Now That We Have Data, How Do We Improve Patient Care?
By Cynthia Davis
I’m a former ICU/ER nurse with three decades in and around healthcare delivery. I understand first hand why we need technology in operating rooms, in the ER, at the patient’s bedside and during clinic visits. It is because technology can have a significant impact on improving care and outcomes. Patients are safer. Doctors have access to data on medical history and allergies when they are making decisions that can save the life of someone’s mother or sister or aunt.
Today we are at a critical juncture. Institutions finally have the right technology tools in place. The question is, how do we make that collective leap from data collection to better care? I think it starts with validating and analyzing the data that we are all so busy collecting.
This should be easy. Isn’t that the promise of technology? In my experience, the answer is both yes and no.
Technology is not magic. It does not fix processes. If you have a patient with impending sepsis and the EHR alerts for potential sepsis through vital sign documentation, assessment data, and labs, it doesn’t tell you the process once the alert triggers. It’s a shift in perspective, but for technology to actually improve care, we need to listen and think as clinicians and reexamine workflows and data points as a basis for care decisions.
The first step is going back and reviewing whether we are capturing data at the right time and point of care. The data that is collected needs to be reliable and clean. This sounds simple and straightforward, but in a clinical setting, the challenges can be enormous.
Recently I asked various departments heads what they considered the source of truth for their clinical information for decision making. Six department heads gave me six different answers. They were all using their department reporting tool as the best source of data. As they went along and identified data discrepancies, they fixed these in their own departmental systems, but problems in the original source data were neither corrected nor investigated. Each thought the problem was that the nursing teams had entered the data incorrectly. No one had focused on the data integrity in the primary system.
This breakdown in the data management process highlights the fundamental importance of adopting an overall data governance structure to support data decisions. It reminds me that we all need to examine data design and data management processes to make sure we are capturing the right information at the right time. This critical analysis can point out workflow problems like the one my client encountered, where well-intended workarounds had compromised the integrity of their whole system
Talking to and observing frontline staff is a great way to discover workflow problems that may be undermining the success of your EHR. For example, I once watched a nurse scan a page full of labels before administering a new medication. He did not scan the wristband where the patient identification data was stored until after he had administered the medication. Therefore, he was using the system and accessing stored data, but the order was out of sequence.
This kind of problem will not turn up in a status report from your CIO, which may be more focused on the number of support tickets generated or the ratio of downtime. Clinical leaders have to get to the front line – to the hospitalists or nursing managers – to find out how well the system is working and where there are difficulties.
Finally, fixing workflow issues that compromise data integrity requires a continual emphasis on training. People can only learn so much when you first bring your system live. On an ongoing basis, organizations must invest in management skills training to help clinicians more effectively use these new tools.
Whether it is helping a nurse manager better monitor the nurses who are capturing electronic data or working with a chief medical officer so that they can look at reports and understand what’s happening with their medical staff, training is essential and goes far beyond your go-live.
Cynthia Davis is a principal with CIC Advisory of Clearwater, FL.