Caring for patients by caring about computers: Why nursing informatics is the right choice for me

My training to become a surgical nurse taught me much more than I expected. The hospital hosting the perioperative course was in the midst of implementing an electronic operating room management system.

I was shocked to discover that this implementation entailed pulling several of the best nurses from patient care duties and assigning them to configure software by compiling common responses to pre-fill drop-down documentation boxes. I also learned that entering data into the computer caused the circulating nurse to physically turn away from the patient (not good). What's worse is that computerized documentation frightened long-time nurses so much, that several had threatened to quit rather than attempt to learn this new skill.

The experience caused me to contemplate the time and resources being wasted and, more importantly, wonder why it took so much work to implement software that was very expensive to begin with. I was frustrated that my fellow nurses were more worried about the computer system than the patients. It didn't seem like the developers had ever been in an operating room. It was a painful way to develop awareness of a continued struggle between patient care and computers. Patient care seemed to be on the losing side of the tug-of-war.

A year later, a wrist injury temporarily removed me from direct patient care, and I had the opportunity to see first-hand how information technology systems are developed. I was assigned to lead a supply chain project where I was mentored by a tech savvy nurse leader. She described how, in an ideal world, we could connect surgery scheduling to surgeon preference cards and nurse documentation and supply ordering. In this magical future world, as soon as a surgery is scheduled, we would know what supplies were needed and when the nurse documented which supplies were used, they would automatically be reordered. This idea thrilled and motivated me. It was this glimpse into the power of process automation, made possible with a well-functioning software system, which was my first inspiration to expand my horizons of nursing.

Of course, back in nursing school, I anticipated doing the type of work most people imagined nurses do: distributing medications, administering treatments, interpreting doctor's instructions, or simply comforting a patient at their bedside. But after these initial experiences with technology, I spent increasing amounts of time thinking about computers, the big picture and process improvement.

Inspired by what I knew software to be capable of, I began my civilian career as a surgery manager at a small hospital. At that time, every single process in the operating room was manual and recorded on paper. I was shocked to find no computers, no internet access, and a paper form to complete to request 'typist' services. This setting provided the perfect, flexible environment to test my ideas for process automation. I learned how to use Microsoft Excel, then Microsoft Access. I tinkered with a surgery scheduling program another nurse had developed, and had soon automated scheduling, case and implant logging, and operational and quality reporting. My nursing role had expanded. Instead of caring for one patient at a time, I helped create tools that improved the care experience for all patients at my hospital.

Soon after, I began formal training in technology management and healthcare informatics. As a nursing informaticist, I work with engineers and design teams to develop easy-to-use software to capture accurate data at the point of care, and then work with analysts to interpret the data and turn the results into actionable insights – all to improve patient outcomes. Improving these inefficiencies benefits patients directly, by reducing documentation burden, but also improves the financial bottom line through process standardization.

I believe that those who really understand the issues, who have worked in the muck, must be involved in the creation of solutions. This is the basis for the field of informatics, which bridges the worlds of clinical processes and information technology. Since healthcare is an industry about caring for patients, nurses have the knowledge base require to make a difference in a big way.

From caring for an individual patient, to caring for all patients at a hospital, the scope of my nursing practice continued to grow. Today, I work for a healthcare software company that delivers products used by more than half of all hospitals in the United States. I'm still in school, studying decision making, because I know that we need to understand current processes and practices before we "fix" them with a computerized solution. I'm still inspired by the possibilities, but sometimes shocked by reality.

When my son broke his arm, I found myself immersed in firsthand interoperability issues. It started when the urgent care took an x-ray to confirm, yes – it was broken, and sent us to the emergency room. Being a nosy, nurse-mom, I took a picture of the x-ray with my iPhone to text it to my sister. But, when the emergency room wasn't able to access the file containing my son's x-rays, they had to use my iPhone picture to confirm the diagnosis! It's 2016 - healthcare providers from different hospitals should to be able to quickly access, analyze and respond to a patient's EHRs, regardless of the file format!

Our government has given $31 billion to hospitals and physicians to incent them to implement electronic health records (CMS, 7/1/2015). And healthcare systems follow along, implementing billion dollar systems with uncertain returns (Boston Globe, 6/1/2015). Interoperability is an issue.

Sadly, more than a decade after my experience with the operating room management system, implementations continue be challenging. Partners HealthCare in Massachusetts had to hire over 600 new employees to implement a new electronic health record system, costing them $1.2 billion, double the budgeted number (Boston Globe, 6/1/2015). And today, 90 percent of nurses continue to feel that electronic health records negatively impact communication with patients (Black Book, 10/16/2014). Yet, I still believe these implementations hold the power to reduce documentation burden, automate surgical supply ordering, and even determine how many nurses to staff on a particular shift.

I began my foray into healthcare informatics innocently enough, seeking a solution to improve processes so that nurses could spend more time caring for their patients and less time inputting data. What I found was an opportunity to continue providing quality healthcare, not by holding a patient's hand, but by working outside of the four walls of a hospital and using my experience to improve the way software is built. My decision to move away from a traditional nursing role was the right choice for me – I care about patients by caring about computers.

Elizabeth Meyers is the Chief Nursing Information Officer at Infor. In her role, she is responsible for formulating, communicating and executing business plans for Infor's healthcare solutions. Prior to joining Infor, she led Fairview Supply Chain's business intelligence team, responsible for converting data into actionable information for decision making. Meyers also worked as a perioperative nurse in the U.S. Army and held positions in surgery and clinical management with Baldwin Area Medical Center. Meyers earned a bachelor's degree in nursing from the University of Minnesota and a master's degree in technology management from the University of Wisconsin. She is currently a PhD Candidate in healthcare informatics with the University of Minnesota.

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