tools to promote patient engagement. 

With the interopability of electronic health systems all care providers and patients have access to health records. This allows increased communication between multidisciplinary health care teams and patients. A patient's problem list, allergies and immunizations are shared with other systems. If a patient is admitted to another hospital or sees a new provider their electronic information can be shared. The implementation of electronic health records creates standardized care plans and quality standards that allow nurses to provide high quality patient care. The goal of instituting technology in healthcare is not to benefit the technology but to create a more efficient and safe healthcare system. Error reduction can occur with the effective use of the information health systems and electronic provider entry. An example is bar code medication administration technology that can help in the prevention of medication errors by allowing nruses to double-check medications by scanning them before administration. Patient wristbands and the medication are verified by the system. This checks the accuracy of the "rights of medication administration," which are right patient, right medication right time and right dose. The electronic sharing of patient's health information results in better patient outcomes, reduced admission, better surveillance and monitoring, and decreased costs. Health care can be standardized. 

Health information technology allows for nurses to spend more time at the bedside completing patient care tasks or providing education. Nurses are the largest percentage of the healthcare workforce that will be involved with the selection, implementation and use of technology solution in patient care. At the front lines of health care the nurses, patients and technology all interact. Technology improves nursing productivity and satisfaction which in turn produces increased patient satisfaction. 

Well designed technology allows nurses to focus on care-giving functions and promoting the health of patients! 

Examples of human-technology interfaces the nurse might encounter include:

—  * Defibrillators

—  * Intravenous pumps

—  * Patient-controlled analgesia (PCA) pumps

—  * Physiologic monitoring systems- telemetry, pulse oximetry

—  * Electronic Health Records

—  * Cardiac Monitoring systems

—  * Telephones & Pagers

Here are some other examples of advances in hospital data input devices.

here are the five key trends in health care technology and the top technology trends in patient safety. 

REFERENCES:

Gephart, S. M., & Effken, J. A. (2013). Using health information technology to engage patients in their care. Online Journal of Nursing Informatics, 17(3). 

McBride, S., Delaney, J.M., & Tietze, M. (2012). Health Information Technology and Nursing. American Journal of Nursing, 112(8), 36-42.

Powerll-Cope, G., Nelson, A. L., & Patterson, E. S. Chapter 50. Patient care technology and safety: An evidence-based handbook for nurses, (3), 207-220. 

The Omaha System and ABC Codes

With the development of electronic health records, coding schemes are available to clinicians to describe patient care. An example of this is the Omaha System. The Omaha System is used to document client needs, describe practitioner interventions, and measure client outcomes.

Users include nurses, physicians, occupational therapists, physical therapists, registered dietitians, recreational therapists, speech and language pathologists, and social workers. When multidisciplinary health teams use the Omaha System accurately and consistently, they have an effective basis for documentation, communication, coordination of care, and outcome measurement. 

The Omaha System consists of three components:

•   Problem Classification Scheme-Organize assessment (needs and strengths) for individuals, families, and communities 
• Intervention Scheme - Organize multidisciplinary practitioners’ care plans and the services they deliver
•  Problem Rating Scale for Outcomes- Evaluate individual, family, or community change over time

Domains and Problems of the Problem Classification Scheme

Environmental Domain: Material resources and physical surroundings both inside and outside the living area, neighborhood, and broader community. Some examples are:

Income
Residence
Neighborhood/workplace safety

Psychosocial Domain: Patterns of behavior, emotion, communication, relationships, and development.Some examples are:

Social contact
Role change
Interpersonal relationship
Spirituality
Growth and development

Physiological Domain: Functions and processes that maintain life. Some examples are:

Hearing
Vision
Speech and language
Cognition
Pain
Respiration

Health-related Behaviors Domain: Patterns of activity that maintain or promote wellness, promote recovery, and decrease the risk of disease.

Nutrition
Sleep and rest patterns
Physical activity
Personal care
Medication regimen

Categories of the Intervention Scheme: 

Teaching, Guidance, and Counseling: Activities designed to provide information and materials, encourage action and responsibility for self-care and coping, and assist the individual/family/community to make decisions and solve problems.

Treatments and Procedures: Technical activities such as wound care or and medication prescriptions that are designed to prevent, decrease, or alleviate signs and symptoms of the individual/family/community.

Case Management: Activities such as coordination, advocacy, and referral that facilitate service delivery, improve communication among health and human service providers, promote assertiveness, and guide the individual/family/community toward use of appropriate resources.

Surveillance: Activities such as detection, measurement, critical analysis, and monitoring intended to identify the individual/family/community status in relation to a given condition or phenomenon. 

Concepts and Ratings of the Problem Rating Scale for Outcomes:

Concepts	1	2	3	4	5
Knowledge:Ability of the client to remember and interpret information	No knowledge	Minimal knowledge	Basic knowledge	Adequate knowledge	Superior knowledge
Behavior:Observable responses, actions, or activities of the client fitting the occasion or purpose	Not appropriate behavior	Rarely appropriate behavior	Inconsistently appropriate behavior	Usually appropriate behavior	Consistently appropriate behavior
Status:Condition of the client in relation to objective and subjective defining characteristics	Extreme signs/ symptoms	Severe signs/ symptoms	Moderate signs/ symptoms	Minimal signs/ symptoms	No signs/ symptoms

A full description of the components is available online here

The Omaha System model incorporates the circular, dynamic, interactive nature of the problem-solving process; the practitioner-client relationship; and concepts of critical thinking, clinical decision making, and quality improvement.

ABC (Alternative Billing Codes) Code Structure

ABC codes provide a more detailed description of health care services to assure appropriate reimbursement. ABC codes were originally developed to process claims addressing conventional, complimentary, and alternative health care services not routinely included in traditional medical billing codes.

Here is a link to the ABC code structure website 

Each ABC code consists of a set of five alphabetic characters that are used to identify services. These five characters are organized in a hierarchical structure which groups similar products, remedies, and supplies together. The five character code is then followed by a two character code that identifies the type of practitioner who provided the service reflected in the code. The ABC code is recognized by the American Nurses Association (ANA) and is already integrated with other coding systems including the Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCSII).

This is an example of an ABC code below- For other ABC Code structure examples see website

REFERENCES:

ABC Code Set. (2015). “Find-A-Code.” Retreived January 30, 2015 from http://www.findacode.com/abc-codes-set.html

Garvin, J. H., Martin, K. S., Stassen, D., & Bowles, K. H. (2008). Omaha system: Coded data that describe patient care. Journal of AHIMA, 79(3), 44-49.