eHealth Procurement & Implementation - A nurses perspective

eHealth Insights · 27 October 2015

Nurses should be consulted in the early stages of EMR implementation so healthcare technology companies can create a user friendly EMR. 98% of nurses surveyed in US hospitals agree that they have never been included in hospital technology decision or design. Only 15% of those surveyed thought that their IT department were receptive to nurses’ suggestions in improving electronic documentation. These numbers simply have to be improved upon.

Electronic Health Record (EHR) has been identified as the cornerstone of the eHealth strategy for many countries including Ireland. As we move closer to the reality of a national EHR, the role of the nurse in its design needs to be explored.

While nurses are often involved during testing and as super users for training and support, this is generally too late to have any meaningful input into the usability or content of the selected system. There is great potential for EMRs to streamline workflows, reduce errors, duplication and of course reduce time spent on administration. However to realise these benefits the end user needs to have more involvement at the earlier stages of IT projects, in particular with system procurement and design.

A survey completed for the Royal College of Nursing (RCN) in the UK found that technology, if not used properly can actually increase the workload of nursing staff and over two-thirds of respondents said that the use of Information Technology has increased the amount of time they spend on paperwork and administration (1). This is not good news for an already overstretched health system where on a recent work-to-rule in a Dublin hospital, nurses withdrew from admin work to concentrate on direct patient care.

For a system to be effective, user friendly and adapt to the workflow of the end user, it seems obvious to include their input at the early stages. Nurses represent the largest group of front line staff that will use EMRs, however, 98% of nurses surveyed in US hospitals agree that they have never been included in hospital technology decision or design. Only 15% of those surveyed thought that their IT department were receptive to nurses’ suggestions in improving electronic documentation (2).

In a hospital setting alone there are paediatric, oncology, anaesthetic, critical care and cardiology nurses among many others. Each speciality has its own form of data collection and flow of information. Getting an insight into all these areas is key to achieving an EMR that is directed towards the complex care administered within a hospital setting. If the burden of administration is to be reduced, those experiencing this burden first hand need to have a say in how this can be achieved. Before embarking on the EMR journey.

• Include nurses (and other end-users) from day one when deciding which EMR to choose
• Document clinical workflows
• Assess how processes can be improved.
• Look at duplication of information and how information can be shared through integration
• Identify data which is required for quality improvement initiatives/clinical audits. The ability to retrieve meaningful data is essential in monitoring and improving care.

Time and effort at this stage of the project will help training and go-live run more smoothly. It will lead to a more positive user experience, increased clinical adoption and safer patient care. With the correct approach and utilisation of the clinical expertise available, an EMR implementation that adequately meets the needs of all end users can become a reality.

Sinéad Kane - Project Leader at Sláinte Healthcare

Sinéad has over 20 years nursing experience in both public and private hospitals and has worked in Ireland, Australia and the UK. She has received a BSc & Higher diploma in Nursing and a MSc in Health Informatics. As Project Leader for Sláinte Healthcare she co-ordinates the roll-out and manages project deliverables, of the eHealth software Vitro and Claimsure to hospitals and healthcare organisations.

(1) https://www.rcn.org.uk/newsevents/press_releases/uk/cries_unheard_-_nurses_still_told_not_to_raise_concerns
(2) http://blackbookmarketresearch.newswire.com/press-release/hospital-nurses-forced-to-develop-creative-workarounds-to-deal

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