The first thought that came to mind about this week’s discussion is the way that nursing informatics specialists/data specialists help train hospitals associates on new computer programs and technology.  Darvish et al. (2014) points out how nursing informatics specialists have an important role in teaching and promoting the benefits of technology to other healthcare providers.

In the last major hospital that I worked in; we were told that we would be getting a new computerized documentation system.  The hospital made the transition into a big event, almost to the point that it seemed that it was a celebration.  As the new documentation system was rolled out, we were given a short half day in-service on how the new system worked.  It was clear during the short in-service that there were major issues with the documentation system.  It was cumbersome and required simple items to be documented in multiple places for data to be transferred properly.  Scroll down menus were missing important key items, and overall, it was clear it was going to be a difficult transition.

Resistance to new documentation systems is well documented and researched.  The Office of the National Coordinator for Health Information Technology (2019) points out that it is important for employees to “buy in” to the implementation of the new system for it to be successful.  It was clear however that hospital employees were going to be very resistant to this new system because of the problems we saw during the in-service.  We were told that specialists would be present to help us with documentation issues during the first two weeks of implementation.  The hospital kept its word on that portion of the roll out and there was a person present on every floor to help with issues each shift for two weeks.  As more and more issues were discovered with the new system, we started to ask questions about the system and found out that we were basically being used as “testers” for a new product.  The hospital was given the program by a company, and we were the first hospital to test it out. The informatics specialists told us that nurses were not consulted at all on the development of the program.  Every time we found another issue with information missing, or with the inability to document an issue, we were told that it would be added to the list to be built into an update. Until then we had to just type the missing information into text boxes which made it almost impossible for the next shift to see.

To sum up the entire ordeal, the hospital was required to test the product for a period of 2 years due to the contract they had with the company.  Fortunately, the hospital replaced the documentation system the day the contract was finished.  Unfortunately, during those two years, I saw more employees resign and leave during that period than I could count.  Travel nurses refused to come to our hospital, and it was an unpleasant time for all the regular nurses to work there.

The best way this entire interaction could have been improved would have been to consult with the nursing informatic specialists prior to the implementation of the new system.  By having a physician, respiratory therapist, or a nurse test the system, management would have known that system was a nightmare. Daly (2015) points that “nurses at all levels of the organization—nurse executives, nurse managers, and clinical nurses” should be involved in the implementation of a new electronic health record for it to be successful.  It only makes sense to include those that use the system the most.

As for the future and what it may hold, it is difficult to tell.  Technology has changed so much in the last decade alone that it is hard to tell what the next decade might bring.  I feel that regardless that nursing informatic specialists will always be needed to assist with the implementation of any new hospital programs.

The Office of the National Coordinator for Health Information Technology (ONC) (2021) states that there are five main reasons that electronic health records (EHR) are expensive.  They list the five reasons as hardware costs, software expenses, implementation costs, training and ongoing maintenance and network fees.

Hardware costs is what it will cost the hospital to have the appropriate computers, laptops, and other devices needed to run the software.  Software costs are what it will cost the hospital to purchase the EHR.   When I attempted to find pricing on popular software programs, one website stated that one of the more popular electronic health record systems that hospitals use (EPIC) costs 500,000 dollars to purchase up front (CostHack.com 2021).   After researching software costs more, I found that one of the reasons they are so exorbitant is because of the mandatory HIPPA compliance software that must be included (Tuban, 2021).  To be HIPPA compliant, a hospital must have data encryption and security while data is cached, in-transit and rest, audit logging and usage history, user access controls, automatic logoff, secure authentication, minimum data collection, emergency backups, server scalability, elasticity, and emergency controls, and the ability to remote data wipe just to name a few (Tuban, 2021).  The implementation costs are more involved than what I expected them to be.  The ONC states that implementation costs include expenses such as an IT contractor, attorneys, electricians, and/or consultant support; chart conversion; hardware/network installation; and workflow redesign support (The Office of the National Coordinator for Health Information Technology, 2021) Training costs is the amount the hospital will need to spend on training the staff on how to use the hardware and software properly.  Finally, the maintenance costs include ‘hardware and software license maintenance agreements, ongoing staff education, telecom fees, and IT support fees. In addition, your organization may need to hire new staff, such as IT operations staff, clinical data analysts, or application analysts” (The Office of the National Coordinator for Health Information Technology, 2021).  One website estimated that first year maintenance fees for a new software program would cost approximately 85,000 dollars (Green, 2019) .  

After researching the above information, I have no doubt that the hospital felt that the risks of implementing an untested software program was worth it based on cost savings alone.  I do not fault the hospital for trying to save money with its approach.  I do however feel that they should have at the very least allowed several users to test the program in advance to see if it was going to be problematic or not.  If a single nurse and physician would have been given access to the program for an hour, they would have been able to tell the administration that the program was not worth the savings.  The amount of headaches, employees lost, and lost productivity probably cost the hospital far more that it saved on the program in the long run.

References

CostHack.com Team. (2021, June 8). How Much Does Epic EMR Cost? [Actual Rates Revealed]. CostHack.Com. https://costhack.com/epic-emr-cost/

Daly, P. (2015). Clinical nurses lead the charge with EHR. Nursing, 45(10), 25–26. https://doi.org/10.1097/01.nurse.0000471426.47075.d2

Darvish, A., Bahramnezhad, F., Keyhanian, S., & Navidhamidi, M. (2014). The Role of Nursing Informatics on Promoting Quality of Health Care and the Need for Appropriate Education. Global Journal of Health Science, 6(6). https://doi.org/10.5539/gjhs.v6n6p11

Green, J. (2019). How much EHR costs and how to set your budget. EHR in Practice. https://www.ehrinpractice.com/ehr-cost-and-budget-guide.html#:%7E:text=For%20example%2C%20the%20Health%20Affairs,for%20first%2Dyear%20maintenance%20costs.

The Office of the National Coordinator for Health Information Technology. (2019, February 19). How do I overcome resistance within my organization during electronic health record implementation? | HealthIT.gov. HealthyIT.Gov. https://www.healthit.gov/faq/how-do-i-overcome-resistance-within-my-organization-during-electronic-health-record

Tuban, A. (2021, April 10). 2021 HIPAA Compliant App Development Cost Guide. Technology Rivers. https://technologyrivers.com/blog/hipaa-compliant-app-development-cost-guide/

Discussion: Interaction Between Nurse Informaticists and Other Specialists

Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.

By Day 3 of Week 3

By Day 6 of Week 3

Response

Very interesting post! I too had a similar experience when the PACU went from paper charting to using an EMR. We only had one RN leave. She had worked for 48 years and saw this as a sign to retire. It is unfortunate that there was not full disclosure in your situation. The Office of the National Coordinator for Health Information Technology (2019) offered some additional strategies worth noting. The risk is to identify misperceptions of staff members. This draws a parallel to the first step in the nursing process, assess. Other steps include getting the staff involved, so that they have a vested interest. Listen to the staff and address negative behaviors with positives resolutions. On our go-live we had staff members who were trained as super users. They wore blue vests, as well as EPIC reps, to signify they were someone that could help or to go to with a question. They looked like price checkers at Walmart, we had fun with it and created a positive atmosphere by asking things like, “Can I get a price check or clean up in aisle 5?”

On the topic of embracing advances in healthcare technology, week two had an article discussing patient’s use of mobile devices and apps. While nurses have a tendency to shy away from modern day advances, patients are utilizing mobile devices to enhance their patient experience. “Mobile technological devices with basic features such as interactive voice response and text messaging, along with more sophisticated devices such as smartphones, have the capabilities to support and expand HIT initiatives needed to improve healthcare outcomes.” (Ng et al., , 2018).  In the United States it is estimated that 95% of adults have cell phones, which allows nurse informatics an opportunity to use applications and designs for improved delivery of healthcare. Strategies such as call centers that can offer dissemination of health and facility information has value at an automated level. Short message services allows communication in the form of texts, thus eliminating time spent back-and-forth on the phone. And lastly, what would informatics be without the worldwide web. This strategy hopes to level the quality of care around the world (Ng et al.,, 2018). It’s an exciting time we live in. We just need to embrace the opportunity.

References

 The Office of the National Coordinator for Health Information Technology. (2019, February 19). How do I overcome resistance within my organization during electronic health record implementation? | HealthIT.gov. HealthyIT.Gov. https://www.healthit.gov/faq/how-do-i-overcome-resistance-within-my-organization-during-electronic-health-record

 Ng, Y. C., Alexander, S., & Frith, K. H. (2018). Integration of mobile health applications in health information technology initiatives: Expanding opportunities for nurse participation in population health. CIN: Computers, Informatics, Nursing, 36(5), 209-213.