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Ellen Makar: Nursing Informatics Leader

 |  By Marianne@example.com  
   December 02, 2010

 "We're at that tipping point and [nursing informatics is] going to be one of those things where people are saying, 'I can't believe we didn't do this before.'"

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is Ellen Makar's story.

When Ellen Makar, MSN, RN-BC, CPHIMS, CCM, began her career as an ICU nurse in the mid-1980s, she started to notice workflow patterns that, if corrected, would increase productivity and patient safety. But changes were never made.

"We never really knew what happened with our patients—our job was just keep people alive and transfer them to the floor and we never followed up," she says. "It was a whole different mindset to what we have today. That's when the seeds were planted. I wanted to be able to look at data but there was nothing to look at. The fact that I was asking those questions as a staff nurse was weird to people."

About 25 years later, Makar is now a finance clinical coordinator in the decision support department at Yale New Haven Health System. She was also recently recognized by the American Medical Informatics Association as an emerging leader in the field of nursing informatics.

"Nursing is one of those things and has been referred to as the glue that keeps everything together," Makar says. "Nursing can get hidden because the data is part of other data sets and it's not necessarily associated with nursing. So that's what I'm working on."

But when Makar started down the path toward nursing informatics, she didn't quite know where she was headed.

"It's one of those things that's like a journey when you look back on it—it started early," she says. "You don't realize you're getting there until you're there."

After three years in the ICU, Makar ended up in managed care for the next 10 years.

"It was the late '80s, going into the '90s, when indemnity plans were switching to HMOs and it was all about data," she says. "Bringing in disease management programs and looking at the cost of care was just starting to happen. The health plans were the ones with the computer systems and the power to do that."

But even with this technology, Makar faced an uphill battle. Nursing informatics was still an emerging field and didn't have a certification until 1995. She also had to struggle to use the data she collected to disprove common perceptions, such as the time involved in telling customers their benefits didn't cover certain treatments or other unpleasant news. 

"When I was doing the studies about workflow, people would say, 'Oh no those calls take 20 minutes,' but when you track them, they might have been the most difficult calls but they didn't take that long," she says. "That's how influential perceptions are. When you show them the data and they believe in the data, you can show them what the solutions are."

Next, Makar furthered her experience in analyzing health data when she began working for an IPA, which was the physicians' answer to HMOs at the time, she says.

 "I looked at trends and tracking and evidence to find drivers and improve customer service," she says.

In 2000 Makar transfered to a position with a large New York health plan as an on-call nurse answering patient questions over the phone. The program was a new initiative for the health plan and was created as a counter to an escalation in ER wait times due to non-emergent cases.

"I was on the phone using advanced computer software that today we would call decision-support software," she says.

While working at Oxford, Makar helped a few patients with unique cases. One man who was having a heart attack in a hospital parking lot called the help line to confirm his fears because he was afraid to walk inside. Makar didn't get many calls on September 11, 2001 because cell phone service was out, but the next day she took several calls from people who had fled Manhattan on foot and had developed severe blisters, but didn't want to bother their primary care physician with such a relatively minor problem. Of course, people also called for more severe injuries and because they couldn't get through to their primary care physician.

When Oxford was bought by UnitedHealth Group in 2004, Makar took a buyout package and considered returning to ICU nursing because she had kept up her clinical skills on the weekends. Ultimately, she took a nursing position at a local hospital, but soon decided to enroll in the Yale School of Nursing to earn her master's degree and took her current post at Yale New Haven Health System.

Since she took on the role of finance clinical coordinator for decision support, Makar has focused on collecting and analyzing useful data that speaks to nursing. She believes informatics can make nurses' jobs better and improve patient care.

"Surprisingly, we find nursing data even today it's hand collected—the problem is you are limited on how you can use it," she says. "You have to get really granular with keywords and decision algorithms, which can assist a nurse to offer the best patient care. It's an exciting, dynamic area and it will make a real difference for nurses because nurses are all about patients. If we can have the data speak to nurses' workload, we can make care better for patients."

Using informatics to benefit nurses is also difficult because oftentimes what works for nursing doesn't work for other disciplines, Makar says.

"We have to find solutions that are flexible and scalable enough to work for a variety of stakeholders, so that's why I think it's harder," she says.

But the hard work is worth the effort because when done right, real-time informatics truly benefit both nurses and patients.

"If you have data that tells you this is an unusually high day for patients at risk for falls, or the population on this shift has really vulnerable patients, it will change how you think about it," she says. "To a certain degree that information was kept separate with each individual patient. Aggregated data is very important, but you still must be able to get back down to the individual patient and staff level."

In the future Makar says she would like to take on a broader leadership role, possibly at a national organization related to nursing informatics. As far as what's in the cards for decision support, Makar thinks the field will become more high-tech and commonplace.

"We're at that tipping point and it's going to be one of those things where people will be saying, 'I can't believe we didn't do this before,'" she says.

Marianne Aiello is a contributing writer at HealthLeaders Media.

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