1. Blahna, Betty L. MPM, BSN, RN

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THE HEALTHCARE INDUSTRY is constantly evolving, and nurses have always been on the front lines of both caregiving and implementing facility procedures. To date, no change has been as significant as the integration of technology into our professional practice; this paradigm shift is particularly noticeable in the increasingly common use of electronic health records (EHRs). However, if nurses aren't invited to participate in this shift, it's easy for them to step back and leave it all to the informaticists.This article discusses the importance of nurses working closely with informaticists to optimize EHR systems, and provides a two-team shared governance model (SGM) as a case study in collaboration.


Bring clinicians into the mix

While many informatics departments have extremely knowledgeable staff, these departments are still highly dependent on their subject matter experts. Traditionally, these are point-of-care clinicians who act as liaisons in their respective areas of expertise. These liaisons usually include representation from nursing but they may not act as dedicated resources for the informatics department.


If subject matter experts don't have autonomy and responsibility within the design process, implementing EHRs can take longer because providers are distanced from the outcomes.1,21,2 To overcome this barrier, I propose shared governance as an alternate model. An SGM empowers nurses and other interdisciplinary practitioners to express and manage their practice with a higher level of professional autonomy. This organizational framework promotes sustainability and accountability-based decision making. Additionally, and perhaps most important, it fosters a partnership among everyone involved in the care of our patients.


The SGM is designed to incorporate two teams within the nursing and patient-care service departments: a Patient Care Services (PCS) informatics team and a PCS innovation team. Unit-based council representatives from the inpatient, ambulatory, and outpatient arenas drive these teams, with support from interdisciplinary departments such as information technology (IT), lab, and pharmacy. They represent their colleagues within each unit or department, ultimately giving everyone the opportunity to speak and be heard.


The primary goal for each team is the evaluation of clinician recommendations relative to EHR workflow improvements and enhancements in their respective care settings. The PCS informatics team reviews and makes recommendations on EHR system design and optimizations. The PCS innovation team reviews and provides recommendations for new technologies that will enhance workflow for frontline staff.


When the analysis of EHR requests comes from the frontline staff, it reinforces the notion that the clinical informatics team is listening to and supporting EHR enhancements for the personnel who actually use these systems. It also lets each request move into production more expediently. At the same time, the unit-based representatives can ensure that users of the EHR system are educated on the new functionality and invite staff to feel ownership of successful outcomes.


The two SGM teams also include representatives from the clinical informatics and EHR departments. These members provide technical support for decision making. Additional collaboration with other shared governance councils may also be necessary; for example, when an optimization request related to nursing policy is proposed, approval may be needed from the nurse practice council before it can go into production.


How an SGM works

The SGM involves initial review by our frontline nurses and clinicians before IT is even involved. Representatives bring ideas from the unit-based meetings to the group via a request that's then vetted by the group. An idea we're currently reviewing is the potential impact of early warning detection interventions. These technology solutions push real-time data to nurses, resulting in early interventions that have the potential to improve outcomes. Real-time data also have the potential to decrease length of stay and readmission rates while reducing unnecessary care transitions. Monetarily speaking, these solutions may also impact reimbursement, producing a significant return on investment.


After evaluating the efficacy of the idea, the team reviews the data and provides a recommendation to the appropriate council within our governance structure. If the proposed solution is approved, it's then put through our IT vendor process for implementation.


This SGM shows that clinician integration with the informatics department can emphasize a proactive approach without "knee-jerk" optimization or retrospective solutions. Nurses at the bedside understand that they can continue to evolve and take ownership and design of their EHR and have input into the various technologies they wish to have at their disposal.


Education is key

Investing in nurse informatics education is essential, coupled with a commitment to building a practical EHR system that aids in patient care. Learning opportunities can encompass informatics boot camps, local area informatics offerings through organizational chapters, and distance learning opportunities for our colleagues in remote settings such as webinars. Often, nurses can't attend lengthy national offerings. Local events offer the opportunity to focus on day-to-day skill enhancement. Support from management for these types of educational offerings is key.


Many nurses are hungry for more formal training opportunities. Growing nurses and clinicians from within organizations is a wonderful value-added opportunity to keep institutional knowledge working for us.


Tap into nursing expertise

Thought leaders who are supporting success understand that true innovation can occur if they tap into and develop partnerships among departments, including nursing and informatics. We should take an interdisciplinary focus and not just see the optimization of an EHR system as one department's job. Nurses can help drive and design what they need from an EHR system that supports top quality patient care. If anyone is going to make this paradigm shift happen, it will be frontline nurses and their counterparts in informatics!




1. Daly P. Clinical nurses lead the charge with EHR. Nursing. 2015;45(10):25-26. [Context Link]


2. Laskowski-Jones L. Electronic medical records: don't let the tail wag the dog. Nursing. 2012;42(12):6. [Context Link]