With hospitals preparing to demonstrate meaningful use of electronic health records (EHRs) to qualify for financial subsidies under the American Recovery and Reinvestment Act (ARRA), nurses around the country are understandably concerned about the impact the systems will have on their job functions, patient care activities, and productivity.
In recent years, I have been involved in two highly successful IT implementations: I helped install an EHR in the emergency department (ED) at Union Hospital and a major system upgrade in the ED at Newark Beth Israel Medical Center. The implementations were part of a strategic initiative that Saint Barnabas Health Care System—the largest integrated delivery network in New Jersey—launched in 2002 to automate its six hospital system by 2012.
Based on my experience, I am confident nurses will view EHR as one of the best things that could have happened to them and their patients, once they learn and start using the system. While RNs will have to go through a period of adjustment, they will discover that the learning curve is not as steep as they fear or imagine. Organizations and nurse managers can ensure a successful transition and no downtime resulting from electronic records by focusing in the following areas:
1.Get nurses involved in the EHR selection process
First, it is important for organizations to select a system that is intuitive, matches the ED workflow, and enables nurses to deliver care more efficiently and effectively. All systems are not alike and the system selected can greatly impact nursing workflow and job satisfaction. Wisely, Saint Barnabas made sure nurses were strongly represented on the committees that evaluated EHRs for Union and Newark Beth Israel.
The committees at both hospitals selected an EHR that is specifically designed for emergency departments, EDIMS. At Newark Beth Israel, EDIMS proved to be so easy to use that ED nurses successfully lobbied nursing directors and hospital management to upgrade the system, which was initially implemented in 2006. In November 2009, the facility installed the latest version of the software, which is interfaced with the inpatient EHR. Union Hospital deployed its EHR in 2004
2). Show value to nurses early on
When Saint Barnabas automates a hospital, it starts the project in the ED because it believes the best and fastest way to win over employees is to prove the value of an EHR in a demanding and complex environment.
By streamlining access to information, offering decision support as well as enhancing efficiency and coordination in the ED—which historically has the highest volume and treats the most seriously ill patients—the health system can quickly show the usefulness of the EHR. Once nurses see the positive impact the technology has on productivity, as well as on quality, safety and efficiency of care, they not only embrace the system but also promote it to ED colleagues within and across other hospitals.
3. Provide clinicians as training resources
A major reason Saint Barnabas has successfully implemented EHRs in its EDs is that its trainers are either practicing or former ED RNs and/or physicians. These trainers carried a lot of credibility with our staff—they were one of us with many of them using the same EHR in their own EDs.
Having good clinical educators walking around the floors before, during, and after implementation is a key to securing clinician acceptance. Nurses and physicians will ask questions; the faster they get answers, the quicker they will learn to use and fully leverage the system. For example, when Newark Beth Israel upgraded its EHR last year, trainers were on the floors around-the-clock for five days. To complement the vendor’s clinical resources, they and the hospital also had IT employees on-site ready to address any technical issues.
The vendor’s ability and willingness to provide fast support to users was a high priority for the hospital because it recognized that nurses and physicians could potentially resist adopting the EHR if their questions or problems weren’t resolved in a timely fashion. At Saint Barnabas, we encountered some resistance from older nurses who were uncomfortable using computers. Through one-on-one training with the apprehensive nurses, Saint Barnabas was able to quickly ease their minds and bring them up-to-speed on how to use the EHR successfully.
4. Recruit super users
Hospitals, of course, cannot afford to engage vendors on site indefinitely. To fill the gap, Newark Beth Israel identified and recruited a dozen “super users” to help peers use the EHR after the vendor’s departure. There is at least one super user on every shift at the ED, which is staffed by 95 nurses and is one of the state’s busiest EDs by patient volume.
Identifying super users is not difficult; they stand out because they love to teach, are computer savvy, and enjoy helping peers. At Saint Barnabas, super users—who receive additional training—help the organization promote the EHR in two ways. First, they show their peers the benefits of using the technology. Second, they train new employees to use the system, which usually consists of less than four hours during the orientation period.
5. Keep training intimate and timely
Organizations also should pay attention to class size and the timing of when to train users prior to go-live. At Saint Barnabas, we limited the size of our training classes to 10 people and scheduled training in a test environment 14 days before activating our ED EHR. Keeping the classes small and the training period close to the implementation date ensures a successful adoption of the EHR.
The Results
Following these simple steps made the EHR transitions at Union and Newark Beth Israel seamless and nearly painless. ED nurses at Newark Beth Israel were grateful for being able to document and find the information they need at the bedside. The EHR has made their lives easier by reducing time spent on administrative tasks, eliminating duplicate order entry, and dramatically improving turnaround time for lab results.
Deborah Canfield, RN, is the manager of nursing informatics for East Orange General Hospital. She worked in the emergency departments at Saint Barnabas HealthCare System for 13 years.