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Nurses’ Roles in EMR System Upgrades Creating Opportunities

EMR Jobs Range fromTravel Nurses To Nurse Informaticists

Just as nurses play key roles during hospitals’ implementation of electronic medical records (EMRs), they prove valuable as facilities seek to achieve the next stage of meaningful use and extract data from the records to improve patient care. That creates new opportunities for nurses.

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“As we are refining the systems and getting closer to having them capture data that will lead to outcomes is an optimization issue,” said Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN, vice president of informatics at HIMSS, a global nonprofit organization focused on better health through information technology. “Having nurses involved with the upgrade will enable the systems to be used to their best and optimal purpose.”

The latest HIMSS Nursing Informatics Workforce Survey found nurse informaticists continue to work more on EMR conversions and upgrades, refining and optimizing the systems. Staff nurses also have great ideas about leveraging the systems, she added, and they should be included in planning and discussions.

Master’s-prepared nurse informaticists at South Nassau Communities Hospital in Oceanside, N.Y., work in various capacities, including clinical documentation, core builds, and training. They received additional education and can go in and change the configuration to customize the product to meet the facility’s needs.

“It’s very important to have nurses,” said Barbara B. Guy, RN-BC, MSN, director of the electronic medical record department at South Nassau. “They are strong patient advocates and can look at problems and workflows through the eyes of the different caregivers on the health team.”

Opportunities for staff and contract nurses   

“Nurses can help to make sure [electronic health record] EHR systems are fully functional and meeting the end-user requirements by playing a major role in the choice of the EHR,” said Catherine Fant, PhD, RN, a graduate faculty member with Kaplan University School of Nursing. “Unless nurses are at the table when EHRs are chosen, then the product will not meet their needs, which in turn can compromise patient care.”

Vendors also appreciate nurses’ feedback. Ed Simcox, healthcare practice leader at Logicalis US based in New York, said nurses are his first source of guidance and information when retrofitting a unit with new technology, because “they are masters at making the most efficient use of space and time within the hospital setting.” He recalled shadowing a neurological ICU nurse at a large hospital and asking for her ideas for improving efficiency.

“In 10 minutes, she shared some highly valuable yet very simple system modifications that could save the nurses hundreds of hours of unnecessary screen time just in that one unit,” Simcox said.

Involving nurses increases efficiencies of the system by making it more user-friendly due to their first-hand experience, said Beth Kilmoyer, DNP, RN-BC, nursing informatics manager at Mercy Medical Center in Baltimore.

“Staff nurses are critical to defining the system design to complement the ideal workflows,” added Maureen Scanlan, RN, director of nursing informatics at Montefiore Medical Center in Bronx, N.Y. “In addition, and not less significant, is implementing a system that supports easy adoption by end-users as well as engages the patient. This is best accomplished when staff nurses are involved from the start of the project.

Once systems are in place, nurses help familiarize other clinicians on the team. 

At Holy Cross Hospital in Fort Lauderdale, Fla., nurses also learned the provider portion of the system to assist physicians and mid-level providers if needed.

“Nurses provide elbow-to-elbow support during go-live and are responsible for ongoing education and follow-up,” said Andrew C. Durkel, RN, working in clinical informatics at Holy Cross. “We take feedback from end-users to make changes and additions to improve satisfaction, communication, and patient outcomes.”

Trinity Mother Frances Hospitals and Clinics in Tyler, Texas, trained and deployed new nursing graduates as internal “super users” and contracted with AMN Healthcare’s EMR solutions team to implement their new EMR system. AMN brought in more than 80 contract nurses across various specialties experienced and versed in the software the health care system had selected.

Most of the EMR-trained nurses had been hired by AMN Healthcare, who specializes in EMR conversions and other short-term contract nurse assignments.

“Not only were the individual nurses competent and friendly, AMN’s support role was invaluable,” said Robert Rose, RN, MS, NEA-BC, senior vice president and chief nursing officer at Trinity Mother Frances in a case study. 

With their clinical experience, nurses can help translate changes needed to the information technology people, Guy said.

The next steps for EMR systems 

“Now as the focus moves from implementing to upgrading, we are seeing [nurses’] roles changing,” said Bethany W. Jones, MS, BSN, RN, CPHIMS, health information technology advisor at the Kentucky Regional Extension Center (REC) housed at the University of Kentucky College of Medicine in Lexington.

Nurses have the clinical information and resourcefulness to facilitate electronic transitions of care, help patients access electronic health records online, collaborate among teams, and extract quality data, Jones said.

“Nurses are incredibly effective in navigating this terrain,” Jones said. “Nurses have always been able to think holistically.”

Nurses at Holy Cross design and implement tools to communicate to health care providers across the continuum of care and work with the many different quality indicators that are looked at to stay compliant with accrediting and regulatory agencies, Durkel said.

“EHRs are producing tremendous amounts of data,” Fant reported. “Regardless of the role the nurse plays, whether as a manager, staff or any other position, the nurse will have to deal with these data. Data can be organized, interpreted, and applied to guide the nursing process. The clinical decisions support systems that collect and process data and information enable the nurse to make the critical decisions regarding the health of their patients.”

Opportunities for the future  

Along with short-term contract nursing jobs with EMR systems implementations and upgrades with companies like NurseChoice, nurses can expect to find more long-term career opportunities in the area of health information technology.

“The need [for nurse informaticists] is on the increase,” Sensmeier said. “Their salaries are increasing, and their roles are expanding and changing.”

Kilmoyer agreed that the opportunities are growing. 

“Nurses’ education and work experiences serve really well with technology implementation because we are very analytical and systems organized,” Kilmoyer said.

Additionally, every time the government changes regulations, EHRs will need updating, creating opportunities for nurses to upgrade the systems, Guy said.

“It’s constantly evolving and will never stay static,” Guy added. “There is always a new challenge.”

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