Methodist College

Melissa Dean
MSN 620: Technology in Nursing Practice and Nursing Education
Implementing New Technology Assignment

Introduction
 Upgrading to an Electronic health records (EHR) can be a challenge for institutions.

Staff may be inexperienced with computers and computer software. EHRs are an important

aspect of modern healthcare and “have clear potential to improve quality and safety with better

access to information, clinical decision support, and more reliable provider-to-provider

communication” (Sittig, Singh, & Ash, 2015). Resistance to change can be eased through

planning, preparation and education. The ability to adapt is essential in life, but especially in

healthcare. This paper analyzes a case study in which two nurses deal with change differently.

Part one:

There are likely to be many reasons why Ann is resistant to change. This is something

Methodist has encountered with the addition of EPIC and it applies to many of the doctors as

well as the nursing staff. For Ann specifically, I suspect there is a lot of fear regarding

technology. She has minimal exposure to computers in her home life so the concept is foreign to

her. One of the ways I identify with her with the new EPIC upgrade is that the font is not

adjustable. This is an issue for myself and may be for Ann as well. I struggle to read orders and

others with less than perfect vision do as well. We have some nurses that have difficulty with

touch screens. One of our nurses cannot use the biometrics on the omnicell because it doesn’t

recognize her fingerprint. Ann might not be able to type. It could be a combination of any of

these or more.

Design, develop and implement

 I would recommend following recommendations outlined by Health information

technology (Health IT) as it offers a step by step proven method for implementation of EHRs:

1. “Assess your practice readiness

2. Plan your approach

3. Select or upgrade to a certified EHR

4. Conduct training and implement an EHR system”

5. ("Health IT," 2013).

Staff by in is important when implementing new technology. Looking at workflow prior

to implementing an EHR can identify what is not working in current practice. Assuming this

facility was currently using paper charting and ordering, challenges with this can be related to

decreased workflow and safety concerns. Joseph Conn states “omissions were far more likely

with paper notes compared with EHR notes (41.2% vs. 17.6%)” (Conn, 2016). Paper charting

can be especially concerning with information sharing. With electronic charting, multiple staff

members and physicians can access charts simultaneously.

Creating a workflow map of current practices can assist in planning. Analyzing current

charting practices and comparing them to any government requirements. Create a task force that

includes individuals who are end users from each practice. This should include nurses,

physicians and any technicians having access to charting. From here, research can be conducted

on companies that develop and supply EHR programs. This task force will test different

programs. After programs have been narrowed down to a select few, an open house can be

planned. Over the course of several weeks, multiple open houses are available to all end users

who can try the different options available. Staff can give feedback on how they feel the

different options apply to their work setting prior to final selection. After final selection, the
company that supplies the software will collaborate with the facility to conduct training prior to

implementation. Training will be tailored specifically to staff needs with separate classes for any

staff members who have different applications.

Needed interventions after technology implementation that is unsuccessful

Initially, rounds should be conducted with staff to determine why the implementation is

unsuccessful. Additional open houses can be held where staff opinions can be shared. Any

barriers should be identified prior to solutions being developed. Bringing in staff that are

familiar with computers can help staff like Ann to acclimate herself to the change. Find out

specifically what Ann’s concerns are so that they can be addressed. If it is discovered that Ann

is not able to type, provide her with no cost assistance. Identifying her specific concerns will

assist in her needs being met. Reinforce with Ann and all staff the importance of an EHR.

Patient safety is improved by the EHR by “computerized order entry, drug interaction checks,

medication allergy lists, and active medications lists” ("Health IT," 2013). Provide additional

training to those struggling with the program. Training can be done in groups with staff

members having the same concerns. Group together those who cannot type versus those who

have trouble navigating the system to reduce anxiety. One on one training can be implemented if

needed.

Part 2:

Applying the above strategy in part one to this case study, it is suggested to train John as

a super user. He is familiar with technology and can be a valuable resource for the staff. Use his
and other computer savvy nurses skills to help staff members like Ann to adapt. Appeal to Ann’s

concerns for the patients. Provide her with facts regarding EHRs. Marguerite Kunz states that

“a survey conducted by the American Hospital Association (AHA) estimated that each hour of

inpatient care can generate up to 36 minutes of documentation” (Kunz, 2010). Efficiency in

documentation can save time allowing nurses to spend additional time with their patients.

Showing Ann that the EHR can save her time with cumbersome charting can help increase her

desire to adapt to the change. As one of Ann’s concerns was getting behind in her

documentation, she will find that once she is familiar with the technology, it will be a time saver.

It is suggested that we appeal to her concern for her patients, providing education and statistics

that show evidence that an EHR is safer for her patients.

Referencing part one, we can assume that the practice was not ready for change.

However, a plan can be implemented to proceed to the next step so that staff can be better

prepared. The exception would be an EHR would not need to be selected and the company can

then proceed to additional training as the software has already been implemented.

It is also suggested to have additional open houses to determine staff concerns and any

legitimate issues that may have occurred during the initial rollout. After the open houses are

conducted, IT will analyze the feedback in order to adjust any workarounds. Next, the steps

recommended by Health IT can be initiated beginning with assessing your practice readiness.

These steps can be repeated in the same way we repeat the nursing process. Because these steps

mentioned in part one are effective and can be repeated, I would conduct the same process as

above. During this, involve Ann and John. I would focus on the positives but also educate both

on how EHRs impact healthcare and patient outcomes.

Summary and Conclusion

 The American Recovery and Reinvestment Act stated that “all public and private

healthcare providers and other eligible professionals (EP) were required to adopt and

demonstrate “meaningful use” of electronic medical records (EMR) by January 1, 2014 in order

to maintain their existing Medicaid and Medicare reimbursement levels” ("USF," 2017). This is

not being stressed to alienate either nurse, but to advise them that regardless of their feelings on

EHRs, it is now required by law. The facility does not want to loose either nurse, but they also

do not want to lose their Medicaid and Medicare reimbursement, which would affect their ability

to keep staff. It’s important to focus on the positives while keeping in mind that change is a

constant in life and in health care. EHRs save time and improve safety. Encouraging a positive

change environment will help Ann feel better about adopting a new technology. Her positive

attitude will help her coworker John feel better about his career.

References

Conn, J. (2016). EHRs vs. paper: a split-decision on accuracy. Retrieved from

http://www.modernhealthcare.com/article/20160708/NEWS/160709938

How to Implement EHRs. (2013). Retrieved from

https://www.healthit.gov/providers-professionals/ehr-implementation-steps
Federal Mandates for Healthcare: Digital Record-Keeping Requirements for Public and Private

Healthcare Providers. (2017). Retrieved from

https://www.usfhealthonline.com/resources/healthcare/electronic-medical-records-manda

te/

Kunz, M. K. (2010). Helping Nurses Overcome Possible Barriers. Nursing for Womens

Health, 14(4), 290-300. doi:10.1111/j.1751-486x.2010.01559.x

Sittig, D., Singh, H., & Ash, J. S. (2015). Conceptual Foundation Of Safer Guides. SAFER

Electronic Health Records,105-136. doi:10.1201/b18371-5