the trouble with nursing IS

by Roy L. Simpson, RN, C, CCMA, FNAP, FAAN

We all know that time is tight and dollars are short in healthcare today. Increasingly, information technology is cast as the silver bullet that will reduce costs, increase productivity, and improve caregivers’ workplaces. Sure, it is expensive, but surely healthcare organizations realize its value, right? Don’t be so sure – especially when nursing information systems are the technology in question. With organizations questioning all expenditures, it is no surprise that they are increasingly asking, “Why?” when it comes to nursing information systems. And if nursing is to survive, it had better have an answer to that question.

Generally speaking, nurses use information systems (IS) for three things: education (of nurses and others), administration/management, and patient care delivery.1


Nursing systems can:

maintain outcomes and demographic and health-related data to help
organizations better manage what care they provide and to whom
eliminate routine manual documentation, optimizing human resources
improve accuracy and completeness to ensure timely reimbursement
support practice decisions aimed at providing higher-quality care at
a lower cost1
But do we use them effectively? Or, more important, can we? The reality of nursing suggests not. Why not? For many reasons, two of which are:

For the record, nursing notes are not there. Traditionally, nursing work has been “invisible,” because caregiving and nurturing are highly subjective and difficult to measure.2 So when electronic storage space is limited, the records of nursing care and activity tend to be removed from medical records as soon as possible following an episode of care. In fact, nursing records are often the first items to be purged from patient records, leaving no lasting documentation of nursing diagnoses or nursing interventions and providing no viable way to store or retrieve nursing data.3 As resources dwindle, space is available only for what is vital – and for many organizations, that does not include nursing notes. Most organizations view nurses’ notes as communication between nurses and physicians, relevant only during the episode of care. To save time and money by reducing bulk and making medical records less cumbersome to handle, some hospitals simply remove the nurses’ notes from records (of adult patients) after discharge. The records are then filed in chronological order in a place less accessible than the current files until the statute of limitations has expired and they can be destroyed.
Nursing systems do not work the way nurses do. In the beginning, there was fee-for-service. And when the only problem with reimbursement was how fast an organization could get it, healthcare witnessed the birth of its first automated computer information systems. Financial in nature, these systems were designed to get the bill out so an organization could get the reimbursement in – as quickly as possible. But then along came diagnostic-related groups (DRGs), prospective payment, and managed care. Gone were the days of “if you provide it, they will pay.” In the new reimbursement order, providers had to justify what they did by proving that it produced an outcome worth paying for. Suddenly, finance-centric systems were insufficient. They could not collect enough patient data or the type of data they needed to analyze care. Enter the patient-centered clinical information system, which, unfortunately, was built on non-clinical data structures. IS systems that don’t work the way nurses work, don’t work for nursing.

Whose fault is it that nursing systems aren’t all they should be? Ironically, it is nursing’s fault. We know our primary job is care. So, we take ourselves out of the loop – focusing entirely on patient care – when it comes to decision making for key IS systems.

What can you do? Speak up. Staff nurses know better than anyone else does what works and what doesn’t. In most cases, it is not that administration and the IS department don’t care what you have to say, it is simply that you do not have the opportunity nor the means to say it. In fact, to achieve Magnet-hospital status, an organization must demonstrate that its managers value staff, listening to and involving them whenever possible.

Is there an information technology committee at your hospital? Find out who is on it and how it operates. During the system selection process is the time when your voice is most critical and when the people choosing the system are most open to hearing it. Go to meetings if you can; send emails or memos if you can’t.

Are you a member of a professional organization? Of the 2.5 million nurses in the U.S., only 200,000 are members of professional organizations, a key source of advocacy for, and development of, nursing informatics and technology. There are all kinds of IS committees – domestic and international – working on informatics issues. Find out about them and what they are doing.

At the end of your day, you should be able to see how IS helped you. If you can’t, then it is time to do something about it. Help nursing IS work for nursing. The workplace and your workday depend on it.

References

1. McMurchie, C. (1997). What is the use of nursing information? Information Technology in Nursing, 9. Retrieved August 24, 2006, from http://www.bcsnsg.org.uk/itin09/mcmurch.htm
2. Bowker, G. C. (1997). Lest we remember: Organizational forgetting and the production of knowledge. Accounting, Management, and Information Technologies 7(3), 113-138.
3. Castles, M. R. (1981). Nursing diagnosis: Standardization of nomenclature. Harriet H. Werley & Margaret R. Grier (Eds.), Nursing information systems. New York: Springer. pp. 36-44.

Roy L. Simpson, RN, C, CCMA (Certified Case Management Administrator), FNAP (Fellow of the National Academies of Practice), FAAN (Fellow of the American Academy of Nursing), is vice president of nursing informatics at Cerner Corporation, Kansas City, MO