Over the next four years the practice of nursing will change dramatically as hospitals transition from paper to digital records in order to meet meaningful use requirements of electronic health records under the American Recovery and Reinvestment Act. Based on the successful automation of my emergency department at Jersey City Medical Center, I recommend hospitals use these five strategies to ensure EHR acceptance by their ED — and inpatient — nurses and physicians:
1. Seek input from every constituency. It is essential that every stakeholder be represented on the committee charged with selecting and evaluating the functionality and workflow processes of EHR systems. Jersey City Medical Center formed a committee comprised of ED nurses, physicians, administrators, information technology professionals and other personnel to make the most informed decision on which system was best for the organization, quality care and patient safety.
2. Choose whether to go with a best-of-breed or enterprise EHR system. Jersey City Medical Center selected a best-of-breed ED EHR solution, EDIMS, rather than an enterprise system because the latter was not designed to meet the specific needs of ED nurses and physicians. If this criteria is not met, clinicians won’t use the technology, and hospitals likely will have to purchase another EHR, not to mention have a harder time securing buy-in.
3. Avoid creating order sets. Providers can save a lot of time by implementing ED EHRs with built-in order sets. Developing orders from scratch is time consuming and challenging because the task requires significant energy and consensus from busy physicians.
4. Determine implementation approach. When rolling out an EHR, organizations can deploy a phased or “Big Bang” installation. At Jersey City Medical Center, we phased in the technology over two stages, implementing computerized physician order entry and physician documentation in March 2008, and nursing documentation and charge capture in 2009. I would recommend, however, implementing all components of the EHR at the same time, because supporting electronic and paper charting simultaneously created time lapses for our ED. Also, many of the benefits of using an EHR only unfolded after we executed the second phase.
5. Station "super users" on the floor. A key to successful implementation is to identify nurses to serve as super users after go-live. Super users, who are trained by the vendor staff, should be available on every shift for the first week or two after go-live. This ensures that nurses and doctors receive prompt assistance, preventing care disruptions and clinical staff from turning against the technology — an outcome that commonly occurs when an organization fails to provide help or answer questions from users quickly.
6. Institute a "shadow" program. Jersey City Medical Center assigned super users to provide extra one-on-one training for older, technology averse nurses, who were uncomfortable with the prospect of using an EHR. This personalized training approach was key; the apprehensive nurses were able to easily acclimate and are now as comfortable with the EHR as those nurses just out of school.
Christine Wade has a featured e-session at HIMSS 11, “EHR to Identify ED Throughput Issues and Prepare for Meaningful Use,” which elaborates on the topic of securing nurse buy-in for ED EHRs. She will be available to answer questions during HIMSS at the EDIMS booth #2031 or on Twitter at Twitter.com/ChristineWadeRN.
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1. Seek input from every constituency. It is essential that every stakeholder be represented on the committee charged with selecting and evaluating the functionality and workflow processes of EHR systems. Jersey City Medical Center formed a committee comprised of ED nurses, physicians, administrators, information technology professionals and other personnel to make the most informed decision on which system was best for the organization, quality care and patient safety.
2. Choose whether to go with a best-of-breed or enterprise EHR system. Jersey City Medical Center selected a best-of-breed ED EHR solution, EDIMS, rather than an enterprise system because the latter was not designed to meet the specific needs of ED nurses and physicians. If this criteria is not met, clinicians won’t use the technology, and hospitals likely will have to purchase another EHR, not to mention have a harder time securing buy-in.
3. Avoid creating order sets. Providers can save a lot of time by implementing ED EHRs with built-in order sets. Developing orders from scratch is time consuming and challenging because the task requires significant energy and consensus from busy physicians.
4. Determine implementation approach. When rolling out an EHR, organizations can deploy a phased or “Big Bang” installation. At Jersey City Medical Center, we phased in the technology over two stages, implementing computerized physician order entry and physician documentation in March 2008, and nursing documentation and charge capture in 2009. I would recommend, however, implementing all components of the EHR at the same time, because supporting electronic and paper charting simultaneously created time lapses for our ED. Also, many of the benefits of using an EHR only unfolded after we executed the second phase.
5. Station "super users" on the floor. A key to successful implementation is to identify nurses to serve as super users after go-live. Super users, who are trained by the vendor staff, should be available on every shift for the first week or two after go-live. This ensures that nurses and doctors receive prompt assistance, preventing care disruptions and clinical staff from turning against the technology — an outcome that commonly occurs when an organization fails to provide help or answer questions from users quickly.
6. Institute a "shadow" program. Jersey City Medical Center assigned super users to provide extra one-on-one training for older, technology averse nurses, who were uncomfortable with the prospect of using an EHR. This personalized training approach was key; the apprehensive nurses were able to easily acclimate and are now as comfortable with the EHR as those nurses just out of school.
Christine Wade has a featured e-session at HIMSS 11, “EHR to Identify ED Throughput Issues and Prepare for Meaningful Use,” which elaborates on the topic of securing nurse buy-in for ED EHRs. She will be available to answer questions during HIMSS at the EDIMS booth #2031 or on Twitter at Twitter.com/ChristineWadeRN.
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