Nurses are increasingly technology savvy, using information systems to enable timely and efficient patient-care delivery. While a nurse's workflow can be supported and enhanced by the use of information technology (IT), healthcare organizations are still learning the best methods for effective implementation.
Software developers recognize the important role nurses play in the design, selection, and implementation of successful information systems. Several prominent healthcare organizations have received the Nicholas E. Davies Award, acknowledging their efforts toward meeting certain criteria when implementing comprehensive electronic healthcare record (EHR) systems. 1 Many of the current trends in healthcare IT focus on implementing technology to support nursing practice and patient safety. Consider some of the hottest IT trends and their benefits to nurses.
1. Patient safety and error reduction. The Healthcare Information and Management Systems Society (HIMSS) 2005 Leadership Survey identified patient-safety promotion and medical error reduction as the top two current IT priorities for the next 12 months. 2 Published in February 2005, this survey represents the opinions of 253 Chief Information Officers and Directors of Information Systems at healthcare facilities across the United States. (See "2005 Leadership Survey.") However, using IT to address patient safety isn't cheap: Implementation costs can reach tens of millions of dollars for a single hospital. 3
2. Wireless networks. Another "hot" trend, wireless networks enable clinicians to remotely access needed information at the point of care. In addition to implementing wireless systems, replacing/upgrading clinical systems and workflow/process redesign also topped users' list of priorities. Looking ahead to the next 2 years, the number one priority is implementing an EHR.
3. Auto-identification. Selected by 55% of survey respondents as the IT application considered most important to their organization in the next 2 years, bar coding is one component of a broader category called auto-identification. 4 This technology uses radio-frequency identification (RFID) or bar-code capability to automatically identify a person or item, enabling speed and accuracy of data input and documentation.
In November 2004, the Food and Drug Administration speedily approved the use of an RFID tag to mark surgical sites in order to reduce medical errors resulting from surgeries performed on the wrong site or patient. The RFID tag system consists of the tag, a printer, encoder, and the RFID reader. Clinicians print the patient's name and surgical site on a label on the tag. They also encode the tag with the date of the surgery, type of procedure, and name of the surgeon. Finally, they scan the tag with a desktop RFID reader to confirm the information with the patient. Just prior to surgery, the tag is scanned again to verify the information and is placed on the patient's body near the surgical site. In the operating room, the tag is scanned to verify the data with information in the patient's chart. 5
Another emerging use of RFID microchips is for patient identification, which involves the injection of the chip into the patient's upper arm. The chip itself doesn't carry medical data, but when scanned it gives clinicians access to a database where the patient's medical data are stored. 6 This technology holds promise for identifying unconscious patients in the emergency department, or for patients unable to speak.
4. Computerized provider order entry (CPOE). Growing in its popularity, CPOE eliminates reliance on oral and handwritten communication, and minimizes transcription, translation, and misinterpretation of prescriber's orders. More than half of informatics nurses are currently involved with this technology's implementation. 7 The Leapfrog Group-a national nonprofit group formed by healthcare purchasers-has identified CPOE as the number one priority for improving patient safety and has developed an incentive program to encourage rapid adoption in healthcare organizations. Success or failure of CPOE depends on a number of factors, including system architecture, deployment, and use. A recent study found that a leading CPOE system often facilitated medication error risks. Factors contributing to the errors included data fragmentation, lack of systems integration, and human-machine interface flaws. 8
Recommendations for successfully implementing CPOE include idea exchange with vendors; careful choice of software; good systems analysis, tailoring, and implementation; and training and evaluation. According to technology experts, careful planning and realistic expectations are essential for use of CPOE in healthcare.
5. Picture archiving and communication systems (PACS). Used for conversion from film to digital radiology image storage and transmission, PACS enable simultaneous viewing and eliminate the need for retakes, provide immediate access on all units at the point of care, and make images easier to store-eliminating the need for film. Although this technology is expensive, one leading U.S. facility-Mercy Medical Center, Cedar Rapids, Iowa-was able to recover its costs within 30 months.
6. Special purpose computers. The interconnection of medical and IT devices and systems where medical data are being exchanged is rapidly growing. Medical devices and systems are designed and operated as special purpose computers, offering more automated features and a greater amount of data collection, analysis, and storage. One example is a product used by a sleep apnea clinic to capture patient information during home-based sleep study. This technology connects to various medical devices that measure a patient's blood pressure (BP), oxygen saturation, temperature, leg movement, coughs, and other parameters.
7. Cellular technology. Medical equipment companies are collaborating with telecommunication companies to develop customized cell phones that monitor clinical indicators such as glucose level, weight, and BP, automatically sending the data to physicians. Using a secure network, physicians can set parameters for how frequently they receive data readings. Another telemedicine company is developing a cell phone with built-in biosensors for diabetics. Barriers to adoption of this type of technology include resistance by older patients, physician skepticism, and concerns about patient confidentiality.
8. Biometrics. Using physical characteristics to identify individuals, biometrics encompasses fingerprints or retinal scans. In healthcare, fingerprint readers are the dominant biometric technology. Other tools include iris scanners, hand readers, and voice recognition systems. Obstacles to use of this technology include its high cost, user resistance, limited space, use of gloves or glasses, and a noisy work environment.
9. Clinical decision support. A promising technology for clinicians, clinical decision support provides the capability of recognizing knowledge as a critical asset. It also enables knowledge management and use of evidence-based medicine to apply outcomes to practice. The key to success of this technology is linking documentation and work-flow. A white paper recently sponsored by the U.S. Department of Health and Human Services describes the value of clinical decision support systems and explores incentives and protections to increasing its adoption. 9
10. Clinical systems. Tools and methods that support workflow and care delivery are essential for enabling nurses to take full advantage of IT's new capabilities. Clinical systems, among the hottest trends in health-care IT, offer a new opportunity to improve health-care's quality and safety by ensuring that the most recent information is available for clinical decision-making, improving evidence-based practice, and enhancing communication among nurses and other healthcare providers. 10
Many of the current trends in healthcare IT focus on implementing technology to support nursing practice and patient safety. However, using IT to address patient safety isn't cheap: Implementation costs can reach tens of millions of dollars for a single hospital.
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