Informatics nurses are working on new models to support critical thinking

NASHVILLE, TN – Hospitals are taking steps to avoid overdocumentation, according to clinical informatics experts.

“We’re moving away from a task orientation to a model that supports nurses’ critical thinking,” said Deborah Ariosto, director of patient care informatics and CNIO at Vanderbilt University Medical Center in Nashville.

Ariosto spoke during a panel discussion at the HIMSS Summit of the Southeast in Nashville on Sept. 29.

"To aid in that effort, we’ve  adopted the 188 Clinical Care Classification Nursing Diagnoses, developed by Virginia Saba and colleagues, for our nursing problem list." Ariosto said. "It brings significant value as a nursing terminology framework, and has the added benefit of SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) equivalent terrns. which will aid with interoperability issues across disciplines and institutions. It keeps things concise so that we can provide a coded problem list that focuses on patient priorities, whether the patient goes from our hospital to a nursing home or even to some other state.”

Julie Luengas, clinical informatics systems director at St. Thomas Health in Nashville, noted that “meaningful use doesn’t necessarily add up to meaningful workflow” for nurses. “At our facility, we don’t want to focus on a few narrow things just to get MU incentive dollars,” she said. “So before we implement IT solutions, we follow the staff around – all three shifts and weekends. We find out which adult-education learning styles they prefer, and we ask them to define what an‘ideal’ system might look like. Many of our nurses want us to move in the direction of a voice recognition system that automatically puts data into standard fields in an EMR.”

Luengas added that without workflow analysis, it’s easy to wind up with a system that forces nurses to overdocument – something they have little time or inclination to do. “Most nurses are really tired of hearing the phrase ‘regulatory requirements,’” she said. “They want the assurance that what they document actually improves patient care.”

The panelists agreed that nurses nationwide are eager to make improvements in clinical informatics. Susan Newbold, an informatics educator, said, “People who come from a purely clinical background really want to get the technical training.” For example, Newbold is seeing more interest from dietitians, many of whom feel they don’t have a voice in the clinical informatics discussion.