Utilization of Electronic Health Record Software in a Nursing Program. Project summary
The Gap: Information literacy is a fundamental component in the provision of high quality and safe patient care which is also culturally sound. The implementation of evidence-based practice in any given organization is a central focus hence the need to be competent in the field of nursing informatics.
It is heartbreaking to learn that most schools of nursing are still using the traditional methods of teaching in the technologically advanced world. There are only a few institutions that embrace advanced technology such as high-fidelity simulations and electronic health records in their teaching (Borycki et al, 2015). Such strategies are geared towards stimulating critical thinking and decision making despite the fact that they are rarely employed in the schools of nursing.
The transition from paper to electronic medical records (EHRs) demands that the nursing curriculum reflects the technologies employed in current nursing practice. Students also need nursing informatics competencies which they can use to enhance their critical thinking. Most undergraduate students have not been in a position to learn about EHR only to find them at the practice level (Borycki et al., 2015). The application of EHRs is essential in both the classroom and clinical teaching of the nursing students as well as other healthcare professionals.
Organizational Trends
All healthcare facilities in the United States were supposed to implement electronic health records by the year 2014 as per the 2009 Health Information Technology Act (US Department of Health and Human Services, 2014). The act implies that all nurses in the healthcare institutions should be able to utilize the electronic health records in addition to the possession of other skills in nursing. It is, therefore, logical to deduce that the nursing students, as well as staff, should be in a position to use the EHRs at the time of implementation. The intervention completely alters the most aspects of nursing practice, and it would be disastrous to fail to teach students about informatics. The students need the informatics skills to provide high-quality care in addition to other topics in nursing.
Technology is ever evolving hence prompting the need for curricula to race to meet the standards. The development in technologies poses challenges as well as opportunities for the healthcare system to advance. EHRs are known to enhance the quality of care, efficiency in time management and also contribute to cost-effectiveness (Nelson & Staggers, 2016). They also enhance job satisfaction among the healthcare professionals as there are better communication and satisfactory data management. It is the goal; of every institution to ensure that their students benefit from upcoming technologies hence it would be necessary for the nursing students to be taught on EHR.
Causes of Failure to Incorporate EHR in Nursing Curriculum
The primary cause of the delay to integrate the training on EHR in the nursing curriculum is the fact that most of the lectures were not taught about it in their time. The education gap arises from the fact that the nurse educators were not trained on EHRs yet they have to teach it to their students (Borycki et al, 2015). The nurse educators, therefore, might be reluctant to incorporate the concept into the nursing curriculum as it could be new to them as it is to the students. The educators should be first trained about EHRs so that they can comfortably teach their students the concepts of electronic health records.
Another problem in the failure to teach EHRs in the nursing education is the fact that people are resistant to change. The implementation of new strategies are associated with a lot of challenges hence most people prefer not having the change at all. There is a lot of pressure not only for the management but also the staff when it comes to the adoption of inventions. Change forces organizations to restructure their way of doing things hence people are afraid of change. Most individuals are naturally resistant to change; hence they would do their best to avoid the change (Iwasiw et al, 2014). The same issue occurs in the implementation of a new curriculum with a focus on EHRs whereby nurse educators are not willing to take up the challenge.
Identification of Target Audience
Characteristics of Target Audience
The project targets the adoption of EHR teaching in the nursing curriculum which will facilitate the acquisition of more knowledge and skills on nursing informatics. The nurse educators are expected to incorporate the teaching of EHR to the nursing students at the entry level. The project, therefore, targets administrators in the schools of nursing who can push ahead for the implementation of EHR training for students. The nurse educators also form the stakeholders as they are responsible for curriculum development and review. Other stakeholders include the nursing students who will be the learners of the curriculum in a bid to acquire excellent skills in nursing informatics through electronic health records training.
Professional development
Most nurse educators had their training when there was no story about the electronic health records. EHR is, therefore, a new concept among the lectures in most schools of nursing hence there is a need for training most of them. The change, thus, poses challenges to the existing teachers as they are not aware of the EHRs systems and would need to be taught on the same before they can teach the students (Borycki et al, 2015). However, many people are computer literate which makes it easy to train them about EHR and how it can be implemented in teaching.
Proposed solution
There is need to embrace academic electronic health records (AEHRs) to adopt the teaching of EHRs in the schools of nursing. One of the AEHRs is the Academic electronic Education Solution (AES) which was designed by the Cerner Corporation and aims at integrating an informatics system in the multidisciplinary healthcare curriculum for the nurses. AES is a health record which is tailored to teaching and provides the necessary conditions for teaching about EBP (Choi et al, 2016). Tutors are also capable of teaching the standardized nursing language, and the students get to boast in a healthcare environment that is informatics intensive. Academic Education Solution should be incorporated into the nursing curriculum for teaching student nurses at the entry level.
AES increases the proficiency of students in health information technology. Students can apply skills easily in their jobs due to the previous exposure to the EHRs. The decision-making capabilities of the students are also enhanced by the AES as there are different tools in the technology for support such as links to research (Choi et al, 2016). The AES also strengthens the clinical knowledge of students through the use of real-world scenarios for learning. Students also get to be more prepared for the electronic paperless workplace as a result of exposure to technology.
Intended outcomes
The AES EHR enables the schools of nursing to access and embrace an active and up to date information system in the curricula. It equips students with the skills to identify, find, use and evaluate healthcare information. Such skills are essential for students in the application of evidence based techniques for the delivery of high-quality care. EHR enables individuals to access data on patient care such as vital signs and alerts for drug incompatibility which further increases the quality of care provided and enhances the patient outcomes (Robinson et al, 2014). The program also stimulates critical thinking among students which leads to better clinical reasoning grounded in evidence.
The 2009 act that requires all healthcare facilities to adopt EHR imply that nursing graduates will be exposed to such technologies upon joining the profession. The lack of knowledge in EHR by students interferes with their adaptation in the clinical environment since they cannot execute most informatics tasks (Robinson et al, 2014). The main advantage of AES is that it enables the students to appreciate the importance of entering, managing and using healthcare data. They thus can use such data to generate information and knowledge which enhances their nursing skills. The learners get to realize the basic principles of EHRs which make them adapt easily in the clinical area and nursing practice. The students who rotate in facilities that utilize the Cener’s AES are at an advantage because they can use the same systems in the class and also in the clinical environments.
The key goal of teaching nursing is to produce graduates who can serve in the rapidly changing healthcare environment. It is therefore essential that students should be taught most of the skills so that they do not find it hard to adapt to practice. Many are times that nursing students experience the “shock reality” when they get to practice due to the lack of knowledge in various aspects of practice (Robinson et al, 2014). Nursing students are expected to implement most nursing procedures without supervision after a short time in the profession. Failure to adapt easily implies that the students were not prepared well to face the healthcare system. Knowledge on EHR is thus essential for student nurses before their entry into nursing practice.
Acquiring skills in the use of electronic health records is a first step in the provision of high-quality patient care. Nurses have a mandate to offer high quality and safe care to their patients through appropriate training, research, evidence-based practice and technology which includes EHR. The preparation of students using the AES assures competent nurse graduates who can utilize technology to maximize the care of their patients (Robinson et al, 2014). It is, therefore, the best choice to teach students beforehand so that they can fulfill the need to provide high-quality patient care and achieve excellent outcomes.
Evidence summary
The benefits of academic electronic health records (AEHRs) such as AES have been documented by many authors and academicians. It is the general opinion that the nursing students should be taught about electronic health records in preparation for them to enter the avenue of professional nursing practice. Most of the nursing faculties are comfortable with the introduction of academic electronic health record systems for training of nursing students. Kowitlawakul et al (2014) conducted an exploratory qualitative study to establish the perceptions of different faculties of nursing towards electronic health records in the nursing curriculum. The researchers were motivated by the knowledge that the use of EHR in nursing faculties was on the rise but the perception towards the same was not evaluated.
The success of electronic health records lies in the efforts of not only the nursing students but also the support accorded by the nurse educators. The authors established that both parties were crucial in determining the effectiveness of programs for learning the electronic health records system among nursing students. The researchers set out to explore the experiences and perceptions of members of the nursing fraternity on EHRs in a nursing education software program. The researchers also examined the factors that contribute to the success of such programs in the schools of nursing.
The results on the perception of the participants about the EHRs were grouped as innovation, transition and integration. The participants felt that the technology was innovative and beneficial to the learners despite the challenges it poses. The participants also felt that the use of the new software program for EHR was an innovation as far as their learning was concerned as it was a unique experience. Kowitlawakul et al (2014) established that the success of any EHR implementation program was based on the commitment of the staff and also the willingness of the students to learn. It was also determined that the availability of the relevant resources was essential in enabling the students to adapt to the academic electronic health records system. The success of the project in the school of nursing was attributed to the commitment of faculty members and students by dedicating time to it and also the overwhelming support that the institution of nursing administrators accorded to the implementation.
In another study, Miller et al (2014) conducted a quantitative descriptive study to establish the ability of novice nurses to use EHRs effectively in practice. The researches acknowledged the fact that nursing faculties were reluctant to embrace the concept of EHR in training. Miller et al stated that the academia struggled with what should be included in the different levels of study for the program to be effective. According to Miller et al (2014), many schools of nursing have implemented the training on EHR as part of their training. The program corresponds to the requirement for nursing students to complete care plans electronically collecting patient data and entering into the electronic system in addition to real-time documentation of care.
The study established that novice nurses wanted as far as EHR application skills were concerned. Most of the new nurses were not well conversant EHR and therefore could not apply it appropriately. The findings pose a challenge to the nurse training faculties to offer thorough training for the nurses to enable them to cope adequately with the professional practice. EHR training should be incorporated into the nursing curriculum of all the schools of nursing to ensure that students are well prepared for the task that lies ahead of them when they qualify. Miller et al (2014) recommended that EHR training is a task of not only nursing education programs but also employers to ensure that employees provide safe and high-quality care continuously.
Borycki et al (2014) described the effects of a hands-on exposure of nursing students to an educational EHR system. The researchers wanted to determine whether electronic health records could help the undergraduate nursing students to develop competencies in health informatics. They conducted a quasi-experimental study to establish whether the students who were exposed to an educational preparation for EHR could develop skills in health informatics competency development.
The researchers measured the competencies of the students before and after exposure to the EHR academic program. Borycki et al (2014) found out that the students that were exposed to hands-on training of EHR in their academics developed more competencies as compared to other students who were not predisposed to such technology. The students were also able to provide a greater in-depth and high-quality information regarding case studies when exposed to the hands-on experience as compared to their counterparts. In conclusion, the authors indicate that the implementation of academic training of EHR for students is very critical in the development of health information technology competencies.
Wald et al (2014) conducted a literature analysis to determine the status of EHR training in nursing education programs and also to establish a way forward. The authors acknowledged that EHRs is state of the art yet many institutions had not embraced the teaching of the concept. They determined that the formal pedagogy of electronic health records within the undergraduate medical education was limited. Wald et al sought to establish ways through which medical educators could meet the needs of learners by integrating EHR training in the curriculum.
It was determined that the incorporation of EHR training in the medical curriculum was possible as long as the tutors are willing to overcome the associated barriers. Wald et al (2014) noted that the venture would not come easily but required the dedication and commitment of the nurse educators. The authors recommended that systematic longitudinal curriculum development for EHR training could be done for the medical students in a bid to bridge theory into practice. The strategy would empower the undergraduate nursing students to develop skills that are patient and relationship-centred coupled with the development of health information technology skills.
In another study, Milano et al (2014) sought to determine the effectiveness of teaching EHR skills for disease management and prevention. They described the development and implementation of the Sim-EHR curriculum and established that the curriculum was a practical and interactive method that could provide learners with skills on the use of EHR. It was determined that the simulation of electronic health records in a curriculum is a significant step in the training of highly competent nurses who do not pose a training burden for the employers.
Milano et al (2014) observed that students would haphazardly try to learn health informatics technologies such as EHR in the clinical area. The students would therefore not acquire all the essential skills for the EHR application which makes them prone to mistakes and compromising the safety of patient care. The authors present a report of the implementation of a simulated EHR system in the Oregon Health & Science University (OHSU). The curriculum would enable learners to have a safe and supervised setting in which they could handle a virtual patient in a simulated situated. The result was well-prepared students with vast knowledge and skills in the implementation of EHR technology in patient care.
Evidence summary references
Borycki, E. M., Griffith, J., Reid, P., Kuo, M. H., & Kushniruk, A. W. (2014). Do electronic health records help undergraduate students develop health informatics competencies?.
Kowitlawakul, Y., Chan, S. W. C., Wang, L., & Wang, W. (2014). Exploring faculty perceptions towards electronic health records for nursing education. International nursing review, 61(4), 499-506.
Milano, C. E., Hardman, J. A., Plesiu, A., Rdesinski, M. R. E., & Biagioli, F. E. (2014). Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention. Academic medicine: journal of the Association of American Medical Colleges, 89(3), 399.
Miller, L., Stimely, M., Matheny, P., Pope, M., McAtee, R., & Miller, K. (2014). Novice nurse preparedness to effectively use electronic health records in acute care settings: Critical informatics knowledge and skill gaps. Online Journal of Nursing Informatics (OJNI), 18(2).
Wald, H. S., George, P., Reis, S. P., & Taylor, J. S. (2014). Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient-and relationship-centered care in the computerized setting. Academic Medicine, 89(3), 380-386.
Implementation plan
Plan of action
The project targets the entry-level nursing students who will be taught on the use of Academic Education Solution as an approach to the learning of electronic health records. EHR will be incorporated into two courses within the nursing curriculum at the entry level. The units to bear EHR training are the nursing fundamentals and essential clinical skills. The two units are concerned with enlightening learners about the fundamental skills that a nurse should have, and the use of EHR is necessary. Upon the incorporation of the EHR in the new education curriculum, it will be implemented through teaching the first year nursing students. The students will be equipped with higher information technology skills including the use of EHR by the end of their course, unlike their counterparts. A curriculum review will also be done at the end of the nursing education to establish whether the students are well conversant with the new curriculum.
Timeline
The implementation of the new curriculum has a lot of tasks within the first year when much of the work needs to be done. Students are taught on nursing fundamentals and essential clinical skills in their first year, and that is when most of the changes in the curriculum will be executed. There will be additional topics to be covered within the two units that bear the EHRs concept. The two courses are taught majorly in the first semester hence by the end of the first semester the students will have learnt the theoretical concepts of EHR. Later in the first year, the students will get to apply the skills in the clinical practice as they go for their practical sessions.
By the end of the first year, the students will have gained a lot of practical skills in electronic health records which they will be required to apply throughout the course even as they approach their final year. There are also associated courses in other levels of nursing education that the students will be required to relate the knowledge gained in the first year of study. As the students progress in their studies, they will embrace the knowledge and skills in electronic health records with an ultimate goal of providing high quality, safe and culturally competent healthcare to their patients in future. The students will be best positioned in to utilize electronic health records in the provision of nursing care once they are qualified.
Resources and Personnel
The implementation of the project requires both material and human resources. One of the major items needed for the academic electronic health records implementation are computers in which the software will be installed. The school of nursing should, therefore, purchase adequate computers and establish the program as necessary for learning. Staffs for the teaching of academic EHR are needed for the students. The nurse educators will need to be trained before the implementation of the project to ensure that they are well knowledgeable about the use of EHR so that they can apply them in teaching (Borycki et al, 2015). As a result, a lot of training would be necessary to make sure that the staff can take up the challenge of teaching EHR in nursing informatics.
Lewin’s Change Model
The project will utilize the Lewin’s three-stage model of change in the adoption of EHR training in nursing education. The model was proposed by Kurt Lewin and entails three major steps in the change process which include unfreezing, change and freezing which is also referred to as refreezing (Burke, 2017). The model has remained relevant even in the face of changing times thus can be applied to the project.
The unfreezing stage is all about getting ready for the change, understanding the fact that change is necessary and moving out of the comfort zone (Burke, 2017). The stage involves a deliberate effort by the management of the faculty of nursing to understand that there is need to incorporate EHR training in the nursing curriculum. The department will prepare to change the nursing curriculum so that it can accommodate the issue of electronic health records. The administration should create a sense of urgency for the change such that staffs are willing to apply the new curriculum to the next intake.
The next step is the change in which people are unfrozen and moving towards the new way of doing things (Burke, 2017). In the case of the project, the old curriculum has been dismantled and a new one created for the implemented in the first year class. The stage is often hard as people are unsure of whether the new strategies will work or fail. As a result, a lot of administrative support is essential to ensure that staff are adequately trained for the task and can teach electronic health records effectively. The teaching of the new curriculum will, therefore, begin in the first years at the second step.
The final step of change according to Lewin is the freezing which is establishing stability after the implementation of the change (Burke, 2017). The faculty of nursing will gain stability once a new curriculum bearing the training of EHR has been formulated and implemented. The new practice becomes a norm in that all nursing students must be taught about EHR whenever they enrol in the school of nursing. The teaching of the electronic health records system will; thus be taught to all students as the change has been absorbed in the institution.
Barriers to Action
The implementation of an EHR system is associated with lots of costs which may not be affordable by the institution. Schools of nursing are under intense financial pressure for the installation of EHRs systems and the training of personnel who will be handling the training. A lot of money is therefore needed to ensure that the institutions are well equipped with the relevant technologies and also the nurse educators are well trained about the project (Borycki et al, 2015). Money constraints could, therefore, pose a significant challenge for the adoption of EHR system. Financial constraints, therefore, pose a significant problem in the implementation of electronic health records.
The nursing faculties lack the appropriate skills and knowledge for the adoption of academic EHRs (Borycki et al, 2015). The implementation of the project requires the training of the nurses to ensure that they are well positioned for the training of the students. The lack of knowledge among the teachers is a major challenge that must be addressed before the plans of achieving technologically equipped students as far as EHR is concerned. The training of the nurse educators is therefore a critical step in the success if the incorporation of EHR into the training of nursing students. Failure to achieve optimal training of the lecturers in the faculty of nursing is a great challenge to the success of the project.
The status quo is another barrier to the project implementation as it leads to the resistance to change. People are used to seeing processes and structures the same way hence become resistant to change. The stakeholders in the EHR implementation project may not be willing to adopt a new technology despite knowing its advantages. Resistance to change is one of the commonest problems in organizations as staffs feel threatened to let go and embrace something near. There are also fears of whether the project will succeed or not which leads to uncertainty. The staff could then refuse to implement the project based on their beliefs which could lead to the project failure. It would, therefore, be important to adequately seek the support of the majority, offer training and campaigns for the faculty staffs to join hands and implement the project.
References
Borycki, E. M., Frisch, N., Moreau, J., & Kushniruk, A. (2015, February). Integration of electronic health records into nursing education: issues, challenges and limitations. In ITCH (pp. 88-92).
Borycki, E. M., Griffith, J., Reid, P., Kuo, M. H., & Kushniruk, A. W. (2014). Do electronic health records help undergraduate students develop health informatics competencies?.
Burke, W. W. (2017). Organization change: Theory and practice. Sage Publications.
Choi, M., Park, J. H., & Lee, H. S. (2016). Assessment of the Need to Integrate Academic Electronic Medical Records Into the Undergraduate Clinical Practicum: A Focus Group Interview. CIN: Computers, Informatics, Nursing, 34(6), 259-265.
Iwasiw, C. L., Goldenberg, D., & Andrusyszyn, M. A. (2014). Curriculum development in nursing education. Jones & Bartlett Publishers.
Kowitlawakul, Y., Chan, S. W. C., Wang, L., & Wang, W. (2014). Exploring faculty perceptions towards electronic health records for nursing education. International nursing review, 61(4), 499-506.
Milano, C. E., Hardman, J. A., Plesiu, A., Rdesinski, M. R. E., & Biagioli, F. E. (2014). Simulated electronic health record (Sim-EHR) curriculum: teaching EHR skills and use of the EHR for disease management and prevention. Academic medicine: journal of the Association of American Medical Colleges, 89(3), 399.
Miller, L., Stimely, M., Matheny, P., Pope, M., McAtee, R., & Miller, K. (2014). Novice nurse preparedness to effectively use electronic health records in acute care settings: Critical informatics knowledge and skill gaps. Online Journal of Nursing Informatics (OJNI), 18(2).
Nelson, R., & Staggers, N. (2016). Health Informatics-E-Book: An Interprofessional Approach. Elsevier Health Sciences.
Robinson, M. V., Estes, K. R., & Knapfel, S. (2014). Use of technology in the classroom to increase professional preparation. The Journal for Nurse Practitioners, 10(10), e93-e97.
US Department of Health and Human Services. (2014). Health Information Technology for Economic and Clinical Health (HITECH) Act, 2009.
Wald, H. S., George, P., Reis, S. P., & Taylor, J. S. (2014). Electronic health record training in undergraduate medical education: bridging theory to practice with curricula for empowering patient-and relationship-centered care in the computerized setting. Academic Medicine, 89(3), 380-386.
