Demonstrating Meaningful Use Through Staff Engagement in the Design and Implementation of Electronic Documentation

Purpose:
To demonstrate meaningful use of the EHR through early and continuous involvement of nursing staff in the design and implementation of an electronic nursing documentation system.

Significance:
Involving staff nurses at the ground level of the design and implementation phases has potential to increase awareness of process and workflow issues, improve capture of clinical data, assure more rigorous collection of quality data and enhance patient outcomes, which is meaningful use.

Strategy and Implementation:
In May 2008, a mid-sized, Midwestern urban hospital began the process of implementing a commercial nursing documentation system. From its inception, staff nurses were instrumental in the design and implementation. A Design Team, led by a nurse informaticist, relied heavily on the input of end-users from all clinical areas within the project scope. Meeting weekly for over two years, they designed the documentation screens that would be utilized throughout the organization. Dialogue among the nurses led to the identification of opportunities to improve existing policy, practice and workflow. Best practice, found in the literature, was routinely part of lively team discussions with subsequent changes in both documentation and delivery of patient care. The nurses did not stop contributing once the design phase had been completed; they developed staff education, conducted end-user classes, trained super users for implementation and were major players in the follow-up survey process.

Evaluation:
The commitment of nurse end-users was instrumental to the success of instituting electronic documentation with the end result; improved charting, enhanced data capture, more robust quality measurement and improved patient outcomes. Level of nurse acceptance was surveyed post implementation.

Implications for Practice:
Including nurses early builds buy-in among peers when they teach in a classroom or on the unit as an expert. When nurses own the project they exhibit commitment and acceptance, championing identification of process improvement for patient outcomes, which is the intent of meaningful use.