Spring 2006
Volume IV, Issue I

Cover art by
Eric Mueller

Second Opinion

In this forum for discussing the “hot button” issues facing the nursing profession today, we welcome your thoughts and opinions. Check this space in each issue to see how readers answer the provocative questions we pose.

Our question this issue:
Taking all factors into consideration, how do you think the use of information technology might affect the care that we provide to our patients (in terms of quality of care and number of patients for whom we can provide care)?

The results:
How do you think the use of information technology in health care might
affect the quality of care?
(A) Improves quality of care (91.9%)
(B) Does not change quality of care (5.8%)
(C) Diminishes quality of care (2.3%)

Total Votes: 903

How do you think the use of information technology in health care might
affect the number of patients for whom we can provide care?
(A) Increases the number of patients (42.6%)
(B) Does not change the number of patients (52.3%)
(C) Diminishes the number of patients (5.1%)

Total Votes: 824  

I think that IT systems should improve the quality of patient care in that information should be more rapidly available to any and all involved in the care of the patient. I live in Fargo, North Dakota, and while we have wonderful specialists here, the potential to be able to consult with a more advanced specialist with all records, X-rays, etc., makes me feel very comfortable with the level of care I could and would receive out here on the prairie.

Timeliness is another asset. As quickly as lab tests are run, they are available online. If a patient needs a dosage change, new med added, a transfusion, whatever, it should be accomplished much more quickly than in years past.

Fully utilized to their greatest capacity, IT systems can be a major boon to patient care. Getting institutions to put up the money for these expensive systems is an ongoing issue for another survey!

Dale Stearns, RN, MSN
Innovis Health, Fargo, ND

As a nurse with graduate education in informatics, I believe strongly that the application of information technology to patient care is crucial to improving patient care, to improving health care organizations' workflow processes, to assisting in health care research and the application of research results to the clinical setting....and that's just a starter set. Health professionals need to support information technology initiatives as much as possible.

Aleta Porcella
Advance Practice Nurse
University of Iowa Hospitals & Clinics

I think quality will improve if the clinical data captured in the process of care delivery is automatically monitored, and alerts are given when there is a high probability that a significant deviation from the normal course of health care is detected. Then a human should review the situation and take corrective action if indicated. The health care quality issue is one of providing the right intervention at the right moment in time, and preventing the wrong intervention or preventing intervention at the wrong moment in time. If IT helps providers do that, then quality will improve.

Kathleen Charters, PhD, RN, CPIMS, CNE
First Consulting Group  

A very qualified "will improve" the quality of care. What is a considerable challenge is the transition from manual to electronic. Based on how an organization makes the leap, the transition can be quite painful and result in patient complications and errors, specifically from unintentional misuse of technologies.

Sue Marino, RN
Clinical Analyst, Hartford Hospital

Information technology is not a panacea. If the hardware and the software selected for a given nursing environment is designed to satisfy management or billing then the clinical application can hinder nursing practice and the quality of the care provided. Nurses need to be at the table when clinical software is being designed and need to have a voice in the choice of hardware. Nurses who do the job need to be involved.

Ginny Glazier, RN, MS
Staff Development Specialist
The Home Care Network

Information technology is only part of the puzzle for nursing care. The processes, workflow, policies, and procedures—all need to be "fixed." And nurses need to change the way we do business; stop the redundant charting, reduce the amount of time "hunting and gathering," and then the IT will reduce the amount of time in redundant charting, provide more safety mechanisms for drug administration, and perhaps the nurses will "spend more time with the patient in support, teaching, etc."

Kathleen Smith, MScEd, RN, BC, FHIMSS
Gaithersburg, MD

Caring for a patient is the sum of the whole—meaning that using technology is only one aspect of what we do to care for patients and their family. Technology should be designed in a way to support the caregiver in an efficient and straightforward way so that the caregiver is not spending more time "nursing" the technology and not the patient/family. I believe that technology can provide a clearer picture of what is being provided for the patient (i.e. we can read the documentation) and, in some cases, provide us more time to "touch" patients. Being able to bar-code a med administration does not mean I can take care of more patients—it just means I have a safer process in medication administration. In fact, the bar coding process, although safer, is not faster than just giving the pill. Technology cannot take the place of "being" with a patient and their family—talking, touching, teaching, comforting—thus to assume that a nurse could take care of more patients just because she/he has more technology to help is an incomplete picture of what is involved with caring for the "whole" patient.

Donna Crompton, BSN, RN, MBA, CNA, BC
Director of Nursing, Clinical Operations/Special Projects
Memorial Medical Center

The problem with thinking that patient loads will be increased with the use of information technology is that such a question demonstrates a fundamental ignorance of what computer systems can do and of the nature of patient care today. First, computer systems do not provide hands-on patient care. Clinicians do that. Second, patient care is getting more labor intensive as more types of acute medical problems are managed in the community and only the sickest people are hospitalized. What computer systems may do is assist with cost avoidance in terms of existing staff being able to care for sicker patients with the same number of personnel. What they will not generally do is to allow for staff reductions.

Mary L. McHugh, PhD, RN, BC
Associated Professor
University of Colorado School of Nursing

RNs are maxed out right now on the number of patients they care for. The hope/dream/vision of IT helping this is giving them back a few minutes per patient to improve the quality of the therapeutic relationship by using those minutes for analysis or interacting.

Anne Scharnhorst
Springfield, IL

I think the number of patients depends on how the technology is used. If changes in the payment system allow more telephone, e-mail, and tele-health contact, then many routine things can be handled more quickly and more patients can be served. Also, if data-mining finds that some of our current work is not cost-effective (imagine that!), then we may be able to cut to the chase and do the work that really makes a difference. That may increase the number of patients we can serve effectively.

Melinda Jenkins, FNP
Director of Employee Health
Leake and Watts Services, Inc.
Yonkers, NY

Johns Hopkins University School of Nursing