Many of the policy discussions about health IT appear to focus almost exclusively on how such systems might affect physicians and physician workflow. We're hearing a lot about computerized physician order entry systems, physician performance measurement and physician incentives for electronic health record adoption.
But what about nurses?
Although they might not get as much press time, nurses are actively taking a seat at the table and participating in federal discussions about best practices, standards and the meaningful use of EHRs.
Organizations such as the Alliance for Nursing Informatics, the National League for Nursing and TIGER (Technology Informatics Guiding Education Reform) have been working furiously behind the scenes to get nurses on the frontlines of the health IT debates.
As a result of their efforts, the Health IT Policy Committee and the Health IT Standards Committee both count a nurse among their ranks. Through such representation, nurses are beginning to have a greater say in how federal health IT standards might shape up.
Moreover, federal policymakers and hospital leaders are starting to appreciate the value of bringing nurses to the table for health IT discussions.
But that wasn't always the case.
Finding a Voice for Nursing
Patricia Abbott, associate professor at the Johns Hopkins School of Nursing, has been working in the nursing field since 1988.
Abbott said that when she started out, nurses barely voiced a whisper in federal discussions about health IT. Even at hospitals where nurses make up the majority of health workers, nurses seldom had a chance to air their opinions about information systems.
As a result, many of the systems were not designed with nurses in mind.
"A programmer might sit in a lab somewhere and build what they perceive a step-by-step linear process is of administering a med," Abbott said, adding, "And what we know in the real world is that it is not linear. You go to give the med and then the phone rings, someone has a cardiac arrest, a patient falls out of bed, someone's getting called to the operating room, and it is not a linear process."
Abbott explained that nurses sometimes become so frustrated with poorly designed EHRs that they find ways to work around the systems. Not only do such work-arounds negate the intention of EHRs, they also can be dangerous by enabling nurses to circumvent a system's safety features, Abbott said.
Mark Sugrue -- a registered informatics nurse and director at the consulting firm Blum Shapiro -- said, "The issue is what I would call usability. Making the systems meet the workflow of the nurse, not the other way around. Not changing around the workflow of the nurse to meet the needs of the system."
Sugrue said that in his role as a consultant, he always advises hospitals to include nurses in health IT purchasing decisions. Hospitals are starting to take note, Sugrue said, adding that health IT vendors also are beginning to respond to nurses' needs.
"The vendors realize that while the nurses might not be the ones who are purchasing the software, they certainly influence the decision-making process. So they’ve got to develop solutions that meet the needs of nurses," Sugrue said.
Joyce Sensmeier, vice president of informatics for the Healthcare Information and Management Systems Society, explained that although nurses might have missed out on earlier health IT discussions, they are beginning to take back the reins. She said, "Nurses have in general become frustrated with being given systems that don't necessarily meet their practice needs or their workflow needs. They have really started to speak up and say what it is they do need and want."
Nursing Education: A Foundation for Health IT
According to an April HIMSS survey, a significant percentage of health care organizations believe informatics nurses have a positive impact on patient safety, workflow and clinician acceptance of health IT systems.
Sensmeier said more nurses are starting to enroll in informatics training programs to develop these skill sets. "So as this role matures, and as more organizations have a position for informatics nurses on board, there is really a better opportunity to address the needs of the nursing population," she explained.
Meanwhile, many nursing schools are starting to integrate health IT principles into their curricula to prepare the next generation of nurses for a digital health environment.
Mary Anne Rizzolo, senior director for professional development at the National League for Nursing, said it has been a bit of a struggle to convince nursing faculty to teach students about electronic health systems.
She pointed to a 2006 NLN survey that found that many nursing educators did not fully understand the informatics field. However, Rizzolo said the situation is changing as more instructors start to see EHRs at the hospitals where their nursing students do clinical rotations.
"If they don't see it in the hospitals where they are taking their students, they don't recognize the importance," Rizzolo explained. She added, "We want to make sure that the newer students that are graduating understand the importance of these systems and can participate when hospitals or vendors are designing these systems and hospitals are customizing them."
Some nursing schools already are way ahead of the game in training students to use health IT systems effectively. At the University of Kansas' School of Nursing, instructors use the Simulated E-Health Delivery System, or SEEDS project, to teach students how to coordinate patient care with a fully live Cerner EHR system.
At the Johns Hopkins School of Nursing, students get a hands-on learning experience by practicing in a 37-bed simulation laboratory hooked up to an Eclypsis' Sunrise Clinical Manager system.
Equal Players on a Health IT Team
As nursing schools continue to strengthen their informatics curricula, more and more new graduates will enter the health care work force with the skills and expertise necessary to master health IT systems.
And as the ranks of trained informatics nurses continue to grow, so will their influence in health IT policy discussions.
Johns Hopkins' Abbott explained that policymakers already are starting to appreciate the value of using health IT systems to facilitate care coordination among physicians, nurses and other members of a patient's care team.
Abbott said, "It's always been this 'us vs. them' thing, this 'nurses vs. doctors' or something. And I think what's starting to happen is that we're becoming more and more aware that we work as a team." She added, "It's not just a system to make doctors work better, it's a system to make nurses work better, to increase quality and improve our safety records. And everybody has to play in order for that to happen."