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Health Care Industry

Managing change during an information systems transition

AORN Journal, June, 2002 by Barbara J. Barr

A massive communication paradigm shift associated with information systems technology currently is occurring in health care. This shift will have a profound effect on nursing because it offers bedside documentation of patient care. Improving health care effectiveness through patient-driven, cost-sensitive ventures requires a coordinated approach that ensures best practices are achieved through data-driven and evidence-based practice.

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Policy makers, administrators, nurse executives, and practitioners need to base decision-making on evidence derived from patient experiences, professional judgment, expertise, and research findings. Staying focused on quality, cost-effective patient care requires collecting and interpreting data that translate into patient care activities. Computers can provide the means to collect and interpret this data; however, leaders also must educate nursing staff members about new technology. This is an additional investment that must accompany any computer system purchase.

THE CHANGING ENVIRONMENT

The trend toward managed care has broadened the geographic areas of the perioperative environment and increased the need to share health care information. The perioperative milieu encompasses areas outside the surgical suite, including day surgery areas, endoscopy suites, postanesthesia care units (PACUs), and physician's offices. In these areas, large amounts of data are collected that must be integrated to facilitate quality and continuity of care.

Although a computer system that combines an integrated delivery system with a solid information infrastructure can lead to increased data exchange between hospital departments, as well as data analysis, a 1996 study shows that 58% of surveyed health care organizations spent less than 4% of their budget on information technology, and only 11% spent 5% or more. (1) To capitalize on the power of information technology in health care organizations, executives must be committed to fully supporting the acquisition and maintenance of an adequate information system.

A vital part of restructuring in hospitals is finding ways to meet caregivers' growing demand for efficient methods of entering and retrieving patient information. Studies suggest that nurses spend an estimated 30% of their time documenting patient care. (2) Computerization has the potential to save nurses' time, which then can be spent with patients. Computerization further offers such benefits as accuracy, legibility, timeliness, completeness, and ways to collect clinical outcomes measurement information.

Information is a critical resource for managing health care organizations. It is essential to support patient care, administrative operations, and strategic decision-making. The health care industry has been slow to embrace computers or provide sufficient funding for current computer hardware, software, technical support, or staff member development. Clinicians must use technology correctly and exhibit confidence in tailoring the technology to their specific needs to take full advantage of the information available.

Although computer systems may be capable of collecting the data needed, the resulting measurements will be flawed if nurses do not have a clear understanding of the importance of entering information that is accurate, reliable, and trustworthy. The organizational climate and individual practitioners must be receptive to change, which may require implementing change strategies. One theory that may be useful for operationally addressing change processes and adopting technological innovations is the innovation-diffusion theory. (3)

LITERATURE REVIEW

In the health care environment, patient documentation requirements are growing because of risk management issues, standards of practice, and external regulatory agency requirements (eg, Joint Commission on Accreditation of Healthcare Organizations, Centers for Medicare and Medicaid Services). Computer systems provide nurses with an alternative to time consuming and ineffective manual documentation and data collection methods. Information technology has the potential to change the nature of nurses' work, but it also presents implementation challenges because nurses are inadequately prepared to embrace computer technology. (4)

Coping with the rapidly changing health care environment calls for professional nurses who have the ability to identify problems and carry out planned change through communication and understanding. (5) Bedside terminal use by nursing staff members can offer many benefits, including increased accountability, efficiency, and data collection and retrieval. Unfortunately, this technology has not been adopted as rapidly as predicted. (6) A key to fostering positive attitudes and facilitating successful learning is acceptance of the computer by nursing staff members. (7) Nurses as a group are unsophisticated about the potential represented by computers. Their lack of computer skills is a major drawback when trying to meet the high-technology challenges of the professional nursing domain. (8)

Health Care Industry

Managing change during an information systems transition

AORN Journal, June, 2002 by Barbara J. Barr

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