by Lynn Nagle, PhD RN
Nagle, L. (2014). Going for Gold. Online Journal of Nursing Informatics (OJNI), 18 (1), Available at http://ojni.org/issues/?p=3074
It may be that the aftermath of resolutions real and imagined is at the root of my reflection in this editorial, but I feel the need to test my sense of the current state of informatics, at least as I am observing it in Canada. Specifically, is it my imagination or has the pace of informatics work in health care slowed in recent times? In the wake of Y2K, much EHR strategizing and implementation ensued, likely more than most of us could stand. But lately there seems to be a lull in the conversation, a slowed pace and generally less angst about getting the job done. In particular, there appears to be less frenzied EHR project work and less competition and concern about funding. From where I sit, a disconcerting quietude seems to have has settled within the realm of clinical informatics. Perhaps the unusually bitter cold we have been experiencing in the north has numbed the sensibilities or frozen the intentions of our leadership or maybe it’s just a personal brain freeze regarding the status quo. Further this may not be a cross border shared experience as it appears that our colleagues south of the border continue to be buoyed by significant federal investment motivation. I’m not sure that the same can be said about the Canadian landscape.
If there is any truth to this observation, can it be that what has been achieved to date is deemed to be sufficient? Is there a plateau of complacency prevailing in organizations subsequent to the successful deployment of specific applications? In particular, I know of a number of large provider organizations in which the most commonly unfinished or yet to be implemented elements of the EHR are CPOE and clinical documentation. From the perspective of an outsider, there seems to be no great hurry to get the job done. Moreover, with the exception of a few smaller manageable jurisdictions, site to site provider partnerships, and large health care consortia with deep pockets, instances of success in achieving EHR integration across care settings are few and far between.
It seems to me that the overarching goal of our work in health informatics has been to realize improvements in the continuity of information and care through the provision of integrated information systems. And that healthcare supported by such systems would accrue benefits such as cost-avoidance and improved efficiency. And our patients or clients would experience safer and better quality care, not to mention a reduced burden in having to remember and relay key information to a variety of care givers. And that nursing would leverage the computerization of clinical documentation to embrace standardized clinical terminology and increase the visibility of nurses’ contributions to care, not to mention significantly enhancing evidence-based practice. So I ask you, how are we doing at achieving these albeit ambitious but worthy goals?
While my expectations may have been unrealistic regarding the time needed to achieve these goals, I do think it important to keep them in our sights and take every opportunity to heighten awareness of the work that remains. We need to be unrelenting in sending the message that the good work done thus far remains short of proclaiming success. Otherwise it strikes me that we will have spent much time and effort (never mind the blood, sweat and many tears) without achieving the greatest wins. As the 2014 Olympics remain in recent memory, we need to consider whether or not we can best that which has been achieved thus far. Let’s go for the gold!