and Judith Effken
This column was made possible by an educational grant from
Chamberlain College of Nursing
Culley, J., Polyakova-Norwood, V. & Effken, J. (February, 2012). Preparing Graduate Nursing Students for “Meaningful Use”/ Issues, Impacts and Insights Column. Online Journal of Nursing Informatics (OJNI),16 (1). Available at http://ojni.org/issues/?p=1260
On July 13, 2010, Health and Human Services (HHS) issued their final “meaningful use” criteria mandating improved quality, safety, efficiency and coordination, as well as the engagement of patients and families through electronic communication (Federal Register, 2010). The rules note, in order to meet the financial incentive for a year, a “meaningful EHR user must meet three requirements: (1) Demonstrates use of certified EHR technology in a meaningful manner; (2) demonstrates to the satisfaction of the Secretary that certified EHR technology is connected in a manner that provides for the electronic exchange of health information to improve the quality of health care such as promoting care coordination, in accordance with all laws and standards applicable to the exchange of information; and (3) using its certified EHR technology, submits to the Secretary, in a form and manner specified by the Secretary, information on clinical quality measures and other measures specified by the Secretary” (p. 44324). The document has very clear ramifications for physicians, informatics professionals, hospitals, and health information technology vendors. The implications for nurses are not as clearly outlined, but they are similar. Nurse Practitioners who care for Medicare or Medicaid patients are providers and will be expected to follow the outlined provider rules, using electronic health records for collecting patient information, sharing patient information, ordering medications, and submitting data to Health and Human Services that can be used to improve population health. In hospitals and other agencies, nurses who work as employees will be using electronic health records instead of paper records to collect and transmit patient data. The ultimate goal is to improve the efficiency, effectiveness, and safety of the health care system through the use of appropriate health information technology—and nurses, as the most numerous providers and caregivers, should be prepared to take a leadership role in making this happen. In this commentary, we focus on the implications for nursing education. How do we prepare our graduate nursing students to be effective meaningful users?
Today’s graduate students represent different generations, are geographically dispersed, work either full- or part-time, have varying levels of professional experience, and often have multiple family responsibilities, thus creating a diverse learning community of students. These students also have varying levels of comfort and expertise with health information technology (Culley & Polyakova-Norwood, 2012). Designing learning activities to engage this diverse student population in the world of meaningful use requires creative strategies—whether teaching in a face-to-face or online environment.
To become effective “meaningful users,” graduate nursing students need two things: (1) recognition for the importance of health information technology in their current and/or future practice roles and (2) a safe environment in which to examine and experiment with the information systems and technology required for real-time decision support, order entry management, health information and data management, patient support, administrative processes, results management and population heath management. Graduate students who are already nurse practitioners readily understand the necessity of mastering this technology (and their experience can help engage others); other students may not immediately realize health information technology is as important to their practice as the clinical technologies they find so engaging. Finding a text that links the technology to their clinical practice can help engage this group.
Both students and educators agree learning by doing and solving real-world problems is more effective than other instructional approaches (Moore, Fowler & Watson, 2007). Lombardi (2007) describes authentic learning as focused on “real-world, complex problems and their solutions, using role-play exercises, problem-based activities, case studies, and participation in virtual communities of practice” (p. 2). Preparing “meaningful users” requires planning effective learning activities that stimulate students to examine and explore the meaningful use of information systems and technologies. For example, students can be asked to analyze health care information system/technology issues, evaluate ways in which healthcare data, information, and knowledge influence the design of information and decision support systems, evaluate consumer health information sources for accuracy, timeliness and appropriateness, and use appropriate ethical, regulatory, and legal standards when using, selecting and evaluating information systems. Learning activities can be designed to replicate the tasks and responsibilities expected of advanced practice and Doctor of Nursing Practice (DNP) practitioners and to give students first-hand experience with making decisions regarding the use of technology in practice. Creating a simulated work environment where learners are assigned to teams to work on projects provides opportunities for graduate nursing students to:
- Acquire new knowledge and make complex decisions;
- Experience deadlines and standards that have to be met;
- Experience project-related stress;
- Develop and test leadership, communication, and technology skills; and
- Experience the influences of team dynamic on the success or failure of a project.
This authentic learning environment reinforces the development of cognitive and organizational skills critical to successful management of technological innovation by multidisciplinary healthcare teams. Projects can be designed to facilitate an understanding of the applications of meaningful use requirements to technology and informatics. Students working together in information system (IS) consulting groups or teams have the opportunity to create a consulting portfolio to include such experiences as the evaluation of healthcare websites, the review of software applications, the analysis of clinical data and preparation of recommendations, the development of written proposals as well as multimedia presentations for implementing a meaningful use application in a practice setting. Meaningful users must be able to navigate the healthcare industry to assure information systems and technologies are interwoven transparently into nursing practice (TIGER, 2008). This requires the ability to develop and present information systems proposals to management teams in health care facilities. These important skills are often overlooked in our educational programs.
The experience can culminate in a formal presentation and defense of the proposals in front of the management team, i.e. other students in the class and the instructor. This exercise enables students to apply meaningful use competencies to a specific context and develop collaboration and oral communication skills needed to become successful team players and leaders in multidisciplinary healthcare settings. This skill set includes the ability to present and defend proposals to the team, management or stakeholders in face to face and technology-mediated meetings.
Current technology provides the capability to design challenging and authentic learning activities for campus-based and distance education students that support the examination and experimentation with meaningful use requirements and the development of effective collaboration and communication skills. Graduates who have: a) an understanding of the complexity of the meaningful use requirements; b) the skills to provide guidance in the collection, trending and analysis of meaningful use clinical quality measures; and c) effective collaboration skills will be well