Empower nurses with actionable steps.
In the 1950s, Harriet Werley, PhD, RN, FAAN, FACMI, became one of the first—if not the first—RN to explore the potential of computers in healthcare. She believed that nurses could leverage computers and associated technologies to collect, access, input, store, retrieve, exchange, and evaluate clinical data to provide the highest-quality patient care.
In response to the Health Information Technology for Economic and Clinical Health Act of 2009 and the associated Medicare and Medicaid EHR Incentive Programs (now the Promoting Interoperability Program), the United States experienced rapid electronic health record (EHR) adoption. Today, over 97% of hospital settings and 86% of medical practices use EHRs.
However, nurses face challenges related to documentation burden, workflow optimization, and interoperability. These challenges affect nurse well-being and contribute to burnout, which can affect quality care delivery. In 2019, and more recently in 2022, The National Academy of Medicine provided recommendations to optimize EHRs and other clinical information solutions to support nursing and clinician workflows and address challenges that ultimately impact patient health outcomes.
Steps to enhance EHR experience
National recommendations to improve the EHR experience emphasize the importance of positive change, but this can’t occur without insight and action from those most affected—nurses, who make the largest data contributions to EHRs in care delivery. Nurses working in direct care settings have the experience and knowledge to understand opportunities for user experience improvement and ensure optimal use of healthcare data. However, many nurses don’t realize that their voices can help influence the future direction of the design and implementation of EHRs and other clinical information systems.
To make your voice heard, consider the following 10 steps, which can increase your engagement in optimizing current and future EHR features and functions for safe, equitable, effective, efficient, and patient-centered care.
1. You have a role in the EHR experience.
EHRs and other health information technology (IT) solutions should support nurses’ clinical decision making and care delivery. No healthcare professional can memorize every data point for each patient and organize it in meaningful ways for effective care decisions. When you understand and appreciate how digital tools, such as an EHR, can support your knowledge and wisdom, your perspective can begin to shift toward improving and maximizing human–computer interaction.
All nurses participate in formal training, but frequent feature and function updates require that you stay aware of improvements and changes. When you identify gaps or areas for improvement, bring them to the attention of nursing leadership as well as informatics and health IT team members. Participating in the process of future design and redesign allows you to improve the experience for you and your peers and also for your patients and their families, who place trust in your expertise and ability to know them via clinical and personal data so they receive individualized care.
2. Identify opportunities.
Pay attention to your own behaviors when interacting with the EHR. In response to frustration with an inefficient or ineffective process, you may have developed workarounds. These workarounds, which serve as clues to opportunities for improvement, require immediate response because they can present quality and safety risks. Next, observe the behaviors of your peers and ask how they address challenges with the EHR. Narrow down the list of opportunities for improvement to a manageable number of two or three. Then, begin to brainstorm how to address each one. Offering possible solutions can help when you move to the next step.
3. Discuss your interests and ideas.
Meet with the nurse manager or director to discuss the two or three opportunities identified for improvement. During that discussion, identify the appropriate informatics or IT team members to help move the ideas forward.
4. Meet with informatics and IT team members.
Contact the designated informatics or IT team member associated with the clinical area in which you see room for improvement and ask for 30 minutes to meet and learn more about their role. During that meeting, ask about how best to share opportunities for improvement and submit requests to change or enhance the EHR.
5. Volunteer your expertise.
To help ensure that opportunities for improvement continue to move forward, volunteer to serve as a resource (super user or subject matter expert) in your clinical area or organization. Both roles offer informatics experience and an opportunity to meet those individuals within the healthcare organization who work to maintain and optimize the EHR. Serving as a super user can help you develop informatics relationships and perhaps lead to a career path in nursing informatics and health IT.
6. Submit requests.
Every healthcare organization with an EHR should have a mechanism for submitting enhancement requests. When speaking with the designated nursing informatics or health IT analyst, ask how to submit an enhancement request. If time permits, ask them to walk you through submitting a request on your list of improvement opportunities. Learn about the request review process, and stay in contact with the individual to follow the progress.
7. Follow up and explain.
Implementing change can take time, and the informatics and IT teams manage many enhancements simultaneously. As the person who brought an opportunity for improvement forward, your expertise and answers to questions from the informatics and IT team will help evaluate and address the request. Communicate through email, follow up every 2 to 3 weeks to check on progress, and answer any questions that can help clarify the request. The final result may not be exactly what you initially submitted, but collaboration may lead to an even better solution.
8. Join a committee.
If your interest in nursing informatics and EHR improvement grows, consider joining an EHR committee or a nursing informatics council. These groups meet regularly to discuss current topics, recently published peer-reviewed literature, and concerns from nurses and other healthcare professionals. You can become even more active in this capacity while also understanding the needs of others across the organization.
9. Get educated.
All nurses must have computer and information literacy, but learning more about the fundamentals of informatics can broaden your knowledge and contribute to your ability to share future ideas for EHR enhancement. Consider enrolling in an introductory graduate course or participating in continuing nursing education (conference, seminar, webinar) on the subject. You’ll acquire additional knowledge and skills that support your efforts to improve care through the EHR and other clinical information systems.
10. Advocate for yourself and your patients.
All nurses should serve as patient advocates. Every step you take to raise awareness of areas for EHR enhancement helps improve patient care quality. EHRs serve as tools to support care, and opportunities exist to make improvements even beyond documentation burden, workflow optimization, and interoperability. The more nurses participate, the greater impact we can have in tailoring human interaction with computers and devices to maximize quality care delivery.
Envisioning the future
To provide the highest-quality patient care, the nursing profession must help guide and mold the direction of supportive tools, such as the EHR, to ensure that we can manage clinical data and information in collaboration with clinical workflows. Nurses offer in-depth contextual clinical knowledge and experience, which nursing informatics and IT professionals value. You can make a significant difference in addressing the calls to action from the National Academy of Medicine by taking these strategic steps to methodically identify opportunities, meet with appropriate individuals, and participate in the process of optimizing EHR and clinical data systems.
Tiffany Kelley is the Frederick A DeLuca Foundation Visiting Professor for Innovation and New Knowledge and director of the Healthcare Innovation Online Graduate Certificate Program at the University of Connecticut School of Nursing in Storrs. She’s also the founder and chief executive officer at iCare Nursing Solutions & Nightingale Apps in Boston, Massachusetts.
electronic health record, EHR, informatics
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