1. Aldrich, Kelly DNP, MS, RN-BC, CCRN-A

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Every nurse, physician, or other healthcare team member will tell you that we all just want technology to work and support us as we care for our patients. I have yet to meet a fellow practitioner who doesn't want to be more informed and efficient while providing better patient care. We want healthcare technology to be easy to use and reliably anticipate our needs as clinicians, just as our smartphones do in almost every other aspect of our personal lives. Today, can show me 10 different kinds of low-phosphorus dog food based on my last Google query for "aging bulldog," but I still don't have a reliable and efficient way of knowing which medications are incompatible with my patient's treatment plans.

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The missing link

When I started my healthcare career more than 35 years ago, I didn't realize that a large part of my job as a critical care nurse would be facilitating communication between all of the various medical devices, technologies, and people at the patient's bedside. As the nurse, I was my patient's interoperability. Not only did I manage multiple I.V. pumps, a ventilator, ECG, and numerous other oxygen monitoring devices, but I was also responsible for transmitting the information outputs of each of these machines to the appropriate places and people at precisely the right moment.


Like all good practitioners, I did my best to understand the longitudinal history around the patient, make evidence-based decisions, and coordinate my efforts with others. What I really needed was a computerized system to connect the dots for me, to do the simple things like relaying messages from the ECG to the infusion pump to the bed to the medical record so that I could do the critical work of heading off a secondary complication, or even saving my patient's life.


There have been radical treatment breakthroughs and advances in technology since I was at the bedside on the critical care ICU. We now can do telemedicine-enabled consults in real time, which is why it's confusing that we still have nurses transcribing vital signs, weights, and other patient data into the medical record. Although technologies operating with digital information can do more than ever before, they're limited by the simple fact that they can't connect to each other; they literally speak different languages. There are hundreds of different device manufacturers and over 10,000 different medical devices. Not only does each device require its own unique setup and maintenance, which requires time and specialized labor, but each device also requires its own proprietary software interface needed for basic operation. This leaves the majority of medical devices, electronic health records, and other information technology (IT) systems unable to exchange information with ease at an affordable cost.


Without even a basic level of interoperability between medical devices and technologies, how can we ever hope to realize a health system that harnesses the power of data, data liquidity, and precision medicine?


How we can help

Nurse managers play a critical role in driving change. Who better to help the system learn where interoperability is needed most than those who've been facilitating it for all of these years? I see three main ways that we can help advance medical interoperability: 1) be a voice at the table; 2) partner with IT departments on usability issues; and 3) build strategic roadmaps.


Be a voice at the table. Sharing your opinion and expertise on how technology can improve the clinical care environment can provide the clarity and direction that's been missing from previous improvement efforts. You know the opportunities-and the deficiencies-better than most. Speak up about existing solution tools you work with every day. Are your technology tools meeting the mental model for ideal care delivery? What are your workarounds to providing safe, quality, and efficient care? Do your medical devices connect, and stay connected, with each use? I'm going to guess that they don't. And I'm also going to guess that you don't have time to open a new ticket each time they don't connect. Digital devices and mobile health technology is only going to become more prevalent as time goes on, and the problems of today will only be amplified tomorrow unless we address them now. You have a unique opportunity, as someone who's intimately familiar with these processes, to identify transformative solutions for the many issues that frustrate physicians, nurses, and patients.


Partner with IT departments on usability issues. Clinical teams partnering with informatics and IT teams must continue to evolve and move beyond a limited approach that prioritizes documentation screen optimization. Interoperability should consider blending useful, safe, and satisfying foundations based on frameworks such as the Institute for Safe Medication Practices (ISMP) and others that focus on safety and reliability.


The system that we should all aspire to is the cockpit of the F-35, the smartest and most sophisticated airplane in the world. The F-35 has built-in and completely integrated avionics, advanced sensor fusion, interoperable and data exchange, large liquid displays, the ability to change displays with one-finger touch, and multifunction display to reconfigure and reprioritize with active systems. Imagine if we had the equivalent of that kind of cockpit to manage care coordination. Would we still be addressing alarm fatigue? Empowered frontline clinicians should define and lead the technology requirements that are implemented in their own care environments. This will be critical in crafting a thoughtful design for enhancing usability and workflows to reduce clinician burden from point-of-care solutions. Eventually, this approach could lead to the development of interactive systems of care tools that seamlessly exchange information to improve the care environment.


Build strategic roadmaps. Use your voice to support strategy delivery. As we all focus collaboratively to improve patient engagement and reduce risk of harm and/or injury from within the episode of care, a roadmap to properly advance interoperability beyond infrastructure requirements is an excellent starting point.


Let the data tell the story. Nurse managers championing the collection of baseline data from their units can support decisions being made for interoperable and useful technology solution tools investments. No one knows the opportunities for improvement within your patient population and care environments like you do. Invite graduate students to survey your unit and collect data to support your needs, such as dead spots for wireless connectivity or observations that monitor for noise. These useful data describe current state and identify areas of improvement that need to be prioritized in both the short and long term, at the point of care and across the system. Working alongside leadership, offering your input as new processes are designed will only lead to more effective solutions in the long term. That includes being more specific and clear about requirements for what technology should do for us.


Your voice matters

We should continue to partner with informatics and IT teams to leverage technology for advancing the safety of the complex care environment. Don't stop advocating until our goal of safe, useful, and satisfying care is achieved. I encourage you to invite your technical partners within your system to join you for a day of shadowing. If they walk in your shoes, they'll be better able to partner and advocate for proper solutions. Join the technology and caregivers committee to jointly define and monitor success of roadmaps. If you don't have one, create one. If we want to evaluate care delivery in real time, we'll need to behave differently and address the source of frustration behind open tickets.