Physicians typically get a lot of attention during health IT implementations, but presenters and attendees at HIMSS 2013 said healthcare organizations are overlooking a major opportunity if they leave nurses and other support staff out of the mix.
The focus on physicians makes sense on one level. With a couple exceptions, physicians are the only clinicians eligible for meaningful use incentives. They are the ones whose use of EHRs federal regulators will measure and judge, so they must be able to fit the technology into their workflow.
Nurses get shortchanged yet they're the enablers of care.
Rasu Shrestha, M.D.,
vice president of medical information technology and medical director for interoperability and imaging informatics, University of Pittsburgh Medical Center
But Rasu Shrestha, M.D., vice president of medical information technology and medical director for interoperability and imaging informatics at the University of Pittsburgh Medical Center, said providers are being shortsighted when they only consider doctors' use of EHRs.
For one thing, nurses can improve transition of care outcomes, which tend to be poor at most organizations. The meaningful use rules will require much of the documentation that happens during transition of care situations be made in electronic formats. Shrestha said that the special skills of nurses, like communicating effectively with patients, tend to be needed during care transitions, so it is a natural fit for them to engage with EHRs for this purpose.
Additionally, nurses who are proficient users of technology can support an organization's transition to performance-based payment models, Shrestha said. In a future where accountable care is the norm, discreet doctor-patient encounters will be less important. What will count most is getting an entire team of clinicians involved in supporting the wellness of patients. Shrestha said when nurses and other ancillary staff use technology effectively they can be important members of this team.
"So what we're doing is we're not just measuring the one physician and patient interaction, but the cost of the care and the quality of care around that whole episode," Shrestha said. "Nurses get shortchanged yet they're the enablers of care."
But it is not entirely up to healthcare organizations to make sure IT systems are designed with nurses in mind. Nurses have to come to providers with the skill necessary to take advantage of these opportunities. Janet Mar, a doctorate of nursing practice student at Arizona State University who has studied nursing informatics issues, said in a session she led at HIMSS 2013 that this is often a problem.
Mar has conducted research into the availability and quality of nursing informatics courses at colleges across the country. She said a relatively small percentage of nursing programs offer informatics courses. Even the ones that do tend to have offerings that are limited in scope. Faculty members at schools tend to be older, have limited experience with IT tools and don't understand why it is important for nursing students to learn how to use them.
Faculty "haven't used it, and I think they don't understand how it can improve care," Mar said. "They don't want to use it; they don't see the benefits. It's pretty hit or miss what students are learning these days in informatics programs."
The lack of training in informatics available to nurses could have implications for delivery of quality care in the future. Mar pointed out that nurse practitioners are increasingly being asked to shoulder more of the load in chronic disease management. Chronic conditions like diabetes and heart disease account for a large majority of the nation's total healthcare spending. EHRs represent a powerful tool for tracking information, and recommending targeted interventions that could help minimize this problem. But if nurse practitioners lack the IT skills necessary to use EHRs, it will be a missed opportunity, Mar said.