How Nurses and “Non-IT” Factors Can Improve the

Health IT Experience
Rebecca Freeman, PhD, RN
Chief Nursing Officer

Office of the National Coordinator for Health IT || US Department of Health & Human Services
Overview of Key Takeaways

• Overview
» The Health IT Agenda and Hidden Barriers

• Understanding Workflows
» …and the need for formal assessment.

• Implementation Decisions
» Communication Pathways and Automation

• Clinical Decision Support

» Governance

• Nursing Roles

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Overview: The Health IT Agenda

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Overview: The Hidden Causes of Trouble

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Workflows: What You Think You Do

Shared with permission of General Medicine, MUSC.

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Oops, We Forgot Pharmacy…and Registration Does THAT?

Shared with permission of General Medicine, MUSC.

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Ouch

Shared with permission of General Medicine, MUSC.

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The Reality of Primary Care

Shared with permission of General Medicine, MUSC.

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Implementation Decisions

• Training
» Too much, too little, too early, too late. Who is a Super User? SME?

• Documentation
» Inclusion/Exclusion, EBP, and Consolidation

• Informatics
» Use of Informatics Team (Is there an Informatics team?)

• Interdisciplinary Care and Communication

» Does the team work together?
– The system assumes it does.

» Are communication criteria and pathways established?

• Analytics, Culture, IT/Downtime

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Clinical Decision Support

“Clinical decision support (CDS) provides clinicians, staff, patients or other individuals
with knowledge and person-specific information, intelligently filtered or presented at
appropriate times, to enhance health and health care. CDS encompasses a variety of
tools to enhance decision-making in the clinical workflow. These tools include
computerized alerts and reminders to care providers and patients; clinical guidelines;
condition-specific order sets; focused patient data reports and summaries;
documentation templates; diagnostic support, and contextually relevant reference
information, among other tools.”

Governance is only one key component of CDS management. Ineffective

governance, however, can lead to significant safety and quality concerns.

https://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds

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Nursing Roles

• Care Coordination: Registered Nurses (RNs) excel as care coordinators.

» If utilized to the full scope of their practice, aided by protocols, they can do an
incredible number of things!
– In the outpatient setting, under-utilization is common.

– Task-oriented work in the clinic vs. care coordination across settings

» Many have varied backgrounds that make them a consummate team player.

• Informatician: Nursing Informatics professionals can lead governance

initiatives, system requests, and help to clarify workflows. Nurses at the
bedside can serve as Subject Matter Experts and Super Users to better
inform the efficient use of health IT.

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ONC Resources

• SAFER Guides
» https://www.healthit.gov/safer/safer-guides

• Health IT Playbook
» https://www.healthit.gov/playbook/

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 Questions?

Rebecca Freeman, PhD, RN

rebecca.freeman@hhs.gov

@ONC_HealthIT @HHSONC