Transforming Nursing & Healthcare Through Technology

As the complexity of healthcare increases and becomes more reliant on information technology, it is important that all nurses, especially those in informatics, are familiar with workflow analysis and how a workflow may be influenced by technology (McGonigle & Mastrian, 2015).  Although technology can greatly improve an organization’s safety, quality, and efficiency, implementing new technology without consideration as to how workflow is impacted may lead an opposite effect of more danger and inefficiency instead (McGonigle & Mastrian, 2015).

Transforming Nursing & Healthcare Through Technology Workflow and Vendor Selection

In the two years that I have been at my organization, I was directly involved in the planning and implementation of the introduction of a new technology that would utilize barcode scanning for storing and administering breast milk.  During this project we were asked to map our current and proposed future workflows after receiving education and an overview of the new program we would be using.  Although we were able to outline inefficiencies in the current process, we were only able to correct them in the future state as far as the new technology would allow.  Identifying and outlining the current workflow before a vendor is even selected would have made it possible to design a truly ideal future workflow and see what how different vendors could help us accomplish it and which would work best for our organization (U.S. Department of Health & Human Services, n.d.).  Ideal future state workflows should not have to accommodate a system but rather find a system that best accommodates them, then proposed workflows can be adjusted once an appropriate vendor and program is selected (U.S. Department of Health & Human Services, n.d.).

Concept 2

When I assisted in the planning and implementation of the breast milk scanning system there were team members who had been trained in EQIP processes which is a type of performance improvement tool.  They provided us with a quick overview of how to put together flowcharts and asked us to put them together for our areas current workflow.  Although having the overview of flowcharts and an example to refer to was helpful, it would have also been helpful to understand each of the steps involved in mapping workflow with flowcharts.  Those steps include selecting the process to be evaluated and what team members should be involved, creating a preliminary flowchart, adding detail to it, selecting individuals to observe or interview to assess its correctness, and updating the flowchart based on those interviews and observations (U.S. Department of Health & Human Services, n.d.).   The use of swim-lanes and determining value added versus non-value added steps that can be eliminated would have also been useful training to receive in order to develop the best future state workflow possible (McGonigle & Mastrian, 2015).

Usability Tools

A last concept that I found very interesting from the U.S. Department of Health and Human Services (n.d.) is the use of usability tools and evaluations.  These tools can be used before purchasing a system to see how well it may work with the needs of an organization or after its purchase to determine what improvements can be made (U.S. Department of Health & Human Services, n.d.).   Usability tools can also be used during the planning and design phase of a project in order to gain access to feedback from frontline users and suggestions for designs and workflow (U.S. Department of Health & Human Services, n.d.).   I feel that using ttols such as this during the optimization phase of the several different IT system builds we have put forth in the last few years could help us to see if the future state we had proposed has been obtained and what improvements we can make to get them closer to fruition.

Article Summary

Saleem, Patterson, Militello, Render, Orshansky, and Asch (2005) performed an observational study in order to determine the barriers and facilitators to health care professionals using computerized clinical reminders (CRs) efficiently and effectively.  During their observations they found barriers with subcategories that involved lack of coordination or confusion between nurses and clinicians; lack of coordination involving paper workarounds during patient intake and examination; addressing CRs while not with the patient which did not allow for optimal answering; perceptions of not enough time, CRs not being a core activity, and documentation being duplicated by CRs; CRs not having appropriate answer selections, freezing requiring them to be abandoned, or differing from clinical judgement of the provider; and limitations to technology such as speed and difficulty finding CRs (Saleem et al., 2005).  The facilitators discovered were limiting the number of CRs that fire, have computers located in efficient spaces, and integrate CRs into the workflow (Saleem et al., 2005).

With the barriers and facilitators identified by Saleem and his colleagues (2005) it would be beneficial for my organization to perform similar observations and record what is found within it.  Recently in my organization there has been much discussion regarding alert fatigue and how alerts may be ignored if staff are inundated by them every shift.  Observations and interviews with front line staff could help us to have an idea of where we still have barriers and workarounds that need to be improved.

Monitoring Technology and Workflow

The addition of technology to improve the quality of care cannot stop at implementation alone but must be monitored to ensure the goals of implementation are being met (McGonigle & Mastrian, 2015).  If technology is implemented and end state workflow is not assessed, there is no way for an organization to know whether the technology is improving care or impeding it by causing potentially dangerous workarounds due to inefficiencies, etc (McGonigle & Mastrian, 2015).  Instead, monitoring of process metrics associated with the system and workflow for potential weaknesses and performance improvement needs should be a continual duty of an organization (McGonigle & Mastrian, 2015).

 

References

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge (3rd ed.). Burlington, MA: Jones and Bartlett Learning.

Saleem, J., Patterson, E., Militello, L., Render, M., Orshansky, G., & Asch, S. (n.d). Exploring barriers and facilitators to the use of computerized clinical reminders. Journal Of The American Medical Informatics Association, 12(4), 438-447.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1174889/?tool=pubmed

U.S. Department of Health & Human Services. (n.d.). Workflow assessment for health IT toolkit. Retrieved, June 18, 2012, from http://healthit.ahrq.gov/portal/server.pt/community/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865