Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.

In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.

To Prepare:

Review the Resources and reflect on the evolution of nursing informatics from a science to a nursing specialty.
Consider your experiences with nurse Informaticists or technology specialists within your healthcare organization.

By Day 3 of Week 3

Post a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.

Nurses are found in practically every nook of our economy, which is to say they are woven into the fabric of healthcare. My work in module one focused on readmission occurrences through the ER. For this discussion I am going to continue honing in on this topic by analyzing communication that occurs between facility to facility. The nurse informatics specialist for my hospital was the lead liaison for the conversion to EPIC implementation. The utilization of specific features was essential. It is through these continued efforts that patient outcomes will be improved by using a more efficient healthcare model

When referencing patients, the term frequent flyer is probably not politically correct. For the purposes of the discussion, that reference will not be used as a noun, but rather as a verb to portray the cycle of events that these patients experience. Follow up visits to their PCP happens within the week of discharge and admissions to hospitals are often preceded by visits to PCP. These events, both hospital and office visits, have a critical amount of data generated. “The challenge is in determining how best to coordinate the efforts of subject matter experts from nursing, informatics, and information technology to design, develop, and deploy solutions to very complex problems (Mosier et al., 2019).

According to Vermeir et al., (2015) written communication between hospitals and physician offices remains the most popular form of communication in regards to patient care. Poor communication was cited as the main reason for adverse patient outcomes. These outcomes not only affected the patients, but also the time(s) of physician involvement as well as economic implications for the coordinating healthcare entities. The article concludes with recommending a structured approach. The benefit to this method would be content covered in a comprehensive manner, timeliness, and ownership of the data and then means of relaying it.

A strategy that I would propose as a nurse leader is to harness the full potential of electronic medical records (EMR). Dating back to the inception of the affordable healthcare act, we as healthcare workers have come accustom to regulations set forth which compel healthcare organizations to implement meaningful use of EMR. Department AMR, (2020) has a proficient summary, “EMRs can improve healthcare productivity and efficiency, leading to better public health outcomes. High-quality EMR applications in health care are used as decision-support tools to minimize medical errors. EMRs with Health Information Technology have the potential to reduce medical costs.”

The impact of an EMR used to its fullest potential is a game changer. Envision a ER physician being able to access a patient’s PCP assessment that led to the patient being referred to the hospital. Additionally, the impact of an integrated EMR that could communicate a patients response a hospitalist’s titration of blood pressure medications to someone who was admitted with a new onset of a hypertensive crisis. In closing, communication between the physician’s office and a hospital could improve patient outcomes, make for a more efficient system, along with saving time and money.

References

Department, AMR (2020). Association between electronic medical records and… : medicine. LWW. https://journals.lww.com/md-journal/Fulltext/2020/07310/Association_between_Electronic_Medical_Records_and.26.aspx.

Mosier, S. , Roberts, W. D. & Englebright, J. (2019). A systems-level method for developing nursing informatics solutions. JONA: The Journal of Nursing Administration, 49 (11), 543-548. doi: 10.1097/NNA.0000000000000815.

Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., Hallaert, G., Van Daele, S., Buylaert, W., & Vogelaers, D. (2015). Communication in healthcare: a narrative review of the literature and practical recommendations. International Journal of Clinical Practice, 69(11), 1257–1267. https://doi.org/10.1111/ijcp.12686

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days, offering one or more additional interaction strategies in support of the examples/observations shared or by offering further insight to the thoughts shared about the future of these interactions.

response

I believe that your system is ideal for the evolution in healthcare. I would like to share a different aspect of what other facilities struggle with. I am a nurse educator, so I am familiar with many systems and am required to be “tech-savvy” to some degree. I teach in LTC facilities as well as the local hospital where I am also a nurse. The ED in the local hospital has only 12 beds and serves a very small community. The system that they utilize is different from any other system locally. Their system is also different from what we use in the rest of the hospital. When a patient is admitted, we are unable to see what medications were administered or any treatments that were provided. The only information that we have access to is the H&P. Our facility is small, but not so small that we should not have adequate technology. There are also several convenient care facilities, urgent care, LTC, and many other healthcare providers in the area that can not access our system. Penn Highlands entities are the only ones with accessibility. “Telemedical systems, as we have seen, have been actively explored at the interface between hospital-based specialist services and primary care. Similar problems exist between small hospitals, which may not have access to the highly specialised personnel that can be found in larger institutions like teaching hospitals” (Coiera, E., 2006). Hopefully, with the purchase of our 7^th hospital, new technology will be coming our way.

For continuity of care purposes, it is necessary to have access to patient history and diagnostic studies. With our Meditech system, there are over 2300 institutions worldwide that have access to the system (meditech.com) compared to Epic who serves over 75,000 providers. The antiquated system causes a communication barrier limiting the communication between providers. Advantages to HER include, but are not limited to:

Providing accurate, up-to-date, and complete information about patients at the point of care
Enabling quick access to patient records for more coordinated, efficient care
Securely sharing electronic information with patients and other clinicians
Helping providers more effectively diagnose patients, reduce medical errors and provide safer care
Improving patient and provider interaction and communication, as well as health care convenience
Enabling safer, more reliable prescribing
Helping promote legible, complete documentation and accurate, streamlined coding and billing
Enhancing privacy and security of patient data
Helping providers improve productivity and work-life balance
Enabling providers to improve efficiency and meet their business goals
Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health. (healthIT.gov, 2019).

References

Coiera, E. (2006, May). Communication systems in healthcare. The Clinical biochemist. Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1579411/.

MEDITECH EHR Software. MEDITECH. (n.d.). https://ehr.meditech.com/.

What are the advantages of electronic health records? HealthIT.gov. (2019, May 16). https://www.healthit.gov/faq/what-are-advantages-electronic-health-records.

sample response 2

I have been involved with EPIC electronic health record (EHR) builds and specifically with the Emergency Departments (ED)and recidivism. I work in an outpatient wound care center that is owned by the hospital. When we first opened over 7 years ago, one of my first goals was to contact the ED and see how we could collaborate to reduce wound care patient admissions and coordinate better post-service care. Knowing how important immediate follow-up care post ED discharge is I worked closely with the nursing and hospital informatics team to design a seamless discharge process utilizing the fullest extent of our EHR. “Major contributing factors of ED revisit include the patient not knowing whom to contact for follow-up care as well as failure to contact the provider, which frequently leads to fragmented care(Luciani-McGillivray et al., 2020, p. 2).” Knowing that patients who were discharged from the ED rarely made follow-up appointments I devised a system with the hospital that utilized the consult function in the already existing EHR to generate a general raw data file that included diagnosis, name, date, phone number. Once a day this file would be securely emailed and patients were called and appointments scheduled. There was a 24-hour turnaround from discharge to call. If I had research acumen I would have run a study on this to see if it actually reduced ED readmission and subsequently however this is not off my to-do list when school is over. The collaboration between ED providers and specialists is critical inpatient care. On a weekly basis, the ED team and the wound care team talk about outcomes and referred patients to streamline and enhance care. “Quantitatively, collaborative teamwork may lead to reduced length of hospital stay, improved compliance with standards of drug prescription, improved quality audit results, and improved symptom and psychosocial management(Morley & Cashell, 2017, p. 208) .” I think we have a long way to go to fully understand how we can universalize our EHR’s and how we can better serve our patients. As mentioned I have been on man EPIC hospital builds and each time the wheel has to be reinvented and functionalities have to be redeveloped to make sure the system works as it should.

References

Luciani-McGillivray, I., Cushing, J., Klug, R., Lee, H., & Cahill, J. E. (2020). Nurse-led call back program to improve patient follow-up with providers after discharge from the emergency department. Journal of Patient Experience, 7(6), 1349–1356. https://doi.org/10.1177/2374373520947925

Morley, L., & Cashell, A. (2017). Collaboration in health care. Journal of Medical Imaging and Radiation Sciences, 48(2), 207–216. https://doi.org/10.1016/j.jmir.2017.02.071