American Organization of Nurse Executives 2006 Survey on Nursing and Information Technology (IT)
The knowledgeable participation of nursing leadership in the selection and implementation of information technology (IT) has never been more important because high quality operational and patient care data are critical to drive efficient, effective, and safe care.
The American Organization of Nurse Executives (AONE) recently conducted a survey of members who serve as the top nursing executive in their organizations to explore the role of nursing leadership in IT projects and to better understand these leaders’ IT priorities. The survey was developed by the Technology Task Force and was conducted online between June 19 and
July 14, 2006. Fifteen hundred and fifty-two members were invited to participate. A total of 272 responses were received for a response rate of 17.5%. Of this number, 263 identified themselves as serving in the top nursing role and thus were eligible to complete the entire survey, for a usable response rate of 16.9%. The Task Force wishes to thank those nurse executives who took the time to respond and to provide valuable feedback to the membership on this key issue. The following is a summary of the results of the survey. Full responses can be found on the AONE web site.
Sample
Of the 263 respondents, the majority (79%) were from either freestanding community hospitals (44%) or hospitals that were part of an integrated health system (35%). Eleven percent came from academic health centers and the remainder came from specialty hospitals (4%), corporate offices of health care systems (4%), and ambulatory care facilities (1%). Respondents were distributed evenly across AONE regions with 2 from outside the United States. Only 10% of respondents cited annual gross revenue of less than $10 million. Another 27% cited $10-$100 million, 41% reported $100-$500 million and 17% had revenues of over $500 million, with 6%
American Organization of Nurse Executives 1 2006 Survey on Nursing and Information Technology reporting over $1 billion in annual revenue. Five percent of respondents were from state or federal facilities.
Information Technology (IT) Priorities of Nursing Leadership
Nurse executives were asked to indicate their organization’s top 3 information technology priorities from four different perspectives: from the perspective of the organization as a whole and from the perspective of nursing, both today and in three years. Priorities identified as important today from the perspective of the organization as a whole included: the electronic medical record (EMR), computerized provider order entry (CPOE), clinical documentation, organization-wide information technology solutions, bar coding for medication administration, and picture archiving and communication system.
From the nursing perspective, priorities for today included: clinical documentation, bar coding, CPOE, EMR, process/work flow redesign and organization wide information technology solutions. Obviously in today’s competitive and safety conscious environment tools available through information technology such as the EMR, CPOE and bar coding for medication administration are high priorities.
When asked to project out three years for their organization as a whole, again, CPOE was selected by the highest number as a top priority. Others selected were organization wide information technology solutions, EMR, bar coding, and for the first time, clinical decision support was identified, as was connectivity between providers. Finally, when setting priorities three years out from a nursing perspective, CPOE was also indicated by most nurse executives as a priority, followed by clinical documentation, bar coding, and EMR solutions. At this point, two other technologies were identified as priorities; utility for performance measurement and evidence-based practice and process work flow design. While safety remained a concern, many
American Organization of Nurse Executives 2 2006 Survey on Nursing and Information Technology nurse executives apparently expect that implementation of the EMR will have moved forward,
therefore fewer rated EMR as a top priority and instead looked to expanded uses of the data
generated through a fully operational EMR.
Priority setting demonstrated by nurse executives in this question often corresponded to
responses in the next question where nurse executives indicated their organizations’ status
relative to information technology planning and implementation. Of some concern is the fact
that nurse executives rated CPOE highly in all areas which may indicate that nurse executives
see CPOE as critical, but do not anticipate rapid and full implementation in their settings. Nurse
executives also see bar coding as a priority today and three years out. However, the percentage
selecting this item in three years decreases, perhaps indicating that some expect to have it fully
implemented before that. The emergence of bar-coding solutions as a high priority presumably
reflects growing concerns with medication safety.
Table 1: Top Three Priorities in IT: Today and in Three Years
Nursing Leadership IT Priorities Today from the Today from In three years from the In three years perspective of the nursing’s perspective of the from nursing’s IT Priority organization as a whole perspective organization as a whole perspective # % # % # % # % Bar coding technology for medication administration 77 29% 146 56% 66 25% 81 31% Clinical documentation 90 34% 174 66% 39 15% 81 31% Computerized provider order entry (CPOE) 101 38% 83 31% 115 44% 91 35% Electronic medical record (EMR) 106 40% 80 30% 81 31% 66 25% Organization-wide IT solution connecting acute care through the healthcare continuum, including ED, physician 79 30% 45 17% 92 35% 47 18% offices, and ambulatory clinics
When asked to indicate their organization’s current state of implementation relative to the
EMR, nurse executive ratings demonstrated marked differences between inpatient and outpatient
American Organization of Nurse Executives 3 2006 Survey on Nursing and Information Technology settings. Sixty one percent of nurse executives in inpatient settings indicated that their organization has either partially (47%) or fully (14%) implemented an EMR system. This contrasts with nurse executives stating that in their outpatient settings only 41% have EMR systems that are either partially (33%) or fully (8%) implemented. In line with this finding, nurse executives stated that 29% in inpatient settings have completed plans for EMRs, while
45% in the outpatient settings have not begun to install EMR hardware and software. Of interest on these questions were the “comments” made by nurse executives regarding the “fully implemented” EMR. Some nurse executives stated that although the EMR was fully implemented in the inpatient setting, physicians or certain units were not yet operative. Few comments were made regarding implementation of the EMR in outpatient settings perhaps because so few (8%) outpatient settings had fully operational EMRs.
A study limitation is that definitions of terms and/or description of staging of implementation were not a part of the questionnaire. Consequently questions may have been answered from a nurse executive’s level of understanding of a particular technology.
Identified Barriers to the Successful Use of Information Systems by Nursing Staff
When asked about perceived barriers to the use of IT, respondents had clear ideas regarding these, with many citing more than one barrier. For purposes of analysis, the barriers were grouped into Financial (F), Technological (T), Educational (E), Systems/Organizational
(S/O), Workflow (W), and Cultural (C), which included change and communication. Over 332 barriers were identified. Table 2 lists the percentages of total barriers in each category and representative examples of each. (A full list of responses is found on the AONE website in
Appendix A).
American Organization of Nurse Executives 4 2006 Survey on Nursing and Information Technology Table 2: Perceived Barriers to Successful Use of IT by Nursing Staff
Barriers % Examples Financial 11% Financial and human resources Impact of financial reimbursement not keeping pace with financial resources Cost of devices Lack of funds to purchase the system packages available now Capital ROI Technological 23% User friendliness/ease of use User-friendly, mobile devices that where nurses work Reliability/downtime Design of software that makes it easy to enter information Educational 21% Lack of computer skills/huge learning curve Lack of time for training Staff reluctance/fear to learn the technology Lack of experience in using systems that require extensive training Systems/Organizationa 7% Communication l Responsiveness of IT Department Lack of 24/7 IT resources IT decisions made without clinical support Appropriate implementation of strategic plan Workflow 20% Functionality does not accommodate clinical work flow or national patient safety agenda How will it help the nurse deliver timely, evidence-based care? Interfaces with other systems to decrease redundant work Workspace redesign System does not “think” like a nurse clinician Cultural 17% Resistance due to unfamiliarity (fear of) with computers Physician resistance Change management/staff buy-in Lack of nursing input
Role of Nursing Leadership in IT Projects
When asked if their organization had an information systems steering committee on which nursing formally has a seat 85.% (N= 224) responded yes. In all but 2 organizations nursing had a vote. In 47.5% of the cases (N=125) this committee had full authority to make final purchase decisions and in 66.7% (N= 175) of the organizations this committee had final decision making authority on the implementation roadmap. Table 3 lists the number and percent of nurses on this steering committee.
Table 3. Number and Percent of Nurses on IT Steering Committees.
Response # %
American Organization of Nurse Executives 5 2006 Survey on Nursing and Information Technology Less than 10% 62 28% 10-25% 109 49% 26-50% 43 19% More than 50% 10 4%
Nursing IT Roles in Organizations
The nursing roles identified ranged from CIO to nursing staff in IT or training support staff. Many respondents identified the coordination role of these individuals. Some organizations had many nurses in IT roles and in some, the roles were well defined. In general, the major categories were Administrative/Managerial (A), Systems Analysts (SA), Project
Managers (PM), Applications Development (AD), Programmer (P), Trainer (T). These are listed in Table 4. (A full listing of the roles is found in Appendix B on the AONE website).
Table 4: Identified Nursing Roles in IT
Role % Examples Project Manager 20% Clinical/patient care documentation Project implementation Coordination between departments Member of planning, design & implementation team Administration/Manager 13% Director of IT Manager in IT Chief Nursing Officer Nursing Informatics Director Systems Analyst 36% Clinical application coordinator Implementation specialist Liaison between nursing & IT for problem solving, design, implementation & evaluation Evaluate/analyze workflow, need, etc. Programmer 1% Coordinates and facilitates building of screens and databases Programming specialist Trainer 3% Staff education/support Facilitator of implementation, process improvement, tool development Informatics liaison Educator Application Developer 11% Change architect Process design, build and education functions Screen development Electronic clinical documentation development
American Organization of Nurse Executives 6 2006 Survey on Nursing and Information Technology Other 16% System selection and implementation Informatics consultant Liaison between practice and information systems IT strategic planning
Respondents were also asked to indicate in which applications nursing had a formal role in the development, implementation, or management.
Table 5: Number and percent of respondents identifying nursing involvement in clinical applications. Response # % Clinical data repository 120 46% Clinical decision support integrated into the 161 61% workflow Clinical documentation 252 96% Computerized provider order entry 174 66% Electronic medical record 193 73% Electronic medication administration record 216 82% management (including bar coding) Enterprise-wide master patient index 67 25% Quality improvement (including analytical reports) 167 71% Wireless applications 138 52%
Reporting Relationships
The majority of nurses employed in organizations who were dedicated to the IT role
reported in the IS/IT department (47%), followed by 34% reporting in nursing. Nearly a fifth of
the respondents indicated a shared role. Irrespective of reporting, 29% of these nurses had
masters or doctoral degrees and 28% were certified in Nursing Informatics. Encouragingly, 78%
of them had a vote in IT system selection and roadmap definition.
Table 6: Reporting Relationships of Nurses working in IT
Department Percent Information Systems (IS) 47 Nursing 34 Both IS and Nursing (shared staff) 18 Quality 1 Administration 7
American Organization of Nurse Executives 7 2006 Survey on Nursing and Information Technology Opportunities Identified for AONE to Support CNOs in Participating in Organization’s IT Implementation Activities
Respondent’s suggestions for AONE to support CNOs included the following categories:
Information/Education (E), Research (R), Advocacy (A), Programming/Products (P), and Other
(O). Many respondents identified a desire for networking opportunities, sharing of best practices,
and recommendations for best practices. Table 7 provides the percentages of responses in each
category with category examples. Appendix C (found on AONE website) lists all responses.
Table 7: Suggestions for Support from AONE.
Support AONE Can % Examples Provide Provide 40% Provide workflows and best practices for decision information/education making, implementation, evaluation Share product information/updates/ successes/pitfalls/ lessons learned More information on informatics in nursing Provide networking opportunities Advocacy 10% For universal systems language For funding For standardized barcoding Promote nursing in IT decisions Research/projects 3% Ongoing research for process redesign and implementation Benchmarking data related to EMR systems and other technologies Work environment research Provide research on successful applications Programming 20% Vendors to consider nursing workflow while developing new products Establish forums for dialogue on products, implementations, “lessons learned” Best practice web conferences Certification opportunities Other 14% Streamline nursing documentation Assist with widespread standardization among vendors/ manufacturers including standardized terminology Continue to support American Academy of Nursing’s efforts Help in the design of university masters programs in
American Organization of Nurse Executives 8 2006 Survey on Nursing and Information Technology nursing informatics No Need 11% Nursing already has full participation AONE providing adequate information Vendor provides networking and support
Conclusion:
Nurse executives participating in this survey demonstrated acute awareness of the potential for
IT to enhance patient safety, clinical decision making and speed and span of communication.
There is strong interest in having AONE assist with perceived issues and barriers. In particular,
the need for ongoing education, programming related to IT and benchmarking for nurse
executives and nurses practicing in IT was identified.
Authors:
Ida M. Androwich, PhD, RNC, FAAN Professor & Director, Health Systems Management Niehoff School of Nursing Loyola University Chicago 2160 South First Avenue Building 105, Room 2858 Maywood, IL 60153 (708) 216-9276 (708) 216-9555 (fax) [email protected]
Sheila Haas, PhD, RN, FAAN Dean and Professor Niehoff School of Nursing Loyola University Chicago [email protected]
American Organization of Nurse Executives 9 2006 Survey on Nursing and Information Technology Appendix A. Full list of perceived barriers
1 IT Department responsiveness and providing access to the system to resolve nursing issues 2 Difficulty in navigating through the system. Knowing how and where to retrieve data 3 financial constraints staff resistance to change 4 Transition time to implementation of total system effectiveness on one program data base. 5 Many systems do not communicate with each other. Documentation is time consuming 6 Time requirements 7 Communication 8 Lack of enough computer access fear of computer down time and lost data Physicians being negative regarding the computer being the main form of information on the patient. 9 Education and support. 10 Understanding of use of computers, timeliness 11 It is time consuming, lack of IT resources in house to support the 24/7 nature of our business. Adds complexity, lack of consistency in documentation. 12 Learning curve related to the increased functionality 13 cost of devices 14 Process redesign to keep nurses from doing work arounds. The learning curves are improving over time but we still have time delays when implementing new systems. 15 Workflow and time factors in converting to IS don't always complement nursing functions. Takes nurse away from direct patient care 16 time 17 System is not user friendly- lots of rework, repetitiveness and time consuming 18 None 19 lack of education and experience with these programs. 20 Availability of the technology 21 Fear of computer 22 ongoing increases in regulatory requirements get added to nursing documentation without consideration of workflow and informatics redesign; systems are not streamlined, easy to use, reflective of shorter lengths of stay 23 Impact of financial reimbursement not keeping pace with financial resources need to maintain availability of resources. 24 Often decisions are made without clinical input 25 $ and time for proper staff education
American Organization of Nurse Executives 10 2006 Survey on Nursing and Information Technology 26 education and support 27 Culture change and time to incorporate new methods into current processes, along with the numerous other changes required by regulations and quality initiatives 28 Workforce is aging and they are not as computer savvy as the younger generation-- huge learning curve. 29 training, provider refusal 30 Input to system purchases. 31 providing adequate time for the implementation process, change is coming fast and there is rarely a moment for the staff to acclimate before the next change process begins. 32 Acceptance by the staff. 33 $$$$$, staff training 34 Our staff uses our system successfully. However, the information is difficult for other healthcare providers to use efficiently. 35 Resources, user-friendliness or lack of, resistance to change 36 TIME 37 Upgrades that may lack user features previously available Lack of availability of advanced information systems due to cost 38 ease of use 39 We currently have bar code admin of meds and documentation. Top barrier is any downtime or slow down of system 40 Changing workflow habits, psychological barriers, i.e., "I cannot do this", "This does not work" etc., It seems like it is just never smooth, and it always takes multiple attempts to get the information technology right so that it works correctly - there are technical glitches that are painful to work through. 41 Availability of time for training 42 lack of computer skills and comfort in the older nurses 43 1. Finance 2. Our staff are highly involved and have had bedside computer charting since 1991 3. Time 44 Resources for education during the transition 45 Amount of capital available to make new technologies available. Priority has been set with a physician focus. 46 Change management 47 Ability to change workflow to incorporate new technology. 48 Lack of computer literacy; high patient acuity/complexity of care; skills for care coordination and delegation insufficient 49 The time involved to learn and efficiently use the systems. 50 Access to computers where nurses work--patient rooms.
American Organization of Nurse Executives 11 2006 Survey on Nursing and Information Technology 51 competing priorities 52 Lack of experience in using these systems requiring extensive training. Inadequate numbers of hardware (laptop computers as well as table top computers). 53 Lack of funds to purchase the system packages available now for these functions and to hire the staff needed to fully carry out the human side of these processes in order to eliminate having to switch back & forth between manual and computerized 54 Education ease of system 55 Varied skills sets of numerous generations of nurses and comfort level with working with computer systems. 56 We are blessed to have few if any barriers to successful use of our IT system. We are very automated, including the medical record, and our nursing staff has worked hard to adapt and embrace all applications. 57 1. Availability of training - resources and time 2. User-friendly, mobile devices that fit with work flow needs 58 Expectation and need exceed vendor capabilities Current systems still do not adequately address current workflow complexities 59 capital 60 Lack of knowledge 61 Availability, time, cost 62 appropriate implementation of strategic plan i.e., specifically a framework that ensures adequate training and uniformity of system use 63 ability to show a return on the investment from an efficiency perspective for the nurse. How will it help me, the nurse, deliver more timely, evidenced based care 64 access to devices time wasted 65 Lengthy system implementation. 66 Types of hardware and end user specifications. Login time. Change. Still not efficient workflow. 67 Resources and time 68 Funds/resources to implement the system correctly. 69 Ease of documentation system, must be user friendly and support nursing assessment processes. 70 Typing skills and fear of using an electronic system 71 money physician support/buy-in 72 work process issues and nurse documentation system updates 73 lack of capital resources 74 Change related to human resistance and time to relearn processes. 75 access ease in using integration between departments 76 CAPITAL
American Organization of Nurse Executives 12 2006 Survey on Nursing and Information Technology 77 Comfort and user friendliness of systems; ability to get IT to the bedside due to physical/environmental barriers (aging facility) 78 Number of screens to scroll through and lack of intuitivity of the system 79 Process redesign Too many databases that don't communicate for easy retrieval for reports Lack of accountability of staff 80 Education and training of older nsg staff who enter the system as new employees since we have a totally computerized medical record. 81 Availability of devices; Systems must be easy to use and understand; logical sequencing of information. Clinical systems must all interface, if not have incomplete clinical picture which is a barrier to coordinated excellent care. 82 Timeliness of education prior to implementation. Freeing up staff for super-user training. 83 fragmentation, some things are on line some are not; if they are on line they may be on different systems.eore 84 Finances and time 85 Lack of time and education to fully understand benefits. 86 Initially the change process and changing the charting methodology. 87 Time consuming. 88 No time to do all things. 89 Educating staff for consistent usage without increasing workload. 90 ease and convenient 91 Time required to complete documentation in a cumbersome program. 92 Amount of documentation required utilizing a system that does not 'think' like a nurse clinician 93 Equipment availability, time to utilize systems, knowledge of system 94 Lack of understanding about the process that could assist them in caring for patients. 95 Nurses are successfully using IT 96 Work space redesign is necessary in old architecture. Availability of laptops, PDA, wireless technologies 97 Software that is more user-friendly and single sign on. 98 Staff not technology savvy 99 The cost of implementing the technology, trying to retro fit old buildings with new technology 100 Lack of nursing input into build 101 changing workflow processes 102 time constraints continuous changes in technology 103 Experience, ease of use
American Organization of Nurse Executives 13 2006 Survey on Nursing and Information Technology 104 Capital and human resources to complete multiple large projects 105 Ease of use Reliability Downtime 106 Medical staff fear/resistance and lack of computer competency. 107 too much information and too many different places to input it 108 Functionality of systems does not accommodate clinical work flow or support the national patient safety agenda. 109 Training and an anticipation of computer literacy that does not necessarily exist. 110 Computer skills Availability of equipment 111 funding 112 Time/design of software that makes it difficult to enter info 113 The age of staff, those who have limited if any ability to use the computer. They fear it and are very reluctant to learn the methodology of computer use. 114 have EMR, including CPOE partially implemented. Biggest"barrier" is rate of change and support for staff 115 interfaces with other systems to decrease redundant work 116 large percentage of older nurses not computer literate; Difficulty in implementing change. information systems that are difficult to use, go "down" frequently either for problems or intentionally for "patches" or upgrades. 117 Staff usage 118 Logistics to include bedside solutions. 119 Unfamiliarity with PC functionality 120 Time consuming, does not match work flow 121 inability to use computers and time 122 point of care/service technology with ease of use and avoidance of redundant data entry 123 cost, the speed at which systems become outdated 124 training, building IS systems with a patient focused approach. 125 Fitting the required computers in the old buildings . Not renovating fast enough to accommodate new technology considering the ergonomics and environment needed for nurses to work in 126 "Fear" of computerization We have a strong evidenced based interdisciplinary practice that is supported by our paper documentation system. It is important that we select a system that will incorporate our current practice. 127 Extensive education will be required - staffing issues will continue to be a problem - difficult to release staff for the education. 128 Finding a nurse friendly instrument (i.e. Handheld, Computer on Cart Resistance to change 129 Our staff currently uses the information system we have to its fullest capability. We
American Organization of Nurse Executives 14 2006 Survey on Nursing and Information Technology need to migrate to the next generation to facilitate the look and feel of they system so that it more user friendly. 130 We are currently using a fully integrated electronic medical record. 131 Accomplishing behavior changes required for the necessary process changes that must be made prior to achieving a complete EMR 132 - More experienced nurses (>40 y.o.) aren't comfortable with using the technology - Processes aren't streamlined, they are added on, are cumbersome, and do not save time 133 Time constraints for the staff to learn new technology 134 change management adequate hardware 135 Systems do not address key work processes 136 1. ease of use 2. connectivity to providers 3. enough support staff for trouble shooting 137 poor information flow timeliness of documentation feel it impedes patient care 138 Time Knowledge lack of patient contact due to increase time on computer 139 Physician participation 140 Interfaces, bringing up systems in pieces, real time charting constraints 141 Poor IT support Lack of understanding by IT executives regarding the usefulness and usability of electronic documentation from the nurse's point of view. Funding 142 Workflow redesign. 143 Ease of use of hardware and software 144 System not capable of computerized clinical charting or CPOE 145 Ease (or lack there of) of use. Too frequent changes and upgrades to code. 146 lack of key stakeholders having same priority for IT needs 147 Resistance to change. 148 timing 149 User friendliness, ease of use, education 150 Capital constraints 151 cumbersome. inpt and outpt not integrated 152 Obtaining information from facilities and other organizations who are not integrated with our hospital system. 153 availability of appropriate device 154 Lack managerial resources to educate staff and allow them adequate time to learn new systems. 155 Lack of computer expertise Fear of Technology Have difficulty with process change Resource challenges r/t training 156 1) System is so versatile that documentation is hard to track (multiple places to
American Organization of Nurse Executives 15 2006 Survey on Nursing and Information Technology document same information) 2) Too many screens to move easily through at the point of care 3) System design that meets work-flow needs, not the other way around 157 Lack of knowledge Unwillingness to change 158 Having a software and hardware solution that eliminates additional work for the nurses. It almost alwaysore work not less. 159 resources: people and dollars 160 Staff knowledge/education to fully use system. Availability of sufficient access. Resistance due to unfamiliarity with computers. 161 gaps between IT system functionality and actual clinical practice, processes and workflow 162 Availability of computers, space and education. 163 education and training, entry errors, working with manual and electronic systems simultaneously 164 Connecting the dots with the electronic medical records. 165 1.Insufficient training 2.Adjusting to change in the way they process information (Writing narrative information has been changed to documenting data). 166 lack of experience with IT systems 167 Nursing staff are ready, finances for programs is what slows us down. 168 Adequate educational timeframe and support services post initial education. 169 senior nurses not comfortable with computers 170 time to learn and become efficient gaining buy in prior to decision /implementation 171 Limitations of the software. Ability to provide on-going education support of nurses. Changing practice patterns to incorporate technology documentation at the point of care. 172 lack of funding 173 Ease of use, enough hardware, time it takes to document. 174 We are to go live in oct with Meds/Adm and Horizon expert Documentation - training of staff will be expensive and time consuming. 175 Education, change from prior paper methods which are more familiar and comfortable 176 Changing work processes. 177 Not enough computers for all staff 178 None. Our nurses are already used to computer charting. We have gone live with our EMAR recently, without much trouble. They look forward to medication bar coding. 179 Some staff believe IT complicates rather than facilitates their work. We have many older nurses who are not comfortable with computers. 180 Cost of equipment, software and programming 181 Decision Making at all levels and lack of line staff participation in design and
American Organization of Nurse Executives 16 2006 Survey on Nursing and Information Technology purchase of products. 182 acceptance of technology by older staff nurses process and workflow redesign to leverage the substantial investments made 183 Staff competence in using computers, working with a hybrid medical record 184 process change 185 Resistance to change-especially with the more senior nursing staff 186 We currently have a EMR although some of the documentation is scanned. Our barriers are loss of connectivity (wireless devices) and the bedside nurse looses documentation - causes rework. Lack of integration with other systems which causes many extra steps for the nurse. Lack of adequate support by our helpdesk and a lack of clinical knowledge by IS when support is needed. 187 Access to sufficient devices Streamlining documentation - making it easier and more intuitive. 188 decisions made at corporate level not always best for individual hospitals 189 No Physician CPOE 190 Adequate training on systems and reliability of the systems themselves that are frequently down or experiencing delays. 191 Process issues 192 The learning curve 193 none...cost is the biggest challenge to advancing at the rate we whish to move 194 Lack of a comprehensive technology savvy I.S. department with leadership and project management skills 195 Timeline for implementation of IS products 196 Increase in time required away from direct patient care. 197 capital dollars 198 nursing staff does not want change 199 not enough technology 200 insufficient training 201 hardware and software 202 Change management for the older nursing staff. The younger nurses are doing much better with the implementations we are doing 203 time management; accessibility & availability at the bedside of enough computers for all to use. 204 Changing old patterns of work flow to document is real time in system 205 Access and ease of use. 206 We are 85% on line for inpatient nursing - time is the barrier 207 * space and access * learning curve * normal adjustment to change in workflows and practice
American Organization of Nurse Executives 17 2006 Survey on Nursing and Information Technology 208 systems that do not offer much utility having multiple sign ons access to enough consoles 209 Costs 210 speed for the user 211 Cost associated with providing staff with training and hardware to support this initiative 212 Transitioning from paper to electronic; interim steps are problematic: change, workflow, added steps, duplicate systems. 213 access to computers 214 Staff vacancies; time; too many diverse systems 215 Time and the change management process. Moving from combination paper and computerized medical record. But mostly the time factor 216 Lack of appropriate hardware to support the software programs created a system that was too slow to be effective. This is being combated with the implementation of a new IT system. In addition, there was not adequate support or training of staff to obtain a successful implementation. 217 Current system is not very user friendly. 218 1. Downtime- wireless not working as it should 2. Slow operating system 219 Fear of Change Complicated system 220 Focusing on how the work processes need to change and time for adequate education 221 Computer access and time intensity. 222 Lack of knowledge on how to use basic software 223 Cumbersome system, not fully developed. Lack of computer literacy for older nurses 224 Redesigning workflow to support system and assure efficiency is gained 225 resistance to change availability of wireless devices 226 Have not implemented yet 227 Resistance to change by nurses and physicians 228 Staff desire increased automation to reduce the number of manual forms and audits 229 affordability therefore availability 230 Lack of time and skill in IT programs 231 knowledge of the EMR system to new employees and the time it takes to learn. 232 Maximizing use of a fully digital system, ability to collate data to make better outcome decisions, having better flags. 233 The extra time required to document patient care. 234 Not enough standardization throughout all vendors and systems. Medical team hesitation to adapt the computer as the next MR. 235 Computer carts that do not take into consideration the needs of nurses and their work
American Organization of Nurse Executives 18 2006 Survey on Nursing and Information Technology processes 236 Training difficulties 237 change ad comfort level 238 change management 239 Insufficient initial and ongoing Education and training Poor system performance and slow response times 240 They frequently take more time especially when first implementing. 241 Fragmentation of the medical record by current system. Inability of current system to provide quick access and entry into medical record. Computer access not located in patient rooms for in real time documentation. 242 unfamiliar hardware slow modem processing large intensive educational curve 243 I don't see barriers. The staff look forward to the use of IT in their work. 244 I don't perceive these as barriers since we are addressing through our action plan. Limited computer knowledge Fear of the unknown 245 Time 246 Time, acceptance of change, reluctance about computer use 247 None 248 IT systems are felt to be "clunky" to nurses at the bedside and take time away from direct patient care. The nurses also feel that the computer in the room interferes with their relationship with the patient....they say they are "nursing the computer more than the patient". The systems need to be more streamlined, intuitive and efficient. 249 Some of nurses still not computer literate and rely on paper. Format of order entry and documentation is not intuitive. 250 Adequate education and resistance to change 251 Ease of use 252 Reliability of the infrastructure; if the tools implemented do what consistently work the nurses lose faith in the technology; this is a significant barrier to implementation. 253 Lack of CPOE Inefficiency of drop down screens 254 Base level of knowledge in use of computers 255 One system talking to another. 256 Involvement in selection of systems and appropriate education 257 financial constraints 258 ease of use - some e-forms for example, take an exceedingly long time. age of some staff 259 Adopting change...no one system is perfect 260 finances corporate mandates of not optimal products unwillingness to accept change 261 cost, time, staffing
American Organization of Nurse Executives 19 2006 Survey on Nursing and Information Technology 262 varied computer literacy skill set 263 Resistance due to comfort level of experience with technology
American Organization of Nurse Executives 20 2006 Survey on Nursing and Information Technology Appendix B. Full list of identified nursing roles in IT
1 Responsible for implementation of projects and interfacing with other departments 2 Chief clinical informatics officer at the corporate level Each facility employs an RN as the Project manager 3 I have clinical nursing IS team which is led by a Masters prepared RN Director, a Supervisor RN and 6 direct RN reports all well educated in IT.... 4 director of IT, and Systems Analyst 5 Manager in IT 6 IT Consultant 7 Project Coordinator for IT projects that cross nursing, clinical, and IT 8 Clinical application coordinator and support. Educational provider 9 Develops and oversees the IT process for implementation of new software. 10 Nursing Informatics----is the main leader of the patient care documentation module. Key role in the IT strategic planning. 11 Applications developer and process change architect 12 OR system analyst in patient system analyst 13 coordination and educational function for clinical systems 14 Informatics nurses working in IT providing support to the nursing documentation system, doing builds, making changes 15 education, making changes to the current product 16 Coordinates IT projects 17 Informatic specialists who develop and train 18 Has a full and powerful voice in the planning phase. 19 report writing; revising documentation systems; designing computerized flow systems; educating staff on systems 20 This nurse is one of 3 key persons to analyze and research ways to implement technology in the clinical situations. 21 coordinates the 5 nurses we have in our clinical informatics department also serves to facilitate the dialogue and planning for the system selection and clinical implications for such technology 22 Educator/facilitator of implementation and changes; clinical analysts file building and maintenance 23 Clinical documentation, training, resource 24 Too diverse to type in here. 25 Multiple nurses in the IT department. 26 Input into screen build, teaching new applications to employees and physicians, trouble shooting issues.
American Organization of Nurse Executives 21 2006 Survey on Nursing and Information Technology 27 Work with Nursing to implement and tweak projects, EMR, PMAR, etc 28 Configuration Support 29 nurse informatics 30 Reports directly to CNO. Manages the software functions for clinical documentation 31 Serve as the liaison between Nursing and IT for problem solving, design, implementation and evaluation of issues. 32 Program Specialist 33 helps to facilitate and coordinate as well as builds screens and databases 34 IS a part of the nursing shared governance however reports to the IT department. The role is to oversee and manage the clinical documentation system and interface with the nursing super users group as well as nursing leadership 35 She is the Project Manger for the EHR project. 36 EHR implementation is managed by a nurse and many nurses are involved in the planning and implementation. Several functional applications are lead by nurses 37 There are several nurses in IT. None are in a strategic leadership role. 38 We have nurses from our facility working on the corporate planning process as well as a nurse in our local IT department 39 Set up and implementation of the clinical documentation system 40 Nursing Information Specialist 41 We have 7 Informatics nurses. One teaches Pyxis, three are part of the build team, two do ICIS training, and one manages One Staff. 42 unsure 43 Reporting within the IT structure, the nurses are key to the development and implementation of enterprise-wide nursing applications and multidisciplinary applications. 44 Nursing Informatics Coordinator and Analyst train staff, conduct current state studies and develop future state documents, participate on various teams that design and implement various software programs, etc. etc. 45 Serves as liaison to Medical Staff as well as coordinator of the clinical expert team 46 work with staff nurses and IT on technology 47 role at this time limited to implementing and maintaining a number of IT modules organization is looking for an RN Nursing Informatics experience 48 screen development and education of staff 49 Responsible for the organization, design & development, implementation and ongoing administration of technology and clinical information systems for the Division of Nursing. Collaborate with the Chairman of Nursing regarding the strategic and operational planning related to information technology. Proved consultation to the Division regarding recommendations for improvements related to nursing informatics and clinical practice. Serves as nursing liaison to IT Division.
American Organization of Nurse Executives 22 2006 Survey on Nursing and Information Technology 50 We have a campus based Clinical Informatics person that facilitates users to IS&T. We have robust Nursing Info dpt. She helps translate IT issues to end users and then assists technicians in creating workflows. 51 works closely with the system and the staff to understand design and workflow issues. 52 Manages the planning, development, implementation, training, and quality monitoring of all nursing components on informatics projects. 53 Electronic clinical documentation development and implementation and training. 54 The nurse acts as a project manager for the implementation of advanced clinicals 55 Nurse Informatics - evaluation, education, implementation, improvement 56 Hospital/nursing liaison with the IT department 57 Corporate position for system, responsible for all clinical IT 58 There just happens to be a nurse in IT but she functions as any other IT resource. 59 0.5 FTE Nurse Informatics Coordinator 60 SHE IS 100% DEDICATED TO ALL it PROJECTS THAT INVOLVE NURSING. 61 coordinates IT applications, part of implementation project teams 62 IT nurses serve as liaison between practice and information systems 63 Team of nurses that are integral to builds, go-lives, process flow, tweaks, audits and maintenance. 64 We have 2 RNs that are Clinical Application Coordinators. They design and teach all new employees. They work with nursing staff on trouble shooting and resolving problems. 65 Interface the IT requirements with the recommended clinical functionality. Develop profile screens, test, and monitor after implementation. 66 Oversees and facilitates all clinical IS functions. Liaison between our facility and corp. office. 67 they are programmer/analysts in IT 68 Regional Nurse informaticist- regional implementation planning and working on implementation. local clinical nurse analysts - build and maintain systems 69 One nurse works in the IT Department and is responsible for the coordinating, planning, implementing and evaluating of each process step. The other nurse works in nursing, working with nurse managers, staff, trouble shooting, teaching, etc. 70 Clinical analyst who are a liaison with nursing and other clinical departments 71 Full time informatics nurses. 72 Oversight of selection, implementation and on-going maintenance of documentation applications for departments within Patient Care Services. Resource to other department documentation application, including physician order entry project. 73 Corporate oversight, Facility CNO, IT staff nurse 74 There is a nurse that has an executive role in developing integration across the system.
American Organization of Nurse Executives 23 2006 Survey on Nursing and Information Technology We have a IT nurse based on each campus. 75 These nurses are analysts and help nursing build the clinical systems. 76 There are several RNs working in various roles. 1.5 are within the nursing admin budget. There are about 6FTE in the IT dept.The nursing dept RNs work with implementation teams and are the interface with the IT dept and IT vendor personnel. 77 Clinical CoordinatorM. 78 Clinical Systems coordinator 79 5 RNs as Clinical Informaticists 80 User and analyst lead. Provides input to health system corporate I.T 81 development of system components. assists with staff nursing team on building forms and applications. 82 The organization as a whole has several involved in implementation and training. Our facility has two dedicated to implementation of the Clinical Documentation system 83 Many nurses have leadership roles in centralized IT Department including VP and Directors, RNs in development and implementation teams. 84 Planning, implementation, development of system 85 Clinical informatics support to all patient care areas and they interface on all clinical implementations/upgrades. They also bring demos forward to staff to increase awareness of existing technologies 86 assists with design of patient forms, trains nurses on use of EMR 87 Leading design and implementation of clinical IT systems. 88 Update and maintain clinical dictionaries Install, educate and train on updates 89 Nursing Informatics Director and staff 90 our CIO is also an RN 91 She is an analyst: helps problem-solve issues and make things work for nursing and clinical care 92 Analyst positions/facilitate implementation and "build" modifications 93 Nursing Informatics Coordinator (Master's Prepared) 94 Manage nursing documentation system 95 Design, Implementation, Education, Re-evaluation 96 Implementation, education, development 97 applications specialist 98 A Manger of IS for nursing and several educators within nursing. The IS division Has 5 nurses in developing and supporting systems 99 The CIS Coordinator is a master’s prepared (nursing informatics) nurse. There are two other nurses in this department at this time. We will make a vendor selection later in the summer and expect to add at least one more nurse to this department, among other disciplines.
American Organization of Nurse Executives 24 2006 Survey on Nursing and Information Technology 100 We have a Nurse Informatics person in charge of getting the nursing documentation up and running. He has two nurses that work under him and we are just beginning this process. 101 We have two FTEs dedicated in IS and then a team of superusers that help guide the development and implementation of IS systems. These nurses help communicate the needs from a nursing perspective to the programmers. Serve as project coordinators and help train staff. 102 Clinical Analyst and EMR support 103 Project Leader of what we have termed as Clinical Transformation which is taking us to a fully digital facility. 104 There is a Clinical Information Systems team of all nurses, with a nurse leading the Clinical Applications Division. IN addition, the System CNO has a director responsible for Nursing Informatics strategy. The largest hospital has a director of Nursing Informatics who has an MSN from U of Md Informatics program. 105 provide support to the nursing department for IT projects 106 Executive, management and staff nurses participate in the identification of technology solutions, development of design specifications, review of proposals and preferences 107 Nursing Informatics manager works closely with nursing and IT on projects, 108 System integration making sure all documentation meets regulatory issues and not duplicate for the nurse 109 Develop clinical documentation processes for nursing, oversees committee work related and educates nursing 110 Facility implementation at sites 111 System wide there are several nurses involved in education, programming development and strategic planning for IT. Significant gap is the lack of direct clinical support to nurses for education, upgrades, integration and design. 112 Clinical system development. 113 Staff education and support 114 Nurse Informatics Coordinator is a new role and will be dedicated to the implementation of all applications that affect nursing. this position reports to me. There is also an RN in the IT department that is a project manager for clinical application implementation. 115 nursing informatics analyst - help in the design and redesign of applications. informatics educator - self explanatory 116 There is a clinical informatics department that has at least 3 nurses who help implement, teach and facilitate system requests / revisions. 117 various roles---4 full-time nurses are project managers/team members for clinical system implementation 118 Director of Informatics 119 Trouble shoot, work with Nursing Core team for system upgrades etc
American Organization of Nurse Executives 25 2006 Survey on Nursing and Information Technology 120 there are several RN's that work in IT and they are the analysts that support patient care services 121 Informatics liaison and Education of nursing staff 122 She reports to me and is Director of Clinical Informatics. She is a CNS and was experienced in OB. She is certified in Informatics and working on her second master's degree in this area. 123 Assigned to various functions in the clinical areas... evaluates work flow to design system. Assists with education of staff to the system. Works in the IT department to serve as a liaison between IT and clinical services. 124 Oversees the implementation of new modules. Maintains modules after they "go live". Monitors nursing use of modules. Educates and teaches new nurses and physicians. When implementing new modules (such as CPOE) works will all individuals involved in module. Active role with physicians. 125 They are to work on clinical applications both med staff and Nursing related 126 Director Clinical Information Systems 127 Liaison with nursing to make sure nursing task forces associated with implementation complete their work, remain on target, etc. Education re. systems. Help "interpret" IT and nursing to one another. 128 Project leadership & management roles for implementation of clinical systems that involve nursing and other clinical disciplines (5.5 FTEs) 129 There is a nurse who is a director in IT. Also for the EMR roll out plan, several nurses are employed. 130 clinical analyst for nursing, oversees system upgrades, maps nursing functions, trains new staff on documentation, builds forms 131 Deployment Manager, Clinical Account Managers, Nursing Informatics Coordinator, etc. 132 lead the staff work groups 133 This is a new position primarily to support nurses and other clinicians in effectively documenting in and reporting information from our current vendor. This person also works with other IT products such as staffing and scheduling and will be key in introducing two-way communication. Will be the primary liaison between nursing and IS and vendors. 134 design, implementation of systems, training, continued improvement of systems 135 Responsible for the education of Nursing and the rollout of the EMR for nurses as well as evaluation of the present and future state of Patient flow 136 We have an RN who is the lead. She works with the Informaticists from the other facilities in our system to plan, design, and implement all our new IT strategies. Also, I have a i.0 staff member that works with the physicians on IT implementations such as physician portal, PACs, Document Imaging. We are currently interview for an additional 1.0 to work with nursing and physicians for our HED and Meds/Adm implementation. This team will also be involved in the planning designing and
American Organization of Nurse Executives 26 2006 Survey on Nursing and Information Technology implantation of CPOE by 2008. Most recently we have developed a physician IT committee which has memberhip of PHYSICIAN "CHEERLEADERS" of IT. I also sit on the Corporate IT committee with 2 other CNO's. 137 Oversee planning, education, execution 138 Manager, Nursing Informatics - liaison between IS and Nursing. Also has direct reports of System Administrators for IT systems. 139 Coordinates education, problem solves, direct worker with staff and represents the hospital at the system level. 140 In process of hiring. Job description based on national standards for clinical informatacist 141 Project leader - liaison to the Division of Nursing 142 primarily cl doc design and rollout at this phase IS also has 3 analysts senior project manager roles that are nurses 143 Application Analysts and Nurse Leader 144 We have a dept of five nurses who plan and oversee applications affecting nursing practice 145 Implementation of the advanced clinical systems necessary to support our organizations’ journey to world-class Patient Safety and Quality. This nurse is responsible for the EMR, CPOE, NextGen (OP) EMR, Pharmacy System, Critical Care, Scheduling, Quality Management System, Surgery ED and System Integration. In addition to the planning and technical implementation of the systems, this nurse works closely with CMIO (Chief Medical Information Officer), and the organizations clinical leadership to make sure the systems are widely adopted and incorporated into the day to day activities of our clinical staff. 146 Manages the Clinical Implementation Team 147 a nurse has been responsible for the old IT system and makes changes as needed 148 We have many nurses in our IT department. I am not sure of their exact role. 149 clinical documentation implementation 150 co-directs with a MD 151 Clinical documentation and quality data reporting driven role 152 We have a clinical informatics department, comprised of staff whose clinical backgrounds are as nurses and respiratory therapists. The Director is an RN. Their roles are in planning and implementation of clinical IS products/applications. 153 There are two positions, one for Bar Code Medication Administration and one for Nursing Service IT support. Both interface directly with the nurse users wherever they are practicing. 154 Director, informatics 155 the information management nurse 156 very involved in all applications title is "Applications Coordinator". Works closely with departments in design, build, training and implementation phases.
American Organization of Nurse Executives 27 2006 Survey on Nursing and Information Technology 157 informatics 158 this person is overall responsible for the coordination and integration of the computerized system into practice. Reports the network CNO indirectly for this 159 choosing the systems, set-up screens for documentation, training & orientation, attending users groups and voting on enhancements, monitoring compliance with documentation standards; advisory to IT; 160 Clinical Informatics team (RN's) who lead design and updates of clinical systems 161 Clinical documentation maintenance and development/physician and nursing/all ancillaries also 162 RN with critical care background who is our clinical liaison to all IT applications and serves as Manager of Clinical Applications. 163 decision makers and advisors and train the trainers....they also analyze work flow prior to implementation and evaluation of need 164 All clinical applications of IT are managed by the 3 nurses 165 Has a BSN and a bachelors in Information Systems, reports to the CNO and facilitates use of IT by nursing, helps build and revise processes to best fit with IT. 166 Nurses are in roles of Director for IT, implementation coordinators, trainers and facilitators 167 Nursing and Clinical Informatics. There are RNs in senior positions within I.T. but they do not report to nursing. Nursing had I.T./PhD person who left organization. Waiting to fill job when corporate Chief Nurse Executive is hired (new job). 168 process improvement, tool development, education 169 Directs the clinical IT system applications. Chairperson of the hospital steering committee. 170 IT support to the clinical area on an on-going basis and EMR implementation planning teams facilitation. 171 She is involved in all upgrades / installations of systems which affect nursing or clinical documentation. 172 We are a small organization ; half time position; responsible for building and implementing all clinical systems with support of clinical department staff 173 IT Dept team- various projects 174 IT nurses are involved in process design, build and education functions 175 Coordinates implementation of EHR; oversees superusers; 176 Nurse is at corporate 177 Develops the EMR Collaborates with IT on implementation of new systems Builds new systems with IT. Monitors, troubleshoots systems 178 Clinical Consulting Analysts responsible for design of system and workflow design with staff and education of all clinical staff including MD, RN, and all other members of the Healthcare team.
American Organization of Nurse Executives 28 2006 Survey on Nursing and Information Technology 179 project management of implementation projects 180 Director of Clinical IT section 181 oversee implementation and maintenance of clinical software systems 182 Act as a liaison/system administrator for various clinical applications 183 Training, building templates for notes, suggesting improvements in software 184 Responsible for nurse's needs for the EMR and barcoding 185 We have a clinical informatics department, it is lead and staffed by nurses. 186 Support of electronic clinical documentation and electronic MAR. Education, trouble- shooting, product selection, etc. 187 Currently coordinating readiness assessment - employ two nurses in IT - will lead training when time comes 188 Clinical systems analyst. Evaluates use of computer applications for clinical departments, participates in decisions, builds dictionaries 189 clinical documentation actively involved in implementation 190 develop and maintain nursing modules implement upgrades to system for nursing and clinical areas 191 Director of Clinical Informatics who reports directly to me as CNO and a close working relationship with the CIO 192 3 nurses dedicated to implementing and overseeing the clinical documentation system 193 BarCode Med Coordinator Clinical Application Coordinators (3) Nursing Informaticist 194 Coordination between clinical and technology 195 liaison, technical assistance 196 The individual facilities have IT nurses, that comprise a IT nurse team that interacts with the IT team and reports to the individual CNO'S in the respective facilities and the team reports to the collective CNO Council 197 Informaticist who is responsible for participating in new IT initiatives 198 I have a division of certified nurse informaticists for a total of 8.0 FTEs. They have significant roles throughout the organization related to IT selection, development and implementation 199 Director of Clinical Information Systems 200 One of the directors in IT department with responsibility for clinical applications. 201 Informatics nurses help refine current systems and build new ones. 202 IT System Analyst (We have several) 203 clinical nurse IT analyst 204 Work with physician experts on CPOE order sets. Train caregivers for online documentation, CPOE. Support implementation. Create new work processes and supporting policies and procedures. 205 Inviolved in implementation of clinical projects
American Organization of Nurse Executives 29 2006 Survey on Nursing and Information Technology 206 education, design, testing, development, planning 207 clinical systems manager 208 Formal, high level Director
American Organization of Nurse Executives 30 2006 Survey on Nursing and Information Technology Appendix C. Full list suggestions for AONE support
1 Provide suggestions for organizational structures that support implementation and facilitate communication between nursing and IT 2 Provide workflows and best practices that have been identified by specific vendor selections to assist the CNO's in decision making. 3 continue to provide information on the technologies available 4 Share program installation pitfalls from each member org, and the products positive and negatives...create a network to resource on line 5 Information sharing of what other organizations are doing and what is no the horizon for the future. More info on the informatics in nursing. 6 AONE can support IT implementation by advocating for more funding as well as continuing to support efforts to create a unified or universal systems language so information programs will be able to talk to each other deducing our dependence or expensive interfaces. 7 not at this time 8 On going research for process redesign and implementation 9 Provide networking opportunities to discuss systems, liaison with vendors to take nursing workflow into consideration in development of products such as the barcode scanning systems. 10 Keeping up to date on what is new 11 education 12 Supply information on what organizations are doing in the area if UT 13 Continue to print articles related to this. 14 This type of survey is a good start. It will be interesting to see the results, which I will share with our IT director. 15 AS a small hospital we are held to the same standards and expectations for technology implementation. We struggle just the make enough money to provide good patient care. AONE should be a loud voice for grants to support small (not just critical access) hospitals upgrade technology. We may be able to afford the costs of the hardware and software but the education time away from the bedside for the staff nurse and the full time removal of person from clinical commitment into technology are very stressful for the organization. 16 Continue to focus resources to support learning and sharing of lessons learned 17 It would be helpful to have a position statement as it relates to the role of the Nurse in the development of the future of the IT solutions. A "list serve" that address IT would be helpful. I have been fortunate that the organization I work with is committed to involving the person who his closest to the process in the development and implementation. We are currently implementing the documentation piece for the EMR and only wishing there were more hours in the day to spend with the RN's to allow them more opportunity to be successful sooner. The learning curve is broader
American Organization of Nurse Executives 31 2006 Survey on Nursing and Information Technology for some of the nurse. 18 Sessions and papers on how technology is being used successfully to enhance the role of the nurse. Also, sessions on "lessons learned." 19 Encourage the vendors to work together better and make implementation easier. 20 Pushing for standardized barcoding. Med reconciliation is challenging. We need standardized medication tables so different programs will more easily talk to each other...i.e. First Data vs. Multim vs...... 21 Setting standards, sharing best practices, assisting with ROI, sharing stories of success and unsuccess, including content in the annual meetings, 22 There is a tool called KLAS which provides a comparison among all IT systems. it would be great if that tool or any other similar tool could be analyzed by nursing and the analysis be in language we can understand. 23 Connections with hospitals that have been through the process. 24 Sharing of best practices; lessons learned and pitfalls; frequently used timelines/ time frames for installation; etc 25 Continue to provide updated information on IT systems and how to make them user friendly for nursing 26 Provide information on software products--comparing high quality solutions Provide support--information on implementation--identifying lessons learned by other organizations. 27 Standardized nursing language 28 Overall issues that need solutions: * Funding to assist everyone, but especially the little guy * Interface capability (both forward and backward) within software companies and between software companies * Sharing of information instead of having to re-invent the wheel (e.g. an IT information clearinghouse) 29 unsure 30 Publish success stories from organizations who have successfully implemented various types of software. Publish benchmark data re: implementation strategies. 31 Assistance with wide-spread standardization among the vendors/manufacturers where applicable..ie bar coding standardization 32 establish forums for dialogue on this and all pertinent issues 33 Provide information about the various systems on the market with information about which hospitals are using them. 34 Information regarding best practices 35 Assist with gathering of benchmarking data related to EMR systems and other technologies to support nursing research related to impact of same on nursing practice and patient outcomes. 36 provide access to information on successes and pitfalls to avoid. 37 more IT presentations at national meetings
American Organization of Nurse Executives 32 2006 Survey on Nursing and Information Technology 38 certification opportunities 39 continue with state of the art presentations on integrated IT systems that support patient care across the continuum 40 Providing education, networking, and continue of sharing of best practices. 41 Provide information, lessons learned, roadmaps, etc 42 You are doing a great job now. 43 Continue to support, encourage, be a resource, etc. 44 streamlining nursing documentation---best practices 45 provide research as to successful applications 46 Unknown, I work for a large DoD bureaucracy, nothing seems to change it except acts of terrorism. 47 keeping member apprised of success stories with implementing a system that works for EMR 48 Continued IT information in weekly AONE newsletters 49 On going updates on the various trends in the technology. 50 Best practice web conferences. Y. 51 There is a huge disconnect between education and IT intiatives-we need to be able to better respond to nursing education/IT education and the current nursing educator workforce cannot do it. 52 Providing us specific feedback from organizations who have successfully implemented a system that really works, and by that I mean, either saves the nurse time, or at least does not take her away from the bedside anymore than she already is. Also, it is helpful to learn from other people's mistakes. 53 Keep getting information out. Please put it in newsletters/on-line, etc. 54 keep us informed of what other hospitals are doing and leading technology 55 Regional West medical Center could serve as a model for other organizations 56 Work with The Hospital Association to promote the involvement of nursing in IT programs with the CEOs. Any data that supports the role of Nursing in the IT department. 57 Do not think I need additional support 58 provision of information comparing types of systems, IT information written from the clinical perspective. 59 Good topic for one of the national meetings 60 develop a position paper on CNO / nurses involvement in setting the vision and selection process for EMR implementation and other IT solutions to quality measurement / documentation / cost benefit.etc 61 ongoing presentation of the latest in technology 62 Actually I feel you are giving me all I need in this area but the vendor we have
American Organization of Nurse Executives 33 2006 Survey on Nursing and Information Technology selected also provides us with significant opportunities for support and networking on all levels of staff. 63 Development of criteria for choosing clinical programs for use when evaluating vendors. 64 Provide the survey findings 65 It would be helpful for AONE to develop guidelines or recommendations for clinical IT implementation 66 Continue to support the American Academy of Nursing's efforts. 67 workflow recommendations how to keep patient care the priority lobby for nurses role in implementation 68 Get more involved in pressing IT folks to understand the need for us a the table sooner rather than later. 69 Identify strategic goals for clinical documentation. Push public policy mandating bar coding. Fund/promote research for best practices. Influence public policy related to universal EMR for patient/provider access. 70 Networking opportunities. Any published articles on workflow redesign. 71 Help define best practice role and role requirements 72 This survey did not address the CNO role. In addition to being a member of the steering committee, I am heavily involved as co-chair with the CMO of the leadership committee for the implementation of our new clinical and business system. Plus I have two Directors who chair the clinical documentation portion. These are very big time commitments but necessary, I believe, to make sure that we have a system that is responsive to nurses and that will have broad clinician adoption. I would like to know how many other CNOs are involved to this degree and to have others with whom to network. 73 Profile hospitals and Id what they did well, along with struggles and solutions Profile IT solutions ( i.e. Bar coding)..who is on market, ratings, rankings of companies, based on objective criteria 74 none at this time 75 we are working very closely with our vendor. the only help I can think of is a list of contacts 76 None 77 We are a small critical access hospital. The CFO is very supportive of IT. We already use EMR's in acute care and OB. Out ED is electronic and physicians in ED use CPOE. We maintain the pharmacy module and use BMV with eMAR's. We are in the process of implementing CPOE and plan to have it fully up and running by the end of the year. I feel we are successful because our nursing and physician staff is excellent. 78 making best practices available as it pertains to IT related initiatives. SInce more clinical decision are driven by best practice at the bedside it is a great way to enhance national health care improvement.
American Organization of Nurse Executives 34 2006 Survey on Nursing and Information Technology 79 I believe our system is very supportive of nursing involvement. 80 (1) Education on current and future Clinical Applications to support nursing/clinical practice and evidence based care; clinical technology integration across the continuum; how nursing applications fit into the larger picture of integrated clinical applications across the continuum. (2) Examples/case studies of organizations that have successfully implemented nursing and clinical technology across the continuum and can demonstrate improvements to clinical care and patient safety. 81 Would like to network with others that are in various stages of implementation. 82 present IT related information in publications 83 Information is ALWAYS helpful - Knowledge of systems that support successful implantation at other facilities - Product information (i.e., a "consumer report" for various systems and technologies in the marketplace). 84 Lobbying for government support for IT. 85 review of best practices and cost effective solutions 86 position statements criteria used for decision making r/t software 87 Continue to provide networking info in the newsletter and at annual meeting. 88 Facilitate collaboration with IT and CEO, COO decision-makers regarding IT 89 I think our committee is very pro-active. Our Critical Care Director also functions as our IT nurse. She creates a lot of the screens for nursing documentation. 90 Not sure 91 Work Environment Research related to IT projects. 92 more white papers on technology and ratings such as consumer reports on products with pros and cons 93 By helping to communicate to IT the importance of having nursing informatics specialists on staff and helping to drive the process. These nurses translate medical/nursing language for our IT colleagues 94 Education on systems availability Demonstration of ROI in terms of financial or quality benefit 95 Keep me educated on current trends. I would like to be able to communicate better with IS/IT staff. It seems we speak different languages. 96 Education and preceptorships for Clinical Informatics Nurses as well as education for senior nursing leaders on the role of "driving the strategic direction" of the clinical EMR. 97 Increase availability of nursing informatics/IT options training and certifications. regular updates on what is out there and working to improve patient safety and quality of care. Publish Best Business practices utilizing IT/IM. 98 Help develop a plan of how to obtain it 99 Review of products; research showing benefit of use of such programs 100 Develop a template of "considerations" for nurse execs when evaluating/planning for
American Organization of Nurse Executives 35 2006 Survey on Nursing and Information Technology IT projects. 101 Information on selection, adoption, implementation of systems from peers 102 Items that discuss different IT products and how satisfied or dissatisfied end-users are with the performance. 103 Would love to a toolkit that outlines what someone needs to do. I have inserted myself very forcefully so the implementation is a partnership and supports my nursing practice environment. If I had not done this I think this could easily become an IS project with them telling us how it will be 104 I am pleased to learn of AONE's activity and awareness. keep moving forward, thanks, 105 I think there needs to be easily understood standards for EMR on the acute care side - seems like HIMMS has developed something... but, needs to be endorsed 106 education and best practice offerings - also the talking points of role of CNO and IT will be very helpful 107 I recently was educated as an RWJ Executive Nurse Fellow on role of nurses/informatics - was timely and pertinent. 108 I'd like to know how other small rural hospitals are implementing nursing point of care technology on limited budgets. We have CPSI 109 Keep us informed of best practices 110 Help design college masters programs the connect informatics and masters in nursing degrees. 111 Education of members facilitated at annual meeting and in-between. 112 Nursing is represented. Articles in publication and newsletter to keep me up to date would be appreciated 113 Sharing of best practices, especially in the areas of ROI and work process changes 114 It would be nice to have a spread sheet of what is available; the pros and cons; issues encountered and types of applications. It is very confusing and complicated and vendor sales staff often do not have correct information. 115 Education, articles on the benefits. Different software available for different clinical needs 116 Develop a roadmap for healthcare facilities in implementing nursing IT systems. Develop certification thru ANA in Nursing Informatics. 117 establish a roadmap for Nursing ICT 118 I am very interested in a seminar or workshop where I could learn how other organizations have implemented systems, job descriptions, organizational charts, etc. 119 Sharing of best practices between facilities 120 Not at this time 121 Nursing already has full participation 122 Cont'd information on the benefits of IT and how it can assist nursing in more
American Organization of Nurse Executives 36 2006 Survey on Nursing and Information Technology effective care delivery. 123 White paper and formal statements for the need to have nursing informaticist available for each facility 124 A prepared comparison of the IT systems and what they can and can not do would help in decision making. Something that is user friendly to institutions that can not afford a FT nurse with an IT degree. 125 Continue to provide information 126 By making us aware of opportunities for us to develop competencies in informatics. The transition to an electronic health record is affording opportunities to transform healthcare delivery. It's important that nurses provide leadership to this work in collaboration with IT. There are degrees and certification programs available. However as a CNO I need to know other opportunities to add to my knowledge. I am planning to attend the Univ. of Maryland Summer Clinical Informatics Symposium - an example of an excellent program for me as CNO. Would also be helpful to know what networking opportunities are available. A focus on increasing the knowledge of a CNO to provide leadership as the organization transitions to EMR., Thanks - so glad you're conducting this survey. 127 I do not have any needs 128 More education on the role. 129 Continue the conversation, thank you for asking for this feedback and conducting this survey. Look forward to results. 130 None 131 I have no suggestions for AONE support in our current IT implementation activities. 132 Nuts and bolts of how organizations are hardwiring clinical and quality standards and regulatory compliance through IT. 133 continue to provide information on trends in the industry. 134 Current articles/email information on success stories and problem resolution in other organizations. 135 Provide up to date information of cutting edge initiatives
American Organization of Nurse Executives 37 2006 Survey on Nursing and Information Technology