Effectively Using EHRs with Interdisciplinary Teams: Improving Health & Quality of Care

Submitter Information

Author: Susan McBride, PhD, RN-BC, CPHIMS
Title: Professor
Institution: Texas Tech University Health Sciences Center School of Nursing
Email: susan.mcbride@ttuhsc.edu
Coauthors: Hanley, M.A., Acton, C., Jordan, J., Nixon-Lewis, B., Bradley, C., Gray, D., Mitchell, M.B. , Delaney, J., Thornton, D., Collins, R. & Philips, B.

Competency Category(s)
Evidence-Based Practice, Informatics, Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s)
Continuing Education, Graduate Students

Learner Setting(s)
Classroom, Clinical Setting, Skills or Simulation Laboratories

Strategy Type
modules, Online or Web-based Modules

Learning Objectives

In using the case studies in modules, online education, classroom or conference settings at the completion of the exercise the participant will be able to:
1. Identify gaps in meaningfully using technology to address safe, efficient patient care in a clinical scenario.
2. Discuss knowledge necessary for the multi-disciplinary team to effectively use the data that was integrated in the EHR.
3. Describe how an interprofessional team approach along with the EHR improvements might have contributed to Mr. Head Injury’s care and ultimately, how this approach and use of EHRs could be used to improve health outcomes in other areas of their institution or organization.
4. Identify any workflow issues or common practices that contributed to Mr. Head Injury’s care.

Strategy Overview

EHR case scenarios simulating patient safety and/or
clinical events in which electronic information might improve care and electronic
information that might hinder clinical care were developed and tested. A rubric
designed for this project guided students in their analysis and solution
development, and collaborative work processes and was used by faculty members
to evaluate both solutions and work processes.  Multi-disciplinary of healthcare professionals
and students applied knowledge gained through participation in the conference
to the EHR case scenarios and demonstrated the capacity to “think
smarter.”   They analyzed the case scenarios
and were able to identify solutions to new technologies which contributed to
potential patient safety events, thus supporting and reinforcing quality of
care. Participants questioned information presented via technology, when it did
not appear to make clinical sense, and determined whether the electronic
information was accurate, and proposed solutions to the scenario.  

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Submitted Materials

135.-Case-Scenario-1-2_FINAL-Teaching-Samples_June-28.pdf
135.-EHR-Teamwork-Solution-Finding-Rubriic.pdf
135.-Guidelines-for-Case-Study-Write-up.pdf

Additional Materials

This case study can be used on multiple levels and settings. Additionally, the case studies have been used in online classes (MSN Core Informatics course), in classroom settings (DNP Intensives), and in conference settings for workshops reinforcing patient safety, quality, interdisciplinary teams and effective use of EHRs. This case study has been used coupled with workflow redesign to address gaps identified in the workflow related to safe and effect use of EHRs.

Evaluation Description

The case scenarios were
developed, tested and evaluated by interprofessional teams. The development
team included eight nurses: two nursing informaticists; two nursing educators
with expertise in simulation, interprofessional team development, patient
safety and curriculum development; a staff nurse actively working in a Texas
Emergency Room in a large healthcare system with hands on experience of working
with an EHR in the emergency Room and the Director of the West Texas HIT
Regional Extension Center and one of the nursing field consultants. The team
also included three Physicians active clinically and Chief Medical Information
Officers at their respective organizations responsible for the implementation
of EHRs at multiple specialty clinics, and finally an Executive and
Epidemiologist responsible for the West Texas HIT Regional Extension Center.

The Case Studies were
developed based on clinical scenarios experienced by the clinicians in
implementation of the EHRs in various practice settings. The goal of the
clinical scenarios was to create a clinical event that could be either helped
or hindered given the proper use of the EHR. The clinical information was
verified by the clinical team as to accuracy of pathophysiologic information
and pharmaceutical products discussed in the scenarios. The electronic
information was verified by a nursing informaticist and the epidemiologist both
with expertise in working with the WTxHITREC.

The
original evaluation plan was to include medical students, nursing students and
pharmaceutical students in an educational event to test the case scenarios
developed by and for interdisciplinary teams. The F. Maria Hall Rural and
Community Health Institute, WTxHITREC and the West Texas Area Health Education
Center (AHEC) agreed to utilize their annual summer conference held June 27 and
28, 2011 in Lubbock Texas as the venue for testing the case studies for this
QEP grant-supported activity. The attendance at the conference included 82
attendees for the lecture series of the conference and 21 participants in the
full interprofessional team exercise to test the case studies. Attendees
included hospital staff support (30%), ambulatory clinics (20%), academic (26%)
and other setting (20%). The 82 participants included 45 (55%) leadership and
administrative professionals, 19 (23%) nurses, 5 (6%) physicians, and 13 16%)
“other” (dietary, social workers, and unspecified).

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