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How knowledge-based care will affect your practice
By Brian Duggan, MSN, RN
Web Services Director
Premier Sourcing Partners
In the very near future, emergency department (ED) nurses and physicians will have more access to expert knowledge that will improve patient care. Here are some developments:
• Better electronic medical records.
The electronic medical record (EMR) has been the holy grail of health care information technology for several years, but its delivery has been less than satisfactory. In theory, the EMR contains a complete record of all episodes of a patient’s care, from the doctor’s office to pre-hospital through hospitalization and discharge. In reality, most organizations have no EMR, and those that do have one that contains a fraction of a patient’s history. The challenge lies in data capture, system compatibility, security concerns, and competition between care providers.
In the future, a unique identifier, verified and authorized by the patient, will be used for each patient. The patient will be in control over who has access to his or her clinical information and to what extent. In the ED, nurses and physicians will have granted access to the patient’s history and be able to update that record on-line. The ED is unique in the health care environment in that often caregivers are forced to make judgments based on very little patient history. By providing access to that history, the quality of care given will improve naturally.
Wireless or handheld devices will give clinicians access to the patient history from any point in the ED. The key to success is not necessarily the technology, but how the data is organized and presented. ED caregivers do not require detailed notes of office visits or discharge summaries. They need a mile-high view of the patient’s history, with the ability to drill down to greater detail on the pertinent portions.
Knowledge-based care also includes increased access to expert information at the point of decision (the point of care isn’t necessarily when and where the decision is made). Physicians will have access to patient clinical results, on-line references, and care guidelines when writing orders.
With computerized physician order entry, orders are checked against standards, and suggestions are made while the physician is entering orders. This has been recognized as one of the top priorities in preventing errors in care provision.
• More access to on-line information.
Nurses also will have more access to on-line references. For example, before giving a medication, nurses can verify with their handheld device that the dosage is within accepted profile, that it doesn’t interact with other medications, and that it meets the five "rights" of medication administration: The right patient, time, drug, dose, and route. The nurse then can wirelessly print patient instructions.
Bluetooth, a short range radio frequency communications standard that is being implemented for handhelds, laptops and other devices, will allow nurses to access on-line databases, print to a local printer, and communicate via instant messaging from anywhere within 30 feet of another Bluetooth device.
• More rapid communication.
Instant messaging (IM) is growing tremendously in the on-line environment. Popularized by teens who rapidly accepted the technology as a way to communicate with many people at once, it is now achieving acceptance within the business environment. It is not as intrusive as telephone calls, yet provides instant access to someone. It allows one to see if someone is available or busy, and it reduces communication time by reducing the communication to essentials.
For instance, Doctor A asks a nurse to call Doctor B for him. Doctor A’s nurse reaches Doctor B’s nurse who has to search for Doctor B, then call him to the phone. Doctor A and B are busy people and have to interrupt their work to get to the phone. Pleasantries are exchanged according to typical telephone courtesy and finally the subject of the call is discussed, then more pleasantries before the call ends.
With IM, Doctor A uses his handheld device into which he is entering patient findings and orders. He has a question that Doctor B might be able to answer. He looks at his IM application to see if Doctor B is on-line and available, and scribbles a quick question. IM etiquette doesn’t require the pleasantries of a telephone call, just as e-mail doesn’t require the formality of a letter.
Doctor B glances at his device but is in a conversation. A minute later he scribbles back an answer and continues in his work. The communication is quick, eliminates several steps, and encourages quick consults and communication between care providers.
IM will be important to health care in the future. The main roadblocks are not technology, but acceptance of a new means of communication and etiquette rules — the same issues that were faced with the acceptance of telephones, then voicemail and e-mail.
[Editor’s note: Premier Sourcing Partners is a division of Premier, which is an information technology solutions company. Duggan can be contacted at Premier Sourcing Partners, 2320 Cascade Pointe Blvd., Charlotte, NC 28108. Telephone: (704) 733-5753. Fax: (208) 330-7859. E-mail: Brian_Duggan@PremierInc.com.]
For more information on stroke and cardiac care, contact:
• Marli Bennewitz, RN, BSN, Chest Pain Center Coordinator, St. Jude Medical Center, 101 E. Valencia Mesa Drive, Fullerton, CA 92832. Telephone: (714) 992-3000, ext. 3463. Fax: (714) 992-3109. E-mail: firstname.lastname@example.org.
• Debra Graf, RN, BSN, CEN, Emergency Department, Community Medical Center, 99 Route 37 W., Toms River, NJ 08755. Telephone: (732) 557-8000, ext. 11925. Fax: (732) 557-2124. E-mail: DGraf@SBHCS.com.