This post is the last part of: What Nurses Expect from Health IT Solutions. Part I of this article can be found here.

Digital documentation

• Templates for recording vital signs can be made available in a module that could save time and energy. This is well-implemented.

• The ability to enter notes and a to-do list each day can be provided: This is well-implemented.

• Health IT systems should be designed such that they are password-protected, and nurses are able to safely log in and lout at any time without fear of data breach: This is implemented in most of the EHRs; however, these are poorly designed. Most of the systems fail to provide this feature as shown in the following scenario: A nurse logs in with her username and password and is entering the medical records of a patient. She logs off the system and takes a break. When she logs in again, the system should display the page where she was entering the medical records. However, most Health IT solutions upon logging in display the homepage or do not provide the option to save the data before logging off. Hence, though implemented, such features are poorly designed.

• A provision to have templates for various consent forms that nurses can keep records of.  This is well-implemented.

• A provision to view and attach radiology images: This is mostly implemented well. However, in the case of apps, the resolution may not allow the user to view the images clearly. It is thus implemented well in most of the systems but poorly designed in apps, be they for a smartphone or a tablet.

• A provision for the EHR to support standardized medical coding languages such as SNOMED, NANDA, and so on: This would help the nurse to enter records in the system based on standardized language systems that are used in practice settings and can be communicated uniformly across health facilities. This feature is well-implemented with good design in most of the systems and apps. Nevertheless, the users should be properly trained to understand the features. Due to lack of training in understanding usage of standardized medical nomenclatures, users are not able to associate the codes with the diagnosis, which leads to medical error. Hence, though this feature is implemented well with a sophisticated design, the design may not be easy to understand.

• Health IT solutions should be such that the nurses can safely share confidential patient information with the clinicians and other senior nurse practitioners: This is mostly well-designed, but fails during implementation.

Organizational responsibilities

• Any Web portal that involves communication between patients and care providers (including nurses) must again ensure that the design supports the security and privacy of patient data: This is mostly well-designed and implemented.

• A proper admin panel within the system where role-based (nurse practitioner, assistant nurse, and so on) access privileges can be assigned: This will ensure that the any sensitive information is accessible to the relevant personnel with the valid access rights to either write, edit, view, or delete. It should be noted here that most of the systems have poorly designed role-based access-privilege modules.

• The Health IT system or the app that the nurse uses to log in can have a separate home page that reveals information and tasks pertaining to her role:  For instance, the home page of a nurse could have the details of the ward and the number of patients she has to attend to that day. Say that on that list there are 10 patients, and out of the 10 there are two emergency cases. Then she could give priority to the emergency cases and then deal with the rest. Likewise, the list can also show the number of OPD doctors that she has to assist (in case of prenatal consultations for OPD). On her home page, other than the routine tasks, there can be links to other informational sites for study purposes. This is poorly designed, but does not fail during implementation.

Apart from the above, a Health IT solution with a well-designed CPOE can benefit nursing practices, simply because it promotes the Five Rights of Medication Administration – right medicine, right dose, right route, right patient, and the right time. The nurses can focus on the administration part by monitoring adverse reactions and continuing to assess patients.

An online forum where nurses can discuss the impact of technology upon their duties and raise issues pertaining to nursing practices and technology safety can encourage them to use health IT solutions. Imparting proper hands-on training and discussing the potential benefits that can be derived from a digital healthcare setting may help nurses come out of their shells and explore the technology. There are many nurses  who have already taken the challenge and are exploring ways to benefit from such systems. There are yet many who fear exploring, perhaps due to the lack of knowledge of such systems or the poor design of Health IT solutions.

In conclusion, nurses play a critical role when it comes to the implementation of any healthcare IT software. As they remain the first point of contact in patient care, it is an absolute must that systems must be efficient and easy to use. As we can see, the healthcare industry is going fully digital, and nurses can be great asset to the successful implementation of such software.

It is thus recommended to actively involve nurses in implementation of EHRs, from requirements and design to the implementation phases. This will help identify any loopholes in the systems.

In order to actively involve nurses, the leadership team of a healthcare facility must identify the needs of nurses with respect to EHRs and make them actively participate during the design and implementation phases. Systems designed, developed, and implemented with nurses as key active users can help in develop an efficient EHR that can deliver quality care to patients. Understanding why nurses embrace or resist EHRs is an important consideration when implementing such systems.