Nursing education after COVID will rely more on technology and digital tools than ever. Simulation and online learning will be part and parcel of the curriculum for nursing students. It will also be more competency-based as the new AACNEssentials further integrate into nursing curriculums.
But what about the content of the curriculum?
Nursing education, according to Mary Dolansky, Ph.D., RN, FAAN, Sarah C. Hirsh Professor, Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school, may include instruction on telehealth, an emphasis on systems thinking, stress on leadership, and a focus on innovation and design thinking.
Mary Dolansky, Ph.D., RN, FAAN, is a Sarah C. Hirsh Professor at the Frances Payne Bolton School of Nursing and Director, QSEN Institute at the school
A Look at Nursing Education After COVID
Telehealth
Understanding how to use telehealth in nursing is key, according to Dolansky. The Frances Payne Bolton School of Nursing at Case Western Reserve University, Cleveland, developed a series of four modules on telehealth so that all students received a basic foundation in telehealth nursing, including telehealth presence. It included teaching on using Zoom or the phone to assess and evaluate patients. She notes that interactive products that give students a feel for how such interactions occur and practice them can provide an excellent education.
Systems Thinking
Another aspect of post-COVID nursing education involves systems thinking, says Dolansky. This involves “really getting students to think beyond one-to-one patient care delivery and about populations. We need to create more curricula for nurses out in primary care sites and nurses out in the community, and that has not been a strong emphasis in schools of nursing. Instead, we focus mainly on acute care.”
More specifically, students should learn, for instance, how to use data registries to look at areas of patient need. One COVID example, notes Dolansky, would be to use registries to identify long-term COVID patients. Another could be to use a registry or database to discover what patients have followed up on their chronic disease since, during COVID, many patients stopped visiting healthcare providers.
Emphasizing Leadership
In the post-COVID curriculum, developing leadership skills may become more critical. “What we observed in the COVID crisis,” says Dolansky, “was an opportunity for nurses to stand up and speak out more. We were the ones at the frontline and had the potential to be more innovative and responsive. Many great nurses did step up and speak up, but we need to ensure that every nurse can speak up for patients in future crises or even advocate for our patients now. Nurses can be the biggest advocates for patients.”
Every school of nursing probably has a leadership course, Dolansky notes. But ensuring that there are case studies from COVID as to how nurses did stand up and speak out and how that made a difference would be a fundamental curriculum change.
“We want to prepare our students that you will be a leader and you will be on TV talking about how you are innovating and adapting to the changing needs of the health of our population. And COVID was a great example for that.”
Innovation
Post-COVID, nursing education needs to help students with innovation and design thinking, notes Dolansky. Over the past 10 years with QSEN, “what we’re trying to advocate is shifting the lens of a nurse from direct patient care delivery, which has been the focus of nursing, to shifting a little bit to systems thinking.”
Critical thinking, notes Dolansky, focuses on making decisions for an individual patient. Design thinking and innovation are more about “looking at the system in which we work and empowering the nurses to fix the systems. This is key to quality and safety, but it’s also key to the need for our nurses to contribute strongly to the health of the future population. They have to be at the table to respond to these crises. We need them to have the skill set of being a leader, standing up, being at the table and when they’re at the table, having ideas, being creative, and knowing how to test them. And having the technical skills to use the technology is probably where most of the solutions will be for the future.”
QSEN and Competencies
With the latest AACN Essentials, there is a drive for competencies in nursing education, notes Dolansky. The Essentials: Core Competencies for Professional Nursing Education, approved by the AACN in April 2021, calls for a transition to competency-based education focusing on entry-level and advanced nursing practice.
While revising the Essentials began before the pandemic, the experiences and learnings from the pandemic greatly impacted the work, notes a recent article in Academic Medicine. As a result, the Essentials includes population health competencies that specifically address disaster and pandemic response and will better prepare the next generation of nurses to respond safely in future events, the article says.
Now, a crosswalk has developed between QSEN competency statements and the 2021 AACN Essential Statements, notes Dolansky. However, she notes that the AACN is taking the QSEN foundation and moving it forward, stating to the public that “the nursing profession has these competencies that are providing safe quality care to the public.”Since 2012, the QSEN effort has been based on the Frances Payne Bolton School of Nursing.
“Own Their Competency”
In the culture of nursing education, students now need to be educated to “own their competency,” says Dolansky. “Students will see that competency development is part of their lifelong professional development.
At the end of each year, there are changes predicted for the following year in terms of the health care industry. Jennifer Flynn, CPHRM, Vice President of the Nurses Service Organization (NSO), gave us information on the top three trends that will shape the nursing profession in 2022.
You’ve identified 3 trends you believe will shape the nursing profession in 2022: Staff Shortages, Travel Nursing, and Telehealth. Why are these three the most prevalent?
We’ve seen constant change in the health care industry. And, never more so then in the last two years. These trends in nursing have great benefits for the facility and the patient, but may increase liability risks for nurses.
While telehealth has its benefits: patients have increased access to care, and they manage some chronic conditions better, especially where remote patient monitoring replaces many routine in-person visits. Telehealth saves patients’ time of travel and waiting in the office which, some studies have shown increases their overall satisfaction.
For nurses, telehealth does provide more flexibility at a time that is most convenient for patient and nurse. However, there are some parts of telehealth that can increase a nurse’s liability risks, such as, providing care to those patients where visits must be in-person. Clinically speaking, you can’t perform all nursing functions virtually, but nurses need to know which patients must be seen in-person versus virtually. Nurses needs to be aware of which patients have barriers to virtual care. While broadband connections are improving, not every patient has access to a good connection. Lastly, licensing laws and reimbursement may limit a nurse’s ability to practice across state lines or be reimbursed for telehealth services. It is the responsibility of the nurse to know the rules of telehealth in their state.
For some, travel nursing is a dream job enabling you to see the country while still enjoying the rewards of providing treatment and care to patients. For others, the endless adjustments of unfamiliar environments may make it not the right career choice. As with any job, there are pros and cons. Some liability risks nurses face with travel nursing are: the constant learning of policies and procedures at each new facility and assignment–though you may be contracted with a particular unit during your travel nurse experience, you may find yourself in even further unfamiliar territory when you have to float to another unit.
Many facilities will send the travel nurse first to float to an understaffed unit, again, learning the policies and procedures of that floated assignment. Lastly, you will need to check your licensing laws–travel nurses may have to have multiple licenses in order to practice. And, each state where you work will require you to hold an active and unrestricted license for that state.
Safe nurse staffing is essential to both the nursing profession and to the overall delivery of treatment and care. Adequate staffing levels ensure better care for patients and reduces nurse fatigue, prevents burnout, and increases patient satisfaction. However, inadequate nurse staffing can endanger patients. Research shows that shortages and inadequate staffing are linked to higher rates of infections, patient falls, medication errors, and even mortality. This is because nurses have too much work to juggle and cannot spend enough time on each patient, resulting in missed care. While staffing was a topic of discussion well before the pandemic, the COVID-19 pandemic has exacerbated the nursing shortage in the United States. Nursing leaders say nurses are tired and frustrated from being asked to work overtime. Some are even considering leaving the profession. Safe nurse staffing affects the ability of all nurses to deliver safe, quality care in all practice settings.
If you hadn’t heard of telehealth before the coronavirus pandemic, you probably know about it now. Medical providers are trying to move as many of their appointments to virtual means as they can. While telehealth options have been around for years, this is the first time it’s been implemented on such a wide scale. Since many people want to know exactly what telehealth is and how it works, we answer all your telehealth FAQs. Ever wonder about security concerns and how providers diagnose symptoms like the coronavirus via video call? We’ve got you covered.
What types of telehealth are available?
There are three main types of telehealth interactions that you might have with your provider. They are:
Live consultations, which are usually held over video conferencing.
Asynchronous messaging, where you send your provider text or pictures and they respond as they are able.
Remote monitoring, when the patient uses at-home devices to measure vitals such as blood glucose and then sends them to a provider for an examination.
A telehealth appointment usually refers to the first option, i.e. scheduling a video call with your provider (white lab coats and nursing scrubs not required), but your telehealth interactions will usually span all three categories.
Is telehealth secure?
Given all the privacy concerns surrounding technology, many people are understandably concerned about the security of their virtual visits. The security will vary depending on the service(s) that your provider uses. If your doctor is part of a larger hospital network, they may contract with a major telehealth provider or use a proprietary system, which should be more secure. Smaller practices may use more general-purpose virtual meeting software, such as Skype, which usually have looser privacy restrictions. Investigate the privacy policies of the services that your provider asks you to use, and you can also ask your provider about implementing security features such as encrypted data transmission.
Is telehealth covered by insurance?
This depends on your insurance, your provider, and the telehealth system they use. In general, telehealth services provided directly by a doctor or a hospital are more likely to be covered, though not always. Even if the virtual visit is covered by insurance, patients may still have a co-pay or another charge. If it’s not covered, patients can choose to pay out of pocket for the entire visit. Common per visit fees range from $50 to $80, while other platforms charge an annual membership fee. If you’re on Medicare or Medicaid, thanks to some recent changes, Medicare will cover telehealth services and Medicare Advantage plans may waive or reduce cost-sharing.
How can I find a telehealth provider?
If you already have a provider, check with them first to see if they have existing telehealth or upcoming telehealth options due to coronavirus. Depending on what insurance you have, you might also be able to filter your provider search on the insurance portal to only show providers that provide telehealth options. Some telehealth service websites, such as Teladoc Health and MD Live, will let you search for providers on their website. If you find doctors via the latter route, you’ll need to contact their offices to see if they accept your insurance before you make an appointment.
What are some advantages of telehealth?
Telehealth offers several benefits over regular appointments. For one, it protects both patients and providers from the transmission of germs (very important in the age of coronavirus). It also eliminates the need to secure transportation and elder or child care. Plus, it reduces the time spent in waiting rooms and on the road. Telehealth appointments save patients and providers money as well as time. They also give providers more flexibility to set their own schedules and schedule appointments when it’s most convenient for everybody involved.
What are some disadvantages of telehealth?
However, telehealth does have some drawbacks. Obviously, some visits simply need to be completed in person. Patients can’t just grab a stethoscope and listen to their own vitals. There can also be issues of access, as not everyone has a smartphone or laptop and a stable internet connection, which are necessary for video consultations. The inconsistency of insurance coverage for patients and reimbursement for providers can also cause headaches and complicate what would ordinarily be a simple visit.
Can I get a prescription via a telehealth appointment?
Yes, doctors can use telehealth to write or renew prescriptions. If you just need a refill on an existing prescription, you might be able to request it by messaging your doctor and eliminating the need to book and pay for an appointment. If it’s a new prescription, or you’re not sure what medication you need, you’ll probably need to book a quick appointment for a diagnosis. They’ll still have to call in the prescription at a local pharmacy, so you’ll have to venture out to pick it up or arrange to get it delivered.
Can coronavirus be diagnosed via a telehealth appointment?
Because the symptoms can vary so widely from patient to patient, and also overlap somewhat with those of other common infectious diseases (including the flu), the only way to confirm that you definitely have coronavirus is to get a test that involves taking a swab in person. However, you can use a telehealth appointment to discuss your symptoms with your doctors and determine whether you need a test or if you’re just suffering from allergies. In fact, many hospitals have set up a coronavirus hotline specifically for this purpose. Your doctors can also talk you through quarantine best practices and how to keep those around you safe.
If you need to talk to your doctor right now, odds are that you’ll be making your visit virtually via telehealth services. Keep these FAQs in mind to make sure that your visit is covered by insurance and your privacy is secure. Welcome to the future of medicine!
Telehealth has slowly been making inroads over the past couple of decades, and the spread of the coronavirus pandemic has only escalated its adoption. Doctors have been told to hold every visit possible remotely in order to cut down on the chances of spreading the virus between patients and medical providers.
While in-person doctor’s visits have been the standard for generations, telehealth offers several benefits that in-person appointments simply can’t match. In fact, telehealth can reduce costs and barriers to access for both doctors and patients. If you’re new to the idea of telehealth, here are nine benefits that you need to know about remote health care.
For Patients
1. You don’t have to worry about transportation.
Getting to and from the doctor’s office can be a large barrier. Even people with reliable vehicles have to make arrangements with their households to use the car, as well as taking both travel time and gas into account. Patients who use public transportation or ride-sharing options have to account for many more unknowns, including unreliable transit schedules and routes that may not take them directly to the doctor’s office. By letting you stay in your home, telehealth visits make it easier to talk to your doctor and increase access to care.
2. You don’t have to find elder or child care.
For adults serving as primary caregivers, getting away from the house can be tough, even if they’re not officially employed. In that case, they have to arrange for their partner to stay home, or if that’s not possible, find or hire other people to watch their children or parents while they go to the doctor. This added expense and hassle serves as a barrier that keeps people from getting to the doctor’s office. Remote health appointments remove the need to find elder or child care for dependents, making it easier to virtually visit the doctor.
3. You’ll waste less time.
Time is a major consideration in scheduling and attending doctor’s appointments. You have to factor in not only the length of the appointment itself, but also transportation time and time spent in the waiting room. Between everything, many patients must sacrifice two or three hours of their day just to talk with their doctor for 15 minutes (or less!). Some people simply can’t get that much time off of work, which makes them reluctant to visit the doctor. Remote appointments eliminate transportation time and significantly reduce delays as well. No more wasting an hour in the waiting room while the minutes tick past your appointed time.
4. It reduces your chances of catching an illness.
We’ve all had the experience of sitting in a waiting room during cold and flu season, listening to other patients around us coughing and coughing and coughing. Simply due to the concentration of sick people, in-person doctor’s offices increase the odds of spreading germs. Plus, if you’re already visiting the doctor because you’re sick, your compromised immune system can make you more vulnerable to picking up more germs. Taking appointments from the comfort of your own home keeps you safe and prevents you from spreading any potentially contagious illness to other people.
5. It’s increasingly covered by insurance.
More and more insurance companies are covering telehealth visits, and as the cascading effects of coronavirus encourage more processes to move online, this trend will only continue in the future. While once considered a luxury, remote doctor visits will soon become as mundane as visiting a typical office for both you and your insurance company.
For Providers
6. You can see more patients.
Because of the increased efficiencies and reduced downtime between appointments, telehealth systems allow you to see more patients that you otherwise would not. Some physicians also use the time they would have spent commuting to extend their office hours, letting them see even more patients. For example, some patients who can’t get off work during the day might be able to hop on a call with you at night for half an hour. (And none of them will know if you’re wearing pajama pants under your white lab coat.)
7. You don’t have to leave your house.
Many of the same benefits that apply to patients are also a boon to physicians. Staying at home eliminates health care providers’ commutes, which saves time and money that they can use to see more patients. Telehealth doesn’t just limit patients’ exposure to germs. It also limits physicians’ exposure, which keeps them healthy and eliminates the chance that they might carry germs between patients. Finally, telehealth visits can ease the burden on physicians and their families who are also caring for children or relatives at home.
8. It reduces costs.
By increasing the number of patients and decreasing overhead expenses, telehealth visits save money. These savings are especially important for physicians who own their own practices instead of working for a big hospital. While you might need to initially invest in setting up or subscribing to a secure telehealth system, remote visits will quickly pay for themselves as they become more popular. In fact, telehealth might actually open new opportunities to bill for activities that were previously uncompensated, such as follow up phone calls.
9. It improves patient engagement and reduces no-shows.
A doctor’s primary goal is to improve patient outcomes, and telehealth can accomplish this on several levels. Unfortunately, the patients most in need of doctor visits are often the ones who struggle the most with getting time off work, finding elder or child care and securing reliable transportation to and from the doctor’s office. Telehealth can help break down these barriers and result in a wide variety of benefits like reducing no-shows and diverting unnecessary visits to the ER. Ultimately, all these benefits ease the strain on the whole health care system.
Now, don’t hang up your nursing scrubs quite yet. There will always be a need for in-person doctors’ visits. But incorporating a telehealth option into your practice can benefit both you and your patients greatly.
From electronic health records (EHRs) to smartphone apps, today’s health IT tools can help nurses develop innovative strategies for closing the gap of racial and ethnic health disparities.
One of the top priorities of President Obama’s Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 is to reduce health disparities—such as disproportionately high rates of chronic diseases in racial and ethnic minority populations—through the “meaningful use” of EHR technology. Seven years after the passage of HITECH, how much progress have we made toward achieving that goal?
In the 2013 report Understanding the Impact of Health IT in Underserved Communities and Those with Health Disparities, the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) showcases many innovative examples of how health care providers nationwide are using EHRs, as well as other types of health IT, to increase access to care and improve health outcomes in communities of color. From the rural Mississippi Delta to immigrant and low-income communities in large metropolitan areas, “health IT offers promising tools to address chronic diseases by facilitating the continuity of care and long-term follow-up needed for successful management of these conditions,” the report concludes.
That, of course, is where nurses come in. Take a close look at successful model programs that are deploying health IT to help close the gap of unequal health outcomes and you’ll see nurses—including hospital and clinic RNs, nurse practitioners, informatics nurses, case management nurses, nurse researchers, and more—playing leadership roles.
“Nurses are coordinators of care for patients. We’re typically the first person they see when they seek health care,” says Joyce Sensmeier, MS, RN-BC, CPHIMS, FAAN, vice president of informatics at HIMSS. “It’s really a natural extension of the nurse’s role with patients to connect the dots from the information technology side.”
For most nurses, health IT begins with the EHR. This essential platform enables them to instantly access a patient’s complete health record, document patient data in real time, monitor changes in the patient’s condition, and use clinical decision support tools—such as computerized alerts—to respond to those changes. But increasingly, nurses are also waging war against health inequities by arming themselves with an arsenal of other high-tech tools, including the following:
• patient portal websites, which give patients convenient access to their personal health information and enhance communication between clinicians and patients;
• health information exchanges, which allow patient data to be securely shared between different providers—such as hospitals, ERs, and primary care providers—to improve continuity of care;
• wireless and mobile health (mHealth) technologies, such as smartphone apps and text messaging;
• external databases, such as state and national disease registries and immunization registries, that collect clinical information about specialized populations of patients across a large geographic area; and
• population management software (PMS) systems, which help nurses track health trends among specific groups of patients they care for—for example, pediatric patients, or patients with diabetes.
Seeing the Bigger Picture
For nurses who are working to improve minority health outcomes, one of the biggest advantages of using health IT is that these tools make it easier than ever before to capture, compare, and analyze patient data. And that translates into unprecedented opportunities for leveraging that data to better manage the needs of patients with chronic illnesses, identify gaps in care, and develop targeted interventions.
“Clinicians have always been information workers,” says David Hunt, MD, FACS, medical director of patient safety and health IT adoption at the ONC. “It’s just that so often we’re focused on that one patient, that one chart. IT tools give you the ability to step back and look across groups of patients to really get insight into how to make care better.”
In other words, these technologies maximize nurses’ ability to address health disparities from a population health perspective. You can “slice and dice” the data stored in the EHR to classify and group patients in many different ways—for example, by race, ethnicity, age, and gender. Nurses can also zero in on patients who have particular conditions—such as heart failure, asthma, or HIV—to generate condition-specific reports and action plans, says Wanda Govan-Jenkins, DNP, MS, MBA, RN, lead nurse informaticist for the ONC.
“You can look at the EHR and extract these groups of patients to see which patients’ blood pressure was elevated at their last visit, or which patient hasn’t been seen for a while,” she explains.
Patient portals are another vehicle for communicating chronic disease management reminders to whole populations of patients, adds Lisa Oldham, PhD, RN, NE-BC, FABC, vice president of practice operations and chief nursing officer at the Institute for Family Health, which provides care to medically underserved communities at multiple facilities in New York City and state. The institute’s portal, MyChart MyHealth, is available in both English and Spanish (MiRecord MiSalud).
“We can create an electronic letter for the entire organization’s patients who fall into a specific category and send it to them through the portal,” Oldham says. “The patient will get an e-mail that says, ‘Please go into your MyChart,’ and that’s where they’ll see the letter. For instance, we just sent out an e-mail blast to all our geriatric patients reminding them to come in for their annual wellness visit.”
At the Cherokee Indian Hospital (CIH) in North Carolina, a tribal health system that serves more than 14,000 members of the Eastern Band of the Cherokee Indians, care management nurses develop outreach campaigns using the hospital’s PMS, which works in conjunction with the EHR.
“By pulling data out of these platforms, our nurses can target in and pinpoint things like how many people need to get a colorectal cancer screening or a Pap test,” says Sonya Wachacha, MHS, RN, CCM, executive director of nursing at CIH. “Then the nurse generates a reminder letter to that person, such as ‘Mrs. Smith, it looks like you’re due for your mammogram. Can you please come in and get that done?’”
On an even larger scale, says Hunt, “disease registries are wonderful resources, because you can identify characteristics and trends that you don’t have insight into when you’re just looking at a group of patients within your own practice. Having the benefit of looking at large amounts of data from many, many providers gives you tremendous insight in terms of being able to infer more information about your patient population.”
Educate, Engage, Empower
Nurses are also finding that consumer-driven health IT tools, like patient portals and mHealth technology, can offer exciting new ways to help patients who are living with chronic diseases become better educated about their conditions, more engaged with their treatment, and more empowered to self-manage their own health.
Patients can log into their care provider’s portal and access disease management educational materials, which health systems can tailor to meet the needs of limited-English-speaking and low-literacy patients. For example, the Institute for Family Health’s portal has links to patient education resources in more than 40 languages.
At the Institute’s Ellenville Family Health Center in Ellenville, New York, a rural community with one of the highest poverty levels in the state, “the most prevalent disease processes in our patient population are diabetes and cardiovascular problems,” says staff nurse Santiago Diaz, RN. “The portal has information specifically for these patients. We walk them through the basics of where to find the information, and we show them the shortcuts so that they don’t get lost in all the information that’s up there.”
Because nearly everybody today seems to have a smartphone or cellphone, these devices can help nurses connect with hard-to-reach populations, such as young people. Jo-Ann Eastwood, PhD, RN, CCNS, CCRN, associate professor and advanced practice program director at UCLA School of Nursing, recently conducted a research study that used custom-designed smartphone apps to teach young African American women who were at high risk for heart disease how to make heart-healthy lifestyle changes.
“When we look at chronic disease prevention in minority populations,” she says, “we have to look at the population that’s between 25 and 45 years old, or even younger. If we’re going to develop prevention strategies that are relevant to this population that is very technologically astute, that is fast-moving, that is busy, we have to hit them where it’s salient.”
Govan-Jenkins, who is also a professor of informatics in the graduate program at Walden University School of Nursing, recommends teaching patients how to download and use the many free or low-cost mobile apps that are available in the consumer health marketplace. For instance, there are diabetes management apps that let patients monitor their blood glucose levels and upload that data to their patient portal for nurses to track.
“Patients who have smartphones or mobile devices can download continuous self-monitoring apps that let them see things like how many steps they took that day and how many calories they burned,” Govan-Jenkins continues. “The nurse can also send weekly or monthly text messages to condition-specific groups of patients, such as reminding them to take their medication.”
Ultimately, Wachacha believes, being able to interact with their own health data and personally follow their progress toward meeting their health improvement goals can make a big difference in engaging patients to take a more active part in their care.
“With our EHR, we can create graphs that let patients see how their blood sugar or blood pressure readings are going up or down over time,” she says. “When our tribal members who have diabetes, for example, can look at that graph and see that their A1C levels are going down after they start exercising, it’s meaningful for them. It gets them motivated to do more with their care, because they can see that the things they’ve done are having an impact on their results.”
Reaching Across Barriers
According to the ONC report, health care providers must find solutions for overcoming “challenges and barriers to the use of health IT” in medically underserved communities of color. Some of those challenges include limited access to Internet service and cellphone connectivity in underdeveloped rural areas, cultural and linguistic differences, and low rates of technology literacy among these patients.
Telehealth remote monitoring systems (software-based IT tools that let nurses collect data via a device they install in the patient’s home) are an effective strategy for reaching patients in rural communities who don’t have access to computers, says LaVerne Perlie, MSN, RN, senior nurse consultant at the ONC.
At the initial home visit, telehealth nurses show patients how to record their health information, such as blood pressure readings, and enter those numbers into the system. “That data is sent directly to the nurse in the provider’s office so that he or she knows when to come out and visit the patient and make recommendations for ongoing care, such as scheduling an office visit or even a hospital admission,” Perlie explains.
As members of the nation’s most trusted profession, nurses are ideally suited to educate patients who are unfamiliar or uncomfortable with technology about how to use health IT tools and become more computer-literate.
At Institute for Family Health facilities, patients receive information about MyChart MyHealth as soon as they walk in the door. In the examination room, says Oldham, nurses explain how the portal works and the benefits of using it. They answer any questions the patient has. Then they help patients register for the portal right there, guiding them through the process of how to log in, create a correctly formatted password, and navigate the website. For patients who don’t have a computer at home, “we encourage them to use the computers at the public library [or to download the MyChart MyHealth mobile app to their smartphone if they have one],” adds Diaz.
Still, another challenge cited in the Understanding the Impact of Health IT report is that “customization of off-the-shelf health IT products often necessary to ensure that they [meet] the needs of underserved populations.” For example, the Cherokee Indian Hospital serves a patient population that has a high risk for suicide, substance abuse, and tobacco use. Because its EHR and PMS didn’t include functions for monitoring these risks, the hospital had to add them.
Hunt and Perlie emphasize that the best way hospitals can make sure their investment in technology will provide information that’s the right fit for their population health management needs is to get nurses involved in the design of health IT systems right from the start—before the technology is implemented. Many health IT projects fail, Govan-Jenkins cautions, because the implementation team didn’t seek input from frontline nursing staff. “And then they had to rebuild and re-implement the system, because it was just not capturing the data they needed to capture for their specific type of patients.”
That, says Sensmeier, is what reducing health disparities through the meaningful use of health IT is really all about. “It’s not just about adopting the technology. It’s about using it in such a way that we can capture the data that’s been entered and learn from it—learn what makes an impact in different patient populations, what care models and treatments work, what outcomes are being realized, and how we can change our practice.”
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