History was made on February 16, 2005, when David Brailer, MD, PhD, National Coordinator, Health Information Technology (HIT), met with a group of nursing informatics leaders at the Annual HIMSS 2005 Conference and Exhibition, held this year in Dallas, TX. The complete list of attendees is presented in Table 1. Dr Brailer had asked for the meeting and specifically had two key areas of concern: electronic health record (EHR) adoption and interoperability between systems. These are the two major goals in his appointment as HIT Coordinator and his worst nightmare is that he will not accomplish these tasks. He asked the group, "How can you, as nurses, help us get tens of thousands of physicians to adopt the EHR?"
In response, Carol Bickford noted that there are 2.7 million registered nurses. Many of them are working in public health or ambulatory settings. Most of these caregivers are using hand-written documents.
Marion Ball then explained the Tiger Team project in which the mission/goal is to infuse nursing education with informatics content. When nurses graduate and begin practicing, they will have necessary computer and informatics skills. Curriculum reform is needed to incorporate informatics competencies across all nursing specialties and settings. In addition, education of nurses in practice is needed. Activities are under way but additional funding is needed to help make these changes continue to happen.
Judy Warren quoted Dr Dorothy Del Bueno, who stated that 80% of nurses are not competent to practice upon graduation. It costs $5000 to train each nurse once he or she is hired.
The American Association of Colleges of Nursing (AACN) and the National League for Nursing (NLN) have made a commitment that every nursing student will have information competencies. They are working directly with the deans of schools and colleges of nursing to effect this change.
Connie Delaney described the Alliance for Nursing Informatics (ANI), which is a newly formed entity that represents informatics nurses through its collaboration of 20 grassroots nursing informatics groups. Dr Delaney and Joyce Sensmeier, along with representatives from the collaborating organizations, have been providing leadership during the formative stage of the ANI.
Charlotte Weaver, Vice President and Chief Nursing Officer, Cerner, explained that EHRs are being implemented in pilot programs with partnerships between vendors and universities to create high-tech learning laboratories. These include the University of Kansas and St Scholastica, which are partnering with Cerner, and Johns Hopkins, which is partnering with Eclipsys. While these initiatives are costly, the pilot projects are expected to bring experience with EHRs to 120 students per year per site.
Dr Brailer asked if there was still a nursing shortage, and the response was YES. Nurse recruitment as well as faculty recruitment is still in crisis. It is estimated that 40% of nursing faculty will be retiring within the next 10 years. The good news is that collaborative practice is evolving between physicians and nurse practitioners.
As the discussion continued, participants noted there is evidence that the use of information technology and EHRs increases nurse satisfaction. A VHA study demonstrated that nurses felt burdened with low-level tasks in a low-tech environment, and organizations with the highest level of technology have the lowest attrition rate.
Dr Brailer asked if use of bar coding was being seen in a positive light by nurses. Ginny Meadows responded that studies have shown that nurses prefer to work on units with bar-coding technology. While it might take a bit longer for medication administration, nurses prefer the technology because of its safe environment. To be successful, workflow is key. Auto-ID is the term being used to describe the technology that is desired.
Dr Brailer asked about the impact of computerized provider order entry (CPOE) automation and its effect on communication between the physician and the nurse. Joyce Sensmeier responded that the HIMSS Nursing Informatics Task Force was recently discussing this topic. The communication and relationship between the nurse and the physician is being challenged by this new technology. Vicky Bradley responded that depending on the impact of the workflow redesign, in many cases communication can improve. Judy Murphy noted that the environment must be evaluated and layers of redesign of clinical processes are needed.
Kathleen McCormick noted that in a paperless environment, busywork goes away. The patient becomes the center of activities, there is a cultural shift, and collaboration can be enhanced. Today many organizations are simply automating the current culture. They need to take the leap to a cultural shift. This results in high patient satisfaction and increased nurse retention rate. Change management is key. Patient safety can be enhanced through automation.
Dr Brailer asked about the job market for nurse informaticians. Do we have enough? Those present noted that at the July 2004 Summit, Charles Safran, MD, AMIA President, stated that
There is a critical need for trained informatics professionals if we seriously hope to implement the President's vision concerning EHRs. I would like to see 6000 physicians and 6000 nurses with high level clinical informatics training-one for every hospital and healthcare setting by 2010.
As the meeting drew to a close, Vicky Bradley reiterated the offer from this group of nurses to assist Dr Brailer in achieving his agenda. We are poised to support the EHR agenda and the goals of Brailer's Office. Dr Brailer told a story about having attended a State of the State address by the Governor of West Virginia the previous week. West Virginia is implementing a statewide regional health information organization. At this event, Dr Brailer's mother was honored for her 50 years of experience as a nurse. Dr Brailer holds nurses in high esteem, and he looks forward to working with us to help further the national agenda.
At a press conference the next day, Dr Brailer mentioned that he had a great meeting with the nurses the day before, and that his office was utilizing nurses throughout the Department of Health and Human Services as well as other agencies to assist his office in fulfilling the Secretary's agenda. He also noted that he would be creating a Nurse Fellowship Position in his office in the coming year to further support this effort.
Key Points
* AACN and NLN commit to information competencies
* Increased use of information technology lowers attrition
* Paperless environment creates patient-centered environment