EHR IN THE NURSING CURRICULUM: IS IT NECESSARY? WHERE TO BEGIN? Laura Gonzalez PhD, ARNP, CNE Spring 2013

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1 1 EHR IN THE NURSING CURRICULUM: IS IT NECESSARY? WHERE TO BEGIN? Laura Gonzalez PhD, ARNP, CNE Spring 2013

2 2 Disclosure I am a Pearson Faculty Consultant and on the Speakers Bureau

3 3 Objectives Participant will appreciate the importance of the EHR in the nursing learning process Participant will leave with valuable ideas for a logical approach for integration of an EHR Participant will be able to identify things to consider when purchasing an EHR

4 Fetter, CURRENT EXPECTATIONS Students should have minimal HIT competency,

5 5 Current State There is a lack of faculty expertise in HIT Lack of infrastructure to support HIT within nursing program Lack of HIT initiatives within the curriculum Technology is advancing so fast in clinical setting, novice nurses lack technology skills

6 6 Opportunity In a study done by Jones & Donelle (2011) students were asked to complete six patient assessment tasks linked to electronic patient documentation using fictional cases. Each task ranged form simple to more complex. Findings: 23% did NOT review history 62% reviewed some of the history Student were unfamiliar with e-document tools Only 23% of students closed out of the browser, leaving confidential data accessible.

7 7 Discussion The results from this study suggest preliminarily fictional patient cases is effective in providing learners with a safe and controlled strategy for learning patient electronic documentation Use of EHR fictional cases was determined to be effective way to increase confidence and skill This type of learning decreased theory-to-practice gap

8 8 Why is exposure to an EHR important? Using an EHR as a teaching tool facilitates the application of theory to practice Alternatively students found use of a training EHR to be an effective tool to support the nursing process Increase the application of theory to a realistic case scenario Not so much about learning an EHR More about learning the nursing process

9 9 Practical Aspects Improved information availability & reliability Better quality of records Improved legibility Eliminates barriers for ESL students

10 Mahon, Nickitas & Nokes, Faculty Perception on Documentation Average age of faculty well in the 50s, most faculty have long practiced paper documentation Nursing faculty ARE still having students write narrative notes and editing each notes Still considered by faculty a viable 1 on 1 teachinglearning strategy Faculty highly reliant on preceptors to teach EHR process to students * this will become obsolete

11 Mahon, Nickitas & Nokes (2010) 11 Importance All three major professional nursing associations as well as nursing informatics coalition, have published policy statements that support competency in nursing informatics for all practicing nurses, as well as student nurses NLN advocates that all students graduate with up-to date knowledge and skills in each of the critical areas: computer literacy, information literacy, and informatics

12 12 QSEN Competencies and Skill Development Seek education about how information is managed in care settings before providing care Apply technology and information management tools to support safe processes of care Navigate the electronic health record Document and plan patient care in an electronic health record Employ communication technologies to coordinate care for patients Respond appropriately to clinical decision-making supports and alerts Use information management tools to monitor outcomes of care processes Use high quality electronic sources of healthcare information

13 13 IOM Recommendations 1. Support clinical informatics 2. Evidenced-base practice 3. Provide patient-centered care 4. Work in interdisciplinary teams 5. Apply quality improvements

14 14 Why is it important? Informatics identified as 1 of the 5 areas of competence in health professions education Supports informatics standards and competencies set by NLN, QSEN Provides a means for interdisciplinary education Prepare graduates to be confident and proficient using information technology in the work setting

15 15 ARE YOU CONVINCED? If so now what?

16 16 Investigate and Plan Use a committee approach, informatics knowledge nice but not important 1. Create a plan Identify and prioritize objectives Documentation Critical thinking and decision making Learning management Identify criteria based on established objectives Establish timeline for review and selection process Identify potential vendors Arrange for vendor demonstration Prepare questions to ask during the demonstration Evaluate and make selection

17 17

18 18 Baby Steps Create a roll out plan Recommend avoiding the big bang approach Identify initial placement in the curriculum Simulation Skills lab Support lecture Data hunt Develop plan for integration throughout the curriculum Be realistic the EHR doesn t have to be in every course Starting point may be determined by faculty champions

19 19 FACULTY NEED TO COMMIT Get comfortable with product, and functionality nothing ensures failure like lack of preparation on the part of the faculty students can smell it!

20 Become familiar with the product before introducing to students Common features and functions: Documentation Structured, free text, discipline specific Results View Assessments Lab Diagnostics with images Order Management What type of orders are included? Medication Administration with barcoding Alerts, embedded decision support ADE alerts Reference ranges Reference text Active Links Inbox Messaging 20

21 21 Potential Curricular Placement Typical curriculum includes Sem I Fundamentals/foundations & Health Assessment Sem II Adult Health, Psych, * Pharmacy Sem III Adult Health, Maternal-Child, Community Sem IV Leadership, Electives

22 22 Exemplars: Health Assessment- During the health assessment theory pull up the physical assessment screens, use a head-totoe approach and instruct students on what is typically assessed in terms of data points, show students how to document. This is a great *passive way to learn medical terminology. During lab have students examine one another and document immediately afterwards. Have student perform head-to-toe for final exam AND document exam as part of assessment

23 23 Exemplars Foundations/Skills: during the psychomotor section of lab Foley catheter insertion, suctioning, always end lab with student documenting specific skill, This ensures this becomes part of the nursing care Great way to create an e-portfolio

24 24 Exemplar Adult Health: During theory use case studies as enhancements to lecture, assign a case and have student break in to teams and retrieve data and come up with conclusions based on available data. Consider using a case study if a student misses a clinical day which CANNOT be made up or for remediation

25 25 Exemplar Leadership: Use embedded data and dashboards for assignments, instruct students to identify trends and potential QI issues

26 26 Exemplar Simulation: by using an EHR you have added an additional dimension to your sim program. Have student review data BEFORE sim, or have them discover information in-time Assign a student role of scribe, have your EHR available on a WOW and have student document in real-time, great adjunct for debriefing

27 27 ADDITIONAL THINGS TO CONSIDER

28 28 Broaden the student experience Teach process and content within the context of an electronic health record Enrich skills lab activities Augment case scenarios Enhance Simulation activities to evaluate decision making and critical thinking

29 29 Are activities built in? Are they leveled for the particular learner

30 30 Are there robust case studies? Across the curriculum

31 31 Meet Informatics Competencies By using an EHR you are meeting the competencies

32 Documenting and Planning Care 32

33 33 Documenting and Planning Care Best practice for teaching health assessment

34 Evidenced Based Patient Care 34

35 35 Document & Planning Care

36 Point of Learning Support 36

37 Point of Learning Support 37

38 Point of Learning Support 38

39 Alerts 39

40 Opportunity to provide faculty feedback 40

41 41 Longitudinal Record of Student Performance

42 42 Closing thoughts Research is needed to determine best teaching approaches and tools to promote informatics competency within the undergraduate curriculum It is not an overnight process Hold the gain! Need administrative buy-in

43 43 DISCUSSION Questions? Feel free to contact me at

44 44 References Fetter, M.S. ( 2009). Collaborating to optimize the nursing students agency information technology use. CIN: Computers, Informatics, Nursing. 27 (6) Jones, S. & Donelle, L. ( 2011). Assessment of electronic health record usability with undergraduate nursing students. International Journal of Nursing Scholarship. 8 (1) Mahon, P.Y., Nickitas, D.M., & Nokes, K.M. (2010). Faculty perception of student documentation skills during the transition from paper-based to electronic health record systems. Journal of Nursing Education. 49 (11)