Nursing's New Voice at the ONC

Rebecca Freeman's IT background and real-world nursing experience will help inform her agenda as CNO for the Office of the National Coordinator.

Nurse leaders often feel frustrated, flummoxed, and frazzled by the government rules and regulations that affect the healthcare industry. After all, we went into nursing to help people, not to decipher legislative jargon created by bureaucrats who aren't clinicians and don't understand what nurses do.

Well, nurses have a new voice in the federal government who understands those sentiments.

On Sept. 8, Rebecca Freeman, RN, PhD, PMP, became chief nursing officer at the Office of the National Coordinator for Health Information Technology, the federal government agency responsible for coordinating implementation and use of health IT and the electronic exchange of health information. And even though she has been in the role for only "two seconds," she took time to speak with me about her background, her goals, and her thoughts on how health IT affects the nursing profession.

Going Full-Circle
Freeman's background makes her particularly suited to understanding nursing's needs as they relate to health IT.

"My first career was in information technology, just straight up IT, and the last ten years or so I worked in networking," she told me. "Ironically, I was really tired of playing with computers, and I thought I would never touch another computer again. I wanted to do something really meaningful and nursing school was a perfect fit for that."

Freeman got her BSN in 2008 and went to work providing bedside care in the emergency department.
It soon became apparent her IT skills were something that could be used to benefit the nursing profession and patient care.

"I realized there were not a lot of highly technical people working in the nursing arena, and I pretty quickly got pulled back into health IT," she says. "I loved the bedside, and I miss that, but I feel like I'm helping nursing, patients, and allied health in a really different way. There are a lot of amazing emergency nurses so they could suffer the loss of me, but I think I can really provide a unique skill set to nursing informatics."

In addition to providing clinical bedside care, which she did up until 2013, Freeman has also held positions as chief nursing informatics officer and manager of nursing informatics at the Medical University of South Carolina in Charleston, and as assistant vice president and Epic national nurse champion at Nashville-based HCA.

The Ugly Duckling that is Data
Freeman has seen how health IT affects bedside nurses, clinical providers, and hospitals, and she understands its use can be akin to either unlocking a Pandora's box or a treasure chest, depending on how it's implemented.

"I saw first-hand the impact of poor implementation on patient outcomes, data, and all of the bedside clinicians' work," she says. "One of the things I like to talk about is quote, unquote, 'ugly EHR implementation' because it does make things very difficult for lots of folks at the bedside."

We all know how this type of IT implementation plays out in real life. Decreased time at the bedside. Increased time documenting. Interrupted workflows.

But the blame can't solely be placed on health IT and EHRs Freeman says.

"The EHR kind of blows things up," she says. "The EHR is just highlighting lots and lots of issues with workflow and communication." Freeman points to documentation standards as one problem that may be unearthed by EHR implementation.

"Documentation standards aren't always standard. Scales and screenings are a good example," she explains. "If we have ten scales and screenings for something, and they're all evidence-based, is there a clear one that is the best? If we could all agree to use that one….now we have the exact same data across all facilities so the interoperability piece is made much easier because a score of seven at one hospital is actually equal to a score of seven at another hospital."

Refining data is something that needs to be done in order to strengthen its usefulness, Freeman says.
"The first thing we have to look at, in the short term, is cleaning up the data sets so that we have valuable data," she says.

"We're gathering all kinds of data, just every data variable imaginable, and a lot of those data inputs haven't really proven their worth. So for many of the higher-level decision makers, they have some quality data they can use to impact nursing practice, but they also frequently have more data than they really know what to do with."

While there now seems to be an overabundance of data, Freeman still sees the potential it has to influence nursing practice.

"I think once we have a really purposeful design of a data set, then absolutely, we can make things more efficient," she says. "We can improve outcomes, we can figure out what nursing does—so quantifying nursing work— and that includes workloads tied with patient acuity. Once we get a really solid, clean, valuable data set, we can impact practice at the bedside for everyone—nursing and everyone else—especially as we go towards these more creative payment models."

Getting Started
Like anyone starting a new job, Freeman is busy getting her feet under her and learning the lay of the land.

"I have a lot of things on my docket but, being brand new to the federal government, I'm really in listening and learning mode right now," she says. "I have a whole lot of nursing interest just within the federal government across agencies—even just within the ONC—it's very reflective of the nursing community at large."

Freeman's role also extends beyond the federal government.

"I'm going to be meeting with lots of external groups and individuals to get a feel for how to pull all of their interests and all of their wish lists together and match it with the ONC initiatives," she says. "Folks say it's hard to jump through all of the hoops, especially when they aren't in alignment."