Meaningful Use for Nurses: Implications and Recommendations - Essay Example

Meaningful Use for Nurses: Implications and Recommendations This paper examines the Meaningful Use program with regard to its impact on nurses and the nursing profession, health policy, patient outcomes, as well as population health. The program is briefly analyzed in order to better understand its implications for the nursing profession. This analysis is based on the observations of senior healthcare administrators from hospitals with mature electronic medical records systems. Recommendations are brought forward for the collection of additional criteria in order to make stage 1 more efficient. The paper concludes by noting that meaningful use goes beyond simply using technology, it also includes interoperability and healthcare staff’s ability to access and use health information to support the duty and standard of care provided to patients in order to make sound clinical decisions. Keywords: Meaningful use, electronic health records, HITECH Act Meaningful Use for Nurses: Implications and Recommendations Introduction This paper will examine the Meaningful Use program with regard to its impact on nurses and the nursing profession, health policy, patient outcomes, as well as population health. This will be accomplished by providing (i) an overview of the meaningful use program; (ii) an analysis of its implications the nursing profession; (iii) recommendations for the collection of additional criteria; and, (iv) concludes with a summary of the analysis, recommendations, and insights gained about the program. The paper was researched by reviewing medical, nursing and IT journals. The following search terms were used: ‘meaningful use’, ‘nursing meaningful use’; ‘meaningful use in practice operationalize’, ‘meaningful use criteria’; ‘data capture sharing meaningful use’, ‘advance clinical processes meaningful use’; ‘meaningful use improved outcomes.’ Overview of Meaningful Use Meaningful Use refers to the appropriate use of Electronic Health Records (EHR) in the delivery of patient care. The definition itself was subject to sever scrutiny due to the $19 billion in funding initially available under the HITECH Act (Baron, 2010, 90). The definition was left to the Department of Health and Human Services where the definition of the attributes determined which physicians would qualify for incentive payment under the Act. As well, meaningful use also refers to improving healthcare delivery, efficiencies, and the removal of disparities (Baron, 2010, 90) in healthcare delivery. Under the Act, use of EHR must be meaningful, exchange health information electronically, and EHR must also be used to submit clinical quality measures to the Department of Health. The coordination of care, particularly given the multi-disciplinary nature of care delivery, the improvement of population and public health, and addressing privacy and security concerns, are all criteria within the definition of meaningful use. The implications of the bureaucratic tangle that the above variables present, highlights the undeniable fact that delivering healthcare is a highly complex process with multiple players, both at the clinical and policy making levels. In an effort to manage this complexity health information technology (HIT) and EHR have become significant tools in healthcare management. Accenture (2010) notes that for every 500 beds, an organization spends $50 million in EMR related investment and that the process can take as long as four years from initial planning to implementation (Accenture, 2010). The top hospitals with mature EMRs indicate in a study the five factors that impacted the meaningful use process. These were identified as, first, time: the process takes longer than generally expected and costs more; secondly, the acquisition of talented healthcare staff was a necessity; third, IT costs increased; fourth, EMR required different thinking; and, fifth, that the healthcare culture of the organization needs to support the adoption of new methods of delivering healthcare (Accenture, 2010). When these factors are examined and viewed through the lens of the nursing profession, national health policy, patient outcomes, and, population health, the degree of adaptability required by healthcare professionals, both clinical and administrative, becomes more obvious. Analysis Using the observations of the top hospitals, noted above, an analysis of the implications for nursing, national health policy, patient outcomes, population health reveals the following. Healthcare professionals are highly stressed for time. When the additional time that is required to learn the new EHR processes, particularly over the course of 4 years, is factored into a professional life, the time commitment is significant. Ongoing professional development related to clinical matters already takes up a significant amount of personal time. Organizational training is also a factor that takes up time. To this would be added EHR training. Many nursing staff find additional time commitment stressful and while the necessity is understood, nurses have concerns about non-clinical training taking away from clinical training and time. Research suggests, however, that if organizations plan for evidence based practice change, that staff will feel better able to cope and adapt their practice to meet the presented evidence (Gale & Schaffer, 2009, 97). Acquiring healthcare staff with appropriate IT skills was identified as an issue by senior hospital administration staff (Accenture, 2010). This could be related to more senior IT staff to administer and maintain the EHR, especially as a project advances over the course of four years. This is related to the direction of IT operational issues and begs the questions of whether there is a difference in operational staff vs. clinical staff response to new technology and processes? Research shows that nurses actually preferred the use of EHR because they believed that patient care and safety improves (Moody, Slocumb, Berg, & Jackson, 2004, 344). Nursing staff were, however, frustrated with issues related to system downtime, when the system was slow, other staff not being computer literate and disliking the use of the EHR, insufficient numbers of computers, duplicate data entry, log-on issues, to name a few issues (Moody, Slocumb, Berg, & Jackson, 2004, 342). In terms of IT costs, as noted above, many senior healthcare administrators noted that the implementation process took longer than initially scheduled and cost more. There was an 80% increase in the operation expenses of the IT department and the budget increased overall by some 1.8% (Accenture, 2010). In using the criteria of the senior healthcare administrators, thinking differently is a prerequisit to being able to work in a strong EHR environment. Nursing staff who are traditional thinkers and who experience difficulty adapting to change, would be in a handicapped position professionally, as EHR is the future. Difficulty now would mean difficulty throughout a nursing professional’s career. Hand –in–hand with this latter criteria in looking at meaningful use of EHR and keeping stage one criteria in mind, is the ability of the organization to both support adopt and adapt to new technology. If senior management is not behind the use of EHR and not behind the appropriate and proper training of staff in its use, nursing staff and other healthcare professionals will experience difficulty in the change process. Of note in terms of public health, is the collection of clinical quality measures to be sent to the Department of Health. This is significant because the collection of this data would allow for better public health coverage. Reportable diseases would be better tracked and, for example, outbreaks identified much more easily. Meaningful Use Recommendations Recommendations for meaningful use criteria would be the following: (i) organizations need to ensure that the appropriate training time and resources are available to staff; (ii) the timeframe from planning to implementation needs to be reexamined and better planning made around implementation issues; and, (iii) operational issues such as downtime, log-on issues, and slow systems needs to reassessed by the IT program staff before the implementation on the floor takes place. The above recommendations are made in order to reduce the difficult that change brings to any organization as well as to professional staff. If staff is better able to understand the use and need for new technology, there will be less resistance to use and more engagement with the new EHR systems. Conclusion To conclude, meaningful use goes beyond simply the use of technology. Meaningful use includes interoperability and the ability of staff to access and use health information so that the standard of care of an organization, as well as clinical decision making, can improve. Research indicates that this is a long process for organizations, evidenced by the six years that the Group Health organization spent developing and working on their EHR delivery model in order to optimize the program to function efficiently (Ralston, Coleman, Reid, Handley, & Larson, 2010, 612). As well, the ability of healthcare professionals to use time more efficiently so that patient centered care is the focus of their profession, is an important one that could be better facilitated by use of EHR. Patients are better supported if healthcare information is more easily accessible to their healthcare team. (Ralston, Coleman, Reid, Handley, & Larson, 2010, 611-612). Bibliography Accenture. (2010). Finding Meaning in Meaningful Use: Insights into Achieving EMR Success. Retrieved from Accenture: http://www.accenture.com/SiteCollectionDocuments/PDF/Accenture_HPS_Health_Achieving_EMR_Success.pdf Baron, R. (2010). Meaningful Use of Health Information Technology in Managing Information. Journal of the American Medical Association, Vol 304 (1), 89-90. Gale, B., & Schaffer, M. (2009). Organizational Readiness for Evidence-based Practice. Journal of Nursing Administration, Vol. 39 (2), 91-97. Moody, L., Slocumb, E., Berg, B., & Jackson, D. (2004). Electronic Health Records Documentation in Nursing: Nurses Perceptions, Attitudes, and Preferences. Comput Inform Nurs, Vol. 22(6), 337-344. Ralston, J., Coleman, K., Reid, R., Handley, M., & Larson, E. (2010). Patient Experience Shoudl be Part of Meaningful-Use Criteria. Health Affairs, Vol. 29(4), 607-613. Read More