Author: Susan McBride, PhD, RN-BC, CPHIMS
Institution: Texas Tech University Health Sciences Center School of Nursing
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.
Online or Web-based Modules
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.
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 the 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.
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.
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).