Tuesday, July 9, 2013

NUR 701 WA 2 with Update


What I Learned
 The world of healthcare is changing and so are the tools we use to care for patients.  The nature of documentation is a prickly one as there are so many different facets that require accurate notation.  This is especially apparrent in the care of pressure ulcers.  These skin problems are costing hospitals millions of dollars for care because of inaccurate documentation.  The need to educate the young nursing students about importance of documentation and accuracy is essential for the future.  I am actually surprised that the focus of nursing school was not completely on what costs the hospitals the most money but a complete caring, holistic approach.  I fear that in the future school will be focused on the more cost cutting, the better.


Siu Bong Wan
Module 2 Nur 701
Teaching Home Care Electronic Documentation Skills to Undergraduate Nursing Students
Kathleen M. Nokes, Judith Aponte, Donna M. Nickitas, Pamela Y. Mahon, Betsy Rodgers, Nancy Reyes, Joan Chaya, and Martin Dornbaum
Nursing Education Perspectives
NOKES, K. M., APONTE, J., NICKITAS, D. M., MAHON, P. Y., RODGERS, B., REYES, N., & ... DORNBAUM, M. (2012). Teaching Home Care Electronic Documentation Skills to Undergraduate Nursing Students. Nursing Education Perspectives, 33(2), 111-115. doi:10.5480/1536-5026-33.2.111

Why was this article, blog, post, or multimedia chosen?

             I chose this article because it interested me.  I went through my nursing curriculum without a class in EHR documentation.  Everything was examples of paper charts and school related template documentation.  This is not how EHR is represented in the real world.  EHRs vary so wildly and many are not standardized.  I wanted to see how effective electronic documentation classes could affect undergraduate nurses. 

What makes it interesting, appropriate, or reputable?

             I found it interesting because this is a new occurrence in the field of undergraduate nursing.  I did not have classes in computer documentation and home care especially.  This kind of field was not a focus for my school and I am curious as to why it was a class offered in this article.  This is a new occurrence and many undergraduate nurses I think could benefit from looking at EHRs in class, instead of orientation when hired.

Is it an opinion? Case study? Research study? Product review?

             This is a literature review of EHR content being taught in nursing schools and the home care settings.  The articles are searched and reviewed to analyze and formulate data for effectiveness.  The research was trying to understand what elements are needed for a competent education the the field of EHR and what is some basic templates in the home care setting of documentation.

What was the need, problem, issue or trend addressed in the article, blog, post, or multimedia?

            The trend being addressed is why are we teaching documentation skills to undergraduates?  This is an important article because it may lead to teaching documentation of EHRs in the classroom, not just for home care either.  These kinds of classes are becoming a trend because of the revolution of electronic charting.  This is being formally introduced in home care with mobile laptops and tablets.  The electronic documentation phenomenon allows less paperwork but more precise documentation of patient data, which is stored digitally.  

What was the solution for which technology had an answer?

            The solution was to introduce OASIS, a government funded reimbursement ready EHR system.  The students are to learn to use the standardized systems that are subsidized by the government and its beneficiaries.  The technology is for students to learn for future reference.  

What implications might this have in healthcare delivery?

             The healthcare system could learn a great deal from EHR introduction in the undergraduate program.  Programs that are standardized by the government for documentation are the most accurate for use in the real world.  This can prove useful because undergraduate students could have a reduced orientation to the computer system or it could help standardize a hospital wide government established EHR system.  The delivery of healthcare is already well into electronic documentation and students rarely see the EHR before being hired by a healthcare facility.  The trend of the curriculum should reflect how the healthcare field is changing and introduce elements that EHRs offer and what they can hope to expect when entering the healthcare world.  

What did you learn from it that might have application for your practice?

            I learned that the undergraduate populations of nursing students are still not introduced to electronic documentation.  This is the fault of a stagnant curriculum that does not reflect the processes of the real clinical world.  Electronic documentation is the new standard and students have to be introduced to the core components of documentation for home care or hospital care.  These kinds of classes could help students adjust to the EHR templates that are required for documentation.  This can affect my practice if I intend to go into a teaching position in undergraduate education.  I could introduce the core components of EHRs and what makes them similar versus different.  The government can facilitate change by standardizing much of the systems that are in use now so it could be easier to teach.  The EHRs currently vary so much and change so rapidly that students may become disenchanted because it may not be the system the students were introduced in school.  Technology advances so fast that hopes of a standard EHR system would prove beneficial for the education of the undergraduate classes.

8 comments:

  1. Adam

    I was curious about your comment,

    "Programs that are standardized by the government for documentation are the most accurate for use in the real world."

    Could you share your thoughts on why this is so??? I was also wondering if you were aware of the TIGER initiative since you might teach in an academic setting in the future...this group is actively working to assure that nursing students are prepared for today's technology...

    Donna

    The Technology Informatics Guiding Education Reform (TIGER). (2013). About TIGER. Retrieved from http://www.tigersummit.com/About_Us.html

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    Replies
    1. From what i have read of the TIGER initiative consists of teaching yes, but to other individiuals that have a background in informatics or nursing. Student nurses are just starting to have classes dedicated to the teaching of EHRs and what documentation systems are available. This is something that has been changing in the curriculum due to the changes in today's workplace. It is about having the future of nursing understand and educate consumers about their health using a multitude of pathways. Whether it be digital, physical handouts, or consultation.

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    2. Adam,
      I am very familiar with OASIS as I have been in home care for 13 years. Oasis is not really a program, it is a standardized set of questions that must be used by Medicare certified home health agencies to collect data and report it to CMS. It is used to determine whether the agency has provided skilled care to the patient that resulted in improvement for the patient (both individual and aggregate data are collected), whether the agency uses best practice processes to deliver care (known as process measures) and to determine payment to the home health agency for the care. An OASIS is not a full assessment, it is embedded in the agency's assessment of the patient. OASIS can be embedded in any EHR application for a home health agency to use, so just as there are many different EHRs for hospitals, so are there many different vendors of EHRS for home health; the vendor can change and the functionality of the EHR may be different, but OASIS is the same everywhere.
      I do like the idea of nursing students learning OASIS on whatever EHR the agency uses because even though it can be cumbersome (it is a lot of questions, approximately 100 for an admission start of care assessment), it is used to assess the patient's physical, social, financial, and environmental status in their home and community. It's holistic in looking at the patient from many angels and used by home care nurses to determine what other services are necessary for the patient to reach their full potential in their home and community.
      if you are interested in seeing the data collected with the OASIS, you can find it here.
      http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Downloads/HHQIOASISCAllTimePoint.pdf

      And if you would like to see some of the aggregate publicly reported outcomes that are derived from the collected OASIS data you can see it at http://www.medicare.gov/homehealthcompare/search.html
      put in your zip code and a list of agencies comes up that you can compare.
      Rita

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  2. Adam this is a real issue for nursing and for the new graduates coming out of school. There is so much to learn as a new novice nurse that Computer Class 101 is an additional burden on these students. It has taken years to get the simulation models into nursing schools so that nurses can learn from real life scenarios and practice emergency skills and critical thinking. My thought is maybe the education of electronic documentation will be coming in the future. As you mentioned this field is a newer Master's degree in nursing and maybe there are not enough seasoned nurses educators with this knowledge to educate the nurses. I do agree that education on EHR is bordering on mandatory for the future of electronic documentation but there are many different EHR programs and this may add to the difficulty in learning. Nurses need to be able to record and locate patient information in the clinical area and become informed about the upcoming trends in healthcare. "Today this requires all healthcare professionals to have an understanding of computers," (Grain, & Proctor, 2009, pg. 3).
    Reference

    Grain, H., & Procter, P. (2009). About data. In S. Chew (Ed.),

    Using health data. Chatswood, Australia: Elsevier Australia.

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    Replies
    1. Alanna
      I am lucky enough to serve on NJ's Nurse of the Future academic progression workgroup. The workgroup is focusing on seamless transitions from Associate degrees to BSN. According to the Massachusetts model nurse of the future competencies the BSN prepared nurse of the future Informatics and Technology competency "The Nurse of the Future will use information and technology to communicate, manage knowledge, mitigate error, and support decision making
      (QSEN, 2007)." The competency then breaks down the knowledge, attitudes and skills under each competency. Looking at them, it appears that nursing informatics specialists will be required to teach many of these including databases and research applications.

      Massachusetts Department of Higher Education Nursing Initiative.(August, 2010.) Building the framework for the future of nursing education and practice. Nurse of the future nursing core competencies. Retrieved from http://www.mass.edu/currentinit/documents/NursingCoreCompetencies.pdf

      Rita

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  3. Hi Adam,

    Nursing curriculums need to reflect the current practice in healthcare. This includes electronic documentation. I believe the Technology Informatics Guiding Education Reform (TIGER) Initiative is trying to do that. I noticed that Donna mentioned this fact in her reply to you. This initiative is currently working on creating a nursing workforce that is capable of using an EMR, while engaging more nurses in the development of a nationwide HIT infrastructure (Technology Informatics Guiding Education Reform [TIGER], 2010). The achievement of these goals is very important as healthcare providers move toward the adoption of an electronic health record by 2014. At a recent TIGER summit, over 100 leaders from the nation's nursing practice, education, informatics/technology organizations and government agencies focused on one central theme: “creating a vision for the future of nursing that bridges the quality chasm with IT, enabling nurses to use informatics in practice and education to provide safer, high-quality patient care” (TIGER, 2010, para. 2). Changing nursing practice and education that better prepare nurses to work in this automated health care environment need to be implemented in the nursing informatics arena.

    Reference

    Technology Informatics Guiding Education Reform (TIGER). (2010). The TIGER
    Initiative. Retrieved from http://www.tigersummit.com/

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    Replies
    1. I agree. As nursing is becoming a more digitally focused field with electronics nursing informatics importance has significantly increased. The problem is that informatics is more of a graduate nursing curriculum from what I have experienced. The current undergraduate classes do not focus much on electronic documentation because it is "learned on orientation." The focus should not be on when you learn informatics, but what encompasses informatics and how it is used in the workplace today and in the future.

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  4. While reading KevinMD.com’s blog How EMR’s are failing nurses there has been a litany of complaints about the unusability of EMR’s. He spoke about EMR’s adding nothing but more work for the average nurse. He feels that there is a huge opportunity in healthcare EMR’s that is being wasted. I have to agree that some EMR’s need to be more streamlined with less screens. I feel that they are wonderful with the right education and the right EMR, some are more cumbersome than others.
    Fiona Stephan
    Sinclair, J. (2009, Nov 9). How EMR's are failing nurses. Retrieved from Medpage Today's KevinMD.com: www.kevinmd.com

    ReplyDelete