The impact of informatics on healthcare.

 

 

Episode Introduction 

Healthcare as a sector has been slow to adopt technology. Healthcare informatics can help to bridge that gap. In this episode, Jim Cagliostro, VIE’s Clinical Operations Performance Improvement Expert, interviewed Joe Cagliostro to discuss the benefits technology offers healthcare. These benefits include patient safety, Joe’s role in bridging the gap between IT and nursing, virtual resources for novice nurses, and how to encourage staff buy-in.  

 

 

Show Topics 

• The shift to healthcare informatics 
• How the ‘’RN tag’’ builds trust between IT and clinical teams 
• Lab specimen barcode scanning  
• How healthcare informatics enhances EMR processes 
• An on-call virtual resource for smaller community hospitals 

• The challenge of keeping patient information secure 
• Encouraging staff buy-in to technology 

 

 

02:33 The shift to healthcare informatics  

Joe outlined his career history and the need to learn a whole new language in nursing informatics.  

 

‘’And as I took on more of those responsibilities, it really developed my interest in the IT side of healthcare in the informatic side of nursing. And an opportunity came up, a job opening within the RWJBarnabas system. And I applied for it after finding out a little bit more. And I started working in that role about a year and a half ago. Now it was eye opening to me because when I was in nursing education, I knew everything about IT because I knew how to double click a mouse, or I knew what an icon was, but then coming into the true IT department, it was like I had to learn a whole new language. Now keep in mind. My MSN was in nursing education. Now it is incredible to see the number of programs out there for an MSN in nursing informatics. It was a whole new language. It was a whole new world that I had to learn working in this clinical informatics role.’’ 

 

07:00 How the ‘’RN tag’’ builds trust between IT and clinical teams 

Joe explained how his experience of the challenges nurses face helps to establish relationships more quickly.  

 

‘’I know when I first came into the role, a lot of my coworkers that I was training with, they said, you know what, Joe, in addition to your ID badge, make sure you hold on to your RN tag that hangs underneath your badge. You want people to know as you're rounding that you are indeed a nurse because the nurses, although they'll respect anyone they interact with, they have just a higher degree of appreciation for someone who knows the struggle. Someone who knows the challenges, the time constraints, the barriers, especially since my role is working specifically with the electronic medical record. When they know that I know the struggles that they have with the EMR, they're more likely to give an open ear. They're more likely to say, Hey, you know what? He knows what it's like. I'm going to listen to what he has to say, because I know a little bit of their struggles. The challenges that come up during any given shift for the nurse, for the physician, the provider, and part of that experience helps me in translating things from the clinician to the analyst and vice versa, right? The clinician has a problem. I have to relay that to the analyst in a way that they'll understand, or the analyst wants to present a solution, or they have a problem. I need to explain that to the clinician in a way that they can understand.’’ 

 

11:22 Lab specimen barcode scanning  

 Joe gave an example of how his role helped analysts to understand workflow on the frontline of healthcare.  

 

‘’A little while ago, one of our last hospitals in our system to go live with lab specimen barcode scanning. So really it's been in the system for a while now, but there was one hospital that we're really trying to catch up to speed. And the analyst, they had the ability to troubleshoot the mapping and the networking of the printers. And if we wanted the lab specimen labels to print to the lab between certain hours, but then to the floor at other hours, I mean, this is above and beyond my knowledge, as far as how they configure all those settings between, well, what's the IP address and naming that printer so that it can be communicated with once the order is put in by the physician. That's above and beyond me, at least at this point. But once I went through the process, I had a little bit better understanding. Whereas those analysts trying to get this system up and running for the nurses didn't understand the workflow that the nurses had to follow. Right. They had to go to their supply room, get their specimen tubes, their alcohol preps, their tourniquets. Then they had to go to the nurse’s station and were moving towards printers installed on our portable works stations, our portable WOWs, but not quite there yet. So they have to go to the nurse's station, get the label printed, but the analyst didn't understand this back and forth, then this WOW being brought to the room. But the nurse, and infection prevention is another factor, going in one time with everything that you need. And I had to explain that workflow to the analyst.’’ 

 

14:38 How healthcare informatics enhances EMR processes 

Joe highlighted the benefits healthcare informatics can bring to patient care and safety.  

‘’And so one of these organizations that ensures we're providing safe care was looking at our process for medication entry into our EMR. And what we did was we had to have myself as well as a provider, someone from the lab, someone from pharmacy, someone from quality and to test our EMR to make sure the appropriate safety alerts pop up. Right. And as we talk about moving into the future, it's almost like every day, every month, every year, more and more of these safety nets are built. For example, we were testing out if I order certain medication for a patient over the age of let's say 79, do I get an age related alert saying this patient might be at risk? If the provider's ordering one beta blocker, but the patient already is on another beta blocker, do I get an alert saying duplicate orders, contraindication, this is not safe for the patient? Along with auto crosschecking meds, Hey, this med might be harmful to the kidneys. What's the renal function, right? So all these alerts that are popping up and the great thing about EMRs and there's a lot of homemade ones, but there are some larger ones that really many healthcare systems are taking part of, they're very customizable. And we say, look, we're noticing this patient's getting a med order they shouldn't have gotten. Our analysts can build that.’’ 

 

18:00 An on-call virtual resource for smaller community hospitals 

Joe said that virtual support for the inpatient setting is vital to the future of healthcare in smaller communities.  

 

‘’One more thing I will share quickly, smaller community hospitals that have a higher turnover rate, many brand new novice nurses. It's a network of experience. Even some nurses that we're planning on retiring have joined this network. And we’re trying out this almost on call experienced nurse system where our new nurses at our smaller hospitals can almost have this on call nurse, this virtual resource nurse that they have a patient that is not as stable as they once were. They're concerned. They can tap into these nurses and have them provide their recommendations, their guidance, their support, when we don't physically have the ability to support nurses at a physical location for whatever reason. So that's one way I see that can become a very big thing in the next 10 to 20 years.’’ 

 

19:53 The challenge of keeping patient information secure  

Joe said that maintaining the privacy of patient information in the face of rapid growth is a challenge for healthcare.  

 

‘’For example, you have a provider, you have a director, a manager, somebody wants to bring in a new application. What we have to do is we have to make sure that it is secure enough to handle our patient information. Back in the day, much of patient information, secure patient information was held on older systems that used physical hardware servers, right? And that's very quickly moving to cloud-based servers. And when you move it to the cloud, obviously it's a whole other method of security. And so even before something's brought into our local hospital, our healthcare system, it has to go through so many checks, so many verifications that it indeed can secure our patient information. So that's a huge thing. Just being able to provide the highest level of protection when dealing with personal and sensitive healthcare information. Cost is always a factor.’’ 

 

20:47 Encouraging staff buy-in to technology 

Joe shared an example of how he overcame resistance to change 

 

‘’One specific example, I was at a IV infusion pump training class, as we're moving to a new EMR throughout our system and we were teaching them the process of integrating our pumps into that new EMR.  Some of the staff were saying, well, man, to associate the pump, now I got to bring my scanner over here to the patient's wristband and then to the pump. And it is, I told them, it's going to slow you down at first because it's new. But to imagine when you associate that pump and scan that patient, that drug, that pump now, instead of having to manually input the name of the drug, the dose, the concentration, the rate, the volume, you scan that bag, that patient, that pump, it pulls it right in. So before you know it, and it becomes muscle memory now, not to the point where we're not thinking about it, but there are safety measures built into these pumps as well. This will in fact, speed up your time. It's ultimately going to make your job easier, quicker, but at the same time, safer and more efficient for the patient. So that's just one specific example in regards to staff buy-in.’’ 

 

Show Links 

Connect with Jim Cagliostro on LinkedIn 

Check out VIE Healthcare Consulting 

 

You’ll Also Hear: 

How nursing informatics bridges the gap between IT and the clinical world of healthcare, nursing and medicine.  

 

When it comes to IT and nursing, communication and teamwork is equally as important as the caregiver/care provider relationship is for patient care.  

 

A practical example of nursing informatics assisting in patient care. ‘’When you're trying to print out a label for blood work and it's not going to the printer, then you have a problem. And then it's people like you that are making that work behind the scenes….I know at the bedside, we're not even thinking about these issues.’’ 

 

Why healthcare informatics is essential to improving patient safety and outcomes by providing better resources and accessibility. ‘’What good is the resource if you can't get it into the hands of the clinicians, into the hands of the patients, right?’’ 

 

How the pandemic has moved the healthcare IT sector forward by at least ten years.  

 

The one quote about change that helps to understand staff resistance to advances in healthcare technology – and why the more rapid the change, the harder it becomes to encourage staff buy-in.  

 

Why ‘’turning it off and turn it back on again’’ really can correct malfunctioning tech equipment. ‘’Maybe 65, 70% of the time, if you're dealing with malfunction equipment, that is what you should try to do. And that has solved the problem 70% of the time. So when in doubt, turn it off and turn it back on again.’’ 

 

 

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