One of the key developments resulting from health care reform is a growing reliance on using “big data” to guide health care systems’ efforts to deliver high-quality, cost-effective care. This trend explains why increasingly many organizations are employing Electronic Health Records (EHR) as a way to track measurable indicators of patient care and outcomes, as well as to meet shifting requirements and reimbursement models.
Yet most EHR platforms today fall short when it comes to providing meaningful opportunities for capturing nursing interventions and outcomes, despite the fact that nurses are such an integral part of the care process.
A Key Role for CNOs
It is essential that Chief Nursing Officers (CNOs) and other nurse executives take a proactive role in helping their organizations to fill in this data gap, explains Patricia Reid Ponte, RN, DNSc, FAAN, who serves as Nurse Scholar in Residence at the Phyllis F. Cantor Center for Research in Nursing and Patient Care Services at the Dana-Farber Cancer Institute, as well as Executive Director of Oncology Nursing and Clinical Services for Brigham & Women’s Hospital. Reid Ponte is also Co-Program Director of Strategic Management and Decision Making for Nurse Executives, a program jointly presented by the Harvard T.H. Chan School of Public Health and Simmons School of Nursing and Health Sciences. This initiative, which builds on both schools’ approach to management and decision making models, aims to train nurse leaders on how to strategically guide their departments to better achieve their organizations’ goals.
“Nursing analytics that measure structure, process, and outcomes can make a valuable contribution to guiding evidence-based standardized nursing interventions, improving outcomes, and enhancing the patient experience,” Reid Ponte says. All of these elements can help to achieve the organization’s guiding mission.
When key nursing data is gathered in a consistent way, it makes it possible to use the information to identify patterns and trends within units, facilities, and populations.
“Right now, nurses typically gather key information through methods like chart reviews, prevalence surveys, and observation, all of which are time intensive and work intensive. But electronic health records can provide a vehicle for nurses to provide data in a way that it can be summarized across many sites,” she stresses. In fact, when key nursing data is gathered in a consistent way, it makes it possible to use the information to identify patterns and trends within units, facilities, and populations.
Need for a Standardized Method
“We need such a uniform way of entering information in a standard language so that we can look at nurse documents for diagnosis and treatment and connect it to the outcome,” Reid Ponte says.
Toward this goal, the American Nurses Association (ANA) recently named a dozen acceptable evidence-based terminologies that health care organizations might incorporate into their EHR systems to describe nursing interventions and actions in a consistent way. The American Academy of Nursing (AAN) further honed this list down to two languages that are currently used for clinical descriptions: Systematized Nomenclature of Medicine—Clinical Terms (SNOMED-CT) and Logical Observation Identifiers Names and Codes (LOINC).
“These are standardized languages at which data entry points are built, so there is a consistent way of entering a diagnosis within those language structures so you can go back and make connections. For instance, you can look at 50 patients on an oncology floor who are all taking narcotics and are all in the same age group and are all put on a standard fall precaution,” Reid Ponte says. “You can see that 20 percent fell, while 80 percent didn’t. So you want to know what happened to that 20 percent. Were they educated about fall prevention? Did they have a high use of narcotics? Did the patients who fell have tailored interventions based on their fall risk? All of these answers are in the big electronic database and are entered in the same way for every patient,” she says. “This allows you to examine the efficiency, effectiveness, and efficacy for sensitive information.”
Regardless of what standard is used by an EHR system, nursing executives are well-positioned to champion broadening the terminology to support the capture of nursing contributions.
Where to Start
Regardless of what standard is used by an EHR system, Reid Ponte says that nursing executives are well-positioned to champion broadening the terminology to support the capture of nursing contributions.
Further, their role can actually start with the planning stage of any EHR efforts. “When implementing an EHR, many organizations are so focused on the upfront work of designing the system that they don’t give enough attention to how they will actually use the data on the back end,” says Mary Finlay, MBA, a Harvard T.H. Chan School of Public Health instructor involved in the school’s Strategic Management and Decision Making for Nurse Executives program. “As one of the major consumers of data, nurses can play an integral role in this area,” she says, adding, “Nurses understand the processes of patient care and can be instrumental in the discussions of how data capture can be incorporated into these workflows.”
What Nursing Executives Can Do
Finlay and Reid Ponte offer the following suggestions of how CNOs and other nurse leaders can contribute to the development of a comprehensive EHR that incorporates nursing measures:
- Take the time to learn more about your organization’s Information Technology (IT) efforts and your EHR platform, so you will understand the strength and weakness of your current system and can help determine what types of change need to be made.
- Review the standardized nursing languages recommended by ANA and AAN.
- Support the creation of a Chief Nursing Information Officer (CNIO) position to help guide the nursing component’s efforts to gather and track key indicators.
- Find out how IT priorities are decided for your organization, and advocate for nursing representation in this process.
- Work with the leadership of your organization to ensure there is adequate support for nursing indicators to be incorporated, along with an adequate timeframe to see such goals are met.
- Encourage patients to contribute to your overall IT and “big data” goals by sharing their own medical history and details through your organization’s patient portal.
Part of a Broader Strategy
Remember that all of your facility’s departments are competing for limited resources, making it important to take a strategic approach to achieve your specific analytics goals. Further, given that instituting such change will not come easily, Reid Ponte says that CNOs and other key nursing leaders should be prepared to remain persistent; the payoff for achieving a clearer view of the contribution nurses bring to the organization will ultimately be well worth the time and effort invested.
Patricia Reid Ponte directs Strategic Management and Decision Making for Nurse Executives at Harvard T.H. Chan School of Public Health. To learn more about this opportunity, click here.