VENDOR APPLICATION

Technology
• ,
when it comes to the nursing world, it has met the patient’s sat
isfaction and give desired outcomes reducing clinical errors. 
• “ As  new technologies continue to emerge, nurse’s role will co
ntinue to evolve, with each advance, bringing a safer and healt
hier future for both nurses and the patients in their care”
Overview    
 This chapter presents the current trends, issues,
obstacles, and opportunities facing the nursing
profession with regard to utilization of HCIT.
The focus was on leading HCIT vendors that
provide organization wide, hospital-centric
information systems, and address nursing
applications in context of a patient-centric EMR.
The response of these vendors to the demand
by nursing for improved information systems was
discussed. In addition, the demand for delivery of
standard-based nursing or clinical data sets with
the software application and how leading vendors
are responding to this demand were presented.
 C U R R E N T T R E N D S TO WA R D P R I M E V E N D O R S , E H R S ,
A N D S Y S T E M S I N T E G R AT I O N

• There are a wide variety of software products offered by an array of diverse vendors that
nurses use to plan, document, manage, and evaluate patient care.
“NICHE” applications focus on a discrete set of nursing functions such as care planning.
“DEPARTMENTAL” systems address a more comprehensive set of functions. This is either
of the three: for a single point of service such as labor and delivery; or department such as
cardiology; or closely aligned group of departments such as the perioperative suite.
These departmental systems are more targeted and robust than comparable modules of
EHR solutions since departmental systems focus on one or a few specialties and points of
service. Thus, Departmental Systems continue to be sought by many organizations,
particularly in academic medical centers and for high acuity, specialized care departments.
• The current trend is to limit niche and departmental systems in order to
create an HER via well-integrated applications with a common
database, tools, and technologies. Although the HCIT environment is by
nature heterogeneous, healthcare organizations (HCOs) increasingly
seek a primary clinical vendor who, to the degree possible, delivers a
single system or suite of tightly coupled solutions that spans all points of
service, automates core clinical processes of physicians and all care
providers, and creates a multidisciplinary, longitudinal, and patient-
centric record.
HCIT vendors do not only offer products that
facilitate patient care, but also create products
that support quality management, staff
scheduling, supply management, and other
patient-care-related nursing activities.
These applications and comparable capabilities
within EHRs are increasing in importance as
virtually every HCO faces quality of care, care
management, and fiscal challenges on which
nursing can have a significant positive impact,
using IT as a tool.
 N EW TEC H N O L O G I ES

• New and emerging hardware and software technologies such as

handheld devices are increasingly being incorporated in nursing
applications.
• Key goals are to improve quality of care, mobility of caregivers and
collaboration among the care team. Currently, strong emphasis is being
placed on delivering technology at the point of care via bedside
terminals and wireless devices such as PDAs and Laptops.
• These bedside terminal accesses can facilitate real-time charting,
increase nursing time at the bedside, and eliminate “batch” end of shift
charting.
 H I STO R I C A L PER SPEC TI VE

• Historically, nurse executives have not widely embraced it as a strategic business

tool.
• The nursing profession has been largely underserved by HCIT vendors, even
though Nursing is one large beneficiaries of IT. 
• There are a variety of reasons why Nursing is not highly provided by these vendors.
• In most national and local healthcare debates, nursing has been essentially
invisible, partly because this is the only profession that does not charge for services
rendered.
• However, currently there is a new breed of registered nurses that are engaging into
the field of informatics.
 C U R R EN T S ITU AT IO N

• The majority of nursing-related patient care applications are acquired as part

of EHR decisions. But some of the products released are poorly designed and
user-unfriendly for nurses, basically because of the following factors:

• Nursing is an untapped and underserved resource in provider organizations.

• Workflow inefficiencies are not well addressed by existing solutions. 
• Automation is not highly priority for nursing in their organizations.
• Vendors are out of sync with nursing needs·     
  
  Some new tools and technologies have complicated rather than simplified nursing practice,
at times decreasing productivity and introducing an element of increased risk to patients.
Root causes of poorly designed nursing applications include:·  
•  Vendor product design processes driven by non-nurse professionals·        
• Insufficient nursing representatives on vendor executive and development teams·        
• Then HCIT industry’s overall woeful lack of adequate requirements definition, functional
specifications, and process analysis·        
• Early focus on automation of the paper chart without a full understanding of underlying
nursing process, workflows, and ergonomic challenges
• In response to patient safety concerns, vendors and provider
organizations have focused on two primary HCIT initiatives; (
• 1) Computerized Physician Order Entry [CPOE] and
• 2) Bar-Code Medication Administration [BCMA].
• The ability of nurses to clearly articulate and promote the value of HCIT
for themselves, their patients, and their organizations could be a crucial
factor in accelerating widespread adoption of advanced nursing
applications.
 V EN D O R R ESP O N SE

In response to market demand, HCIT vendors are delivering more robust

and tightly integrated clinical solutions that better address the needs of all
health care providers for more coordinated, streamlined patient care
delivery.
While some vendors offer clearly superior nursing applications, no
solutions; each has different strengths and limitations.
 C A R E F L O W D IA G R A M

• The care flow diagram is a conceptual model that represents a patient-

centric, interdisciplinary, inpatient-oriented view of a clinical information
system that supports a fully integrated HER.
• The model assumes direct physician use of the HER and represents a
multidisciplinary team approach reflecting emerging care delivery
models.
  K E Y C L IN I C A L SYS TE M N U R SIN G A N D
M U LTID ISC IPL IN A RY C A R E C O N C EPT S

 Patient Access  Workplans – Tasklists

 Admission assessments
 Diagnosis/Problem
 Nursing and Multidisciplinary
Orders and Plans of Care
 Integrated Plans of Care
 Kardex
 Results
 Clinical Documentation
 Discharge summaries
 Summary Reports
 Outcome Variance Reports
 S TA N D A R D TER M IN O L O G Y P R O VI D E D W IT H
C L IN I C A L A PP LIC AT IO N S  

Expectation of the marketplace

• Despite the lack of a national consensus regarding one standard nursing terminology or data
set, HCOs expect their HER vendor to deliver a Standards-based set of nursing content for
charting and planning care.
Current Status
• Responding to this market demand, most of the major HCIT vendors now deliver at least basic
starter set of terminology.
• An increase number of these vendors are including standards-based terminology with their
clinical documentation application as well as evidence-based standards of care with their care
planning and clinical pathway applications, and some are using standard terminologies that map
to SNOMED
[Systematized Nomenclature of Medicine].