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Implementation of an electronic health record (EHR) is a significant change in most healthcare facilities. Research indicates that utilization of significant support through trained super-users could be helpful in the transition process. Most facilities utilize super-users only during the initial two to six week implementation period allowing them to function in this support role for clinical informatics, informatics and staff. Expanded use of super-users maximizes the potential of this valuable resource.
Concern: To expect healthcare workers to transition from paper to electronic format and function effectively and safely within the short initial implementation period is an unrealistic goal. In many facilities clinical informatics department consists of only a few staff members making ongoing staff support after initial EHR implementation not feasible. Most initial education in the electronic health record is done several weeks before implementation and rarely graduates highly skilled staff ready to function in a completely electronic environment. In that first six weeks staff are just beginning to learn some of the new terms that standardized terminology changed, haven’t begun to address workflow with the new system of documentation, and have forgotten step number three in a five step process in the five minutes they have given themselves to document. At the end of my official super-user role my anxiety level was very high because staff in my area was still showing a high level confusion about where to document in the new system. In those initial weeks several areas in the Computerized Physician Order Entry and key documentation areas were identified that could significantly impact important workflow processes possibly affecting quality of patient care in the Emergency Department. Other super-users voiced these same concerns about their areas toward the end of the initial implementation phase.
Project: With these concerns I submitted a request to continue the super-user group developing it into a network for support and education for the electronic health record and staff. The clinical informatics group took this initial idea and developed it into the active and effective committee it is today. Renamed the OneCare Champion this group is unique because it has members from every area of our facility and our other two hospitals. This network established a lifeline for staff, supporting them emotionally, mentally, and supporting technology skill development on an individual level. This established an effective communication pathway for clinical informatics. The OneCare Champion Group was approved by nursing management as a work project that would qualify for the nursing clinical ladder which supports nurse’s professional development in our facility.
Role: This champion group is a project which supports transformational leadership in healthcare. In this role the Champions have been given the opportunity to develop continuing education for their areas. This support group is an example of the support role that is needed in health care so that areas of safety and quality can be addressed. This work group can directly facilitate the important changes necessary to develop the electronic record into an effective support tool bringing in positive processes, supporting healthcare and healthcare workers in their patient goals. This group has shown the added benefit of another information source for problems with the electronic health record above and beyond the informatics technology (IT) help desk improving processes of timely fixes and decreasing frustration at the point of care level. This group gives the bedside nurse a voice and a way to impact change improving patient safety and quality of care. The EHR is only a tool and can only benefit if it is used effectively, efficiently and safely.
Implications for the Future: The diversity of healthcare has increased isolation and polarization of nurses from other practicing nurses. This support group gives an identified expert in their area for clinical informatics to consult as problems are identified or when looking at incorporating best practice into the electronic health record. This group is a working example of a way to build a bridge for reconnection for nurses in a polarized work place. This network would be an excellent way to research the electronic health record from pre-implementation to achieving our golden standard and could open the door to new areas of investigation of which we are not aware of at this time. This committee models a network of support that has never been seen by nursing before but is representative of the type of process needed to advance nursing practice in a highly technological environment.