From the bedside to CCIO – A nurse’s journey through informatics
Editor’s note: In celebration of National Nurses Week, May 6 – 12 in the U.S., and International Nurses Day May 12, we are sharing stories of nurses who lead the way in patient care and technological innovation. Children’s of Alabama Chief Clinical Information Officer Stephanie Lenz details her progression as a nurse to a hospital leader.
How I progressed as a nurse to a hospital leader
I started my nursing career in the pediatric intensive care unit at Children’s of Alabama. I worked at the bedside for five years and had my first encounter with the electronic medical record (EMR) early in my career. We transitioned from the paper medication administration form to the electronic medication administration record.
This was the first phase of our EMR, and I saw first-hand how crucial it was to have clinicians engaged in the building of the EMR. There were many lessons learned from the first phase, and I have always kept that experience close to heart, especially when I’m working on developing software/systems for clinician use. Shortly after phase one, my nurse manager asked if I would help with the next phase of the EMR, computerized physician order entry (CPOE).
She explained that I would work with a couple of other nurses to function as the subject matter experts for the clinical workflow. When I later discussed the project with the Chief Nursing Officer, I was told that I would be pulled from the bedside only for a year to help with the project. That was eight years ago! From that point, my career took an important turn to the field of clinical informatics.
An evolving project
The CPOE project was the start of Children’s Nursing Informatics Department, which over time grew from three to 16 nurses. I began as a nurse just wanting to make a difference in the next phase of the computer system, but eventually progressed to the manager, then director and now the Chief Clinical Information Officer overseeing both informatics and clinical IT. I guess you can say informatics chose me; I didn’t choose informatics. I’m grateful for the opportunity I never saw coming, and I still keep the patient at the heart of my health IT work.
Why IT needs nurse informaticists
From the time that I started in informatics, I tried to be the advocate for my colleges at the bedside. In its simplest form, nurse informaticists are the intermediary between IT and the clinicians working at the bedside.
Informatics nurses are often the ones in the meetings discussing how certain computer changes will impact the workflow. With just IT at the table, it’s hard for them to understand implications to the patient or clinical flow. Likewise, with only clinicians at the table, technical intricacies are forgone. Nurse informaticists speak the IT lingo, but compliment that with a nursing skillset.
How my organization involves nurses in health IT and implementation
The longer I’m away from the bedside, the further removed I am from the workflow. Both technology and clinical workflow change from year to year, so we developed the iConnector program. These clinicians are the heartbeat of our efforts in informatics/IT. This group is comprised of at least one individual from each operational clinical area in the hospital. We train them as super users and communicators for the EMR efforts.
We hold quarterly meetings with our iConnectors to discuss updates made to the system and get their feedback on what’s working well and what isn’t. We often use them during testing for projects and depend on them to help supplement go-live support. Their expertise and efforts largely contribute to our health IT project success.
The future is bright for the nurse’s role in HIT
In terms of HIT, it’s no longer about implementing systems, but using the data from those systems to improve patient care. Currently, there’s so much tied to quality care including reimbursement. Now that we finally have all these systems electronic, we can pull data to improve patient care. Having nurses understand what those data elements actually mean is the key to better care. You will see a progression from not merely knowing how to operate the computer system, but to understanding how the data derived from those systems can improve care.
Important HIT projects we are focusing on this year
We have been on an eight-year journey to get to one patient, one record. We are in our last phase of that effort, which includes transitioning all of our peri-op users to our single EMR platform. No longer will we have to worry about medication errors related to disparate systems within our four walls because we will now have one cohesive EMR across the organization.
In addition, we will also be building out service-specific notes in our ambulatory setting to begin better collecting service-specific data. In addition to having more reliable data at the service level, we will also increase efficiency of the individual services by tailoring the notes to that workflow.
Nursing is the pulse of the organization
Nursing is such a vast field. Had you asked me 10 years ago if I would enjoy a career in IT, I would have laughed!
Having nurses in healthcare IT just makes good sense. Nurses touch every aspect of care in an organization. They truly understand the impact of information systems to the organization as a whole. They may not always know the answer, but they know where to find it. At the end of the day, they can’t help but be an advocate for the patient.
I will forever be grateful for the opportunity to see nursing from health IT’s ever-evolving perspective (with the patient in plain sight).