This article was written on 03 Mar 2011, and is filled under Volume 15 Number 1.

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Diving into the deep end of the pool: Creating greater integration

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Crucial Conversations about Optimal Design Column

by Denise Hammel-Jones,  Senior Editor


Hammel-Jones, D. (February, 2011). Diving into the deep end of the pool: Creating greater integration. Crucial Conversations about Optimal Design Column. Online Journal of Nursing Informatics (OJNI),15 (1). Available at http://ojni.org/issues/?p=368


Crucial Conversations about Optimal Design ColumnUndoubtedly, technology has the potential to improve efficiencies within healthcare and the effectiveness of care delivery although when we examine the key decision makers behind technology purchases and implementations it is very often not clinicians or those with operational authority within organizations. This conundrum creates confusion about who is really driving the clinical technology “bus” within healthcare and for what purposes is technology being implemented. Furthermore, there is a question about how many organizations truly purchase and implement clinical technology with a systems view in mind. Is the over-arching goal of mirroring the flow of patients (telling the patient’s story) throughout the organization considered or are disparate technologies purchased with the consideration of integration at a later point? In the recent edition of the Journal of the American Medcial Association the need for a patient-centric approach to technology is again highlighted. The Healthcare Information Technology industry is not there yet.

In the article “Forces and Factors Impacting EHR System Adoption: A Report of a 2004 ACMI Discussion,” interoperability is cited a major contributing factor in whether or not clinicians adapt to technology. The article suggests that clinicians are not techno-phobes as some might perceive as evidenced by their adoption of PDA’s and other social technologies but rather how the technologies are believed to integrate with one another and their overall workflow.

A number of studies have shown that the amount of time clinicians spend with patients engaged in direct patient care can have an impact on infection rates, length of stay and re-admission rates to name just a few outcomes. A 2008 report from the Institute for Healthcare Improvement in collaboration with the Robert Wood Johnson Foundation cites that on average clinicians spend approximately 1.1 to 3.3 hours involved in direct patient care. In a systematic review of the literature featured in another article, nurses were more likely than physicians to experience gains in efficiency relative to technology, however this article mainly noted the role that device placement played in efficiency and not system integration.

It is clear being at the HIMSS11 conference that many of the technologies available contain far greater functionality than in years previous but have they missed the most critical component of all – the patient? A repetitive theme this year at HIMSS11 as well as the frequent voice heard from healthcare organizations is the lack of clinical adoption. I have often stated that technology is still something that we “are doing” to clinicians and not a partnership to achieve the goals of the organization and furthermore the goals of patient care. Organizations must carefully examine what obstacles exist to move the advancement of technology closer to where they wish to be to achieve meaningful use or any other objective. There is a disconnect between creating the patient experience through the eyes of technology and the mere implementation of clinical technologies.

There are essentially two components to address in process analysis for technology initiatives.   The first component is the process of how individuals are doing their work. The second component is the information flow or how information exchanges as part of the process. What is sometimes seen within an implementation is the confusion between what these two items contain and the purpose for each. Process analysis is important in redesigning workflow and understanding where inefficiencies exist or will develop. Information flow will assist in establishing what information needs to pass between applications and departments and furthermore, what will ultimately happen if that communication of information fails to occur. The Institute of Healthcare Improvement (IHI) considers “information hand-offs” for hospitals as one of their greater concerns. These information hand-offs, either occur verbally or through the passage of electronic information. More importantly, information hand-offs are a technology opportunity as they often result in technology blame and dissatisfaction.

Vendors and healthcare organizations alike must seize this vital technology opportunity; determine where clinician dissatisfaction lies and where there are possibilities to create greater integration and information flow.


Ms. Jones currently works for Greencastle Associates Consulting as a Clinical Management Consultant on various healthcare technology projects. Prior to Ms. Jones career in consulting, she worked as a clinical applications and project manager for large healthcare organizations within the Philadelphia area. The experience with working on numerous Computerized Provider Order Management projects has positioned Ms. Jones to provide clinical expertise and guidance for the Computerized Provider Order Management Project at Atlantic Health, located in Northern New Jersey.

A nurse for over 17 years, Ms. Jones began her career in Critical Care nursing at the University of Pennsylvania Health System. While continuing her nursing practice in critical care, Ms. Jones held an adjunct faculty position at LaSalle University. Ms. Jones began her transition into Informatics while working in Disease Management in the late 1990’s. Having experience in CPOE, EMR, Practice Management, eMAR, clinical documentation implementations as well as Nursing Minimum Data Sets and Outcome Measures , Ms. Jones is an experienced Informatics professional

Ms. Jones holds a BSN from Thomas Jefferson University and a MSN from LaSalle University. Since completing her Master’s degree; Ms. Jones has obtained certification in Nursing Informatics, Lean Six Sigma, and Six Sigma Greenbelt. Ms. Jones is active is several professional organizations and is past-president of the Kappa Delta Chapter of Sigma Theta Tau.

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