With its 36 hospitals all at top-rung Stage 7 on the HIMSS EHR adoption scale, Kaiser Permanente knows a thing or two about electronic records. And while having visionaries at the top who champion I.T. is an important part of the program, listening to clinicians in the trenches—particularly nurses—is critical to growth and user acceptance, said Ann O’Brien, R.N., national director clinical informatics, at Kaiser. Speaking before several hundred nurses at the HIMSS Nursing I.T. Symposium in New Orleans on Sunday, March 3, O’Brien noted how in the day to day operation of a hospital, nurses function as a type of “information integrator,” meaning they must pull information from a variety of sources, some digital, some human, in the formulation and delivery of the care plan.

Aside from having nurses in high-level I.T. management roles, Kaiser has taken steps to assure nurse feedback about the way its EHR functions. Nurses were surveyed about their most pressing needs, and the majority said they wanted to quickly access Kaiser’s EHR as they made their rounds. “Nurses would log on 80 to 100 times a day,” O’Brien says.

As a result, Kaiser in in the process of devising a rapid sign-in, sign-out system in which nurses and other staff could tap in quickly using an employee badge, or other identifying means.

Kaiser has also built a quality dashboard for nurses. It displays their patients assigned, with color-coded buttons showing who, for example, has orders pending or who is due for a bed turn. When the nurses click through the screen, they land in the relevant part of the EHR to take action. Having actionable metrics is the best way to drive performance improvement, O’Brien said. Kaiser built supporting metrics to reduce pressure ulcers in its EHR, a move well-appreciated by nurses because avoiding pressure ulcers is not dependent on physician orders to address. And while the EHR gains a lot of attention, O’Brien said that senior management needs to be reminded that technology itself is merely the means to an end of better patient care. “Even if you have sophisticated EHR and analytics, when the patient is in the hospital, they want to be with their family,” O’Brien said.

 

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