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The art of nursing has changed dramatically since the Florence Nightingale days nearly 200 years ago.

Technology has perhaps had the greatest influence on the changing role of nurses in patient care. Some might say today's nurses are experiencing the most profound change, as healthcare reform and resultant adoption of electronic medical records ( EMR ) usher in an increased demand for clinical / nursing informaticists - medical personnel who understand, integrate and support the use of IT in healthcare.

Dee Cantrell has witnessed this transformation over the course of her healthcare career. The CIO of Emory Healthcare - the clinical arm of the Robert W. Woodruff Health Sciences Center of Emory University that comprises more than 24 locations across metro Atlanta - began her career more than 25 years ago as an RN, specializing in surgery. After multiple offers from her CEO of a clinical implementation leadership position, Cantrell dove full-time into the world of clinical informatics.

"Nursing informatics was still a new kind of concept back then," Cantrell says, "and hardly anyone had any clinical automation in place. I thought I should give it a try, and I've been in it ever since." She has been with Emory for 18 years, and has been CIO since 2000. "I have loved every moment of it. Even at its worst it's still great. It's been a wonderful experience and I wouldn't change a thing."

Change Agent
Though she "wouldn't change a thing" about her career path, Cantrell has overseen quite a bit of change at Emory, even before healthcare reform and its Meaningful Use incentives came along. "Meaningful Use wasn't a driver for clinical automation at Emory," she explains. "We embarked on this strategy and this journey before Meaningful Use was even an idea," adding that the foundation for Emory's EMR system was laid well before reform came up for debate. 

The hospital, which has used Cerner's Millenium clinical suite since the 90's, also utilizes McKesson's HealthQuest for patient billing in its hospitals, and IDX solutions (now under the GE Healthcare umbrella) for patient billing in its clinics. "We front-end those two systems with the Cerner Millenium global patient registration system so that along with the Enterprise Master Patient Index makes sure we're tying all of our patients together across all of our sites and varying clinics," Cantrell explains. "As we bring new hospitals and other physician practices on, we leverage this technology along with our virtualization technologies to bring them on as quickly as possible."

"We were actually an early adopter of the clinical data repository and actually were the development partner with Cerner for what is now PowerChart, so we've been automated in some ways for awhile," she says.

Meaningful Use has had some impact to Emory's healthcare IT plans in that it required implemenation of the CCHIT EMR certified code as required by the HITECH Act. "We implemented the Cerner certified code in February. We are already running our audit reports for attesting, because we plan to attest in May, June and July. We will be one of the earliest to attest for Meaningful Use. So far everything looks good."

Bedside Experience Makes all the Difference
Healthcare IT implementations are well and good, but to Cantrell, it's the partnership of physicians, nurses, IT and vendors that have made Emory's implementations run so smoothly. "What I think has influenced things has been having IT seen as a strategic partner rather than just a utility," says Cantrell, adding that as a member of the C-Suite, she is privy to and can influence the health system's strategies. "Part of influencing those means bringing the right clinical informaticians on board in order to help with implementation, support and looking beyond the four walls to think about strategy for connecting us in varying ways - not just internal to Emory."

Cantrell stresses that to her, bedside experience is a key characteristic of a clinical/nursing informaticist. "I think it's vital that you have practicing nurses who have an interest in informatics, because you bring the real world with you into that kind of role, which then allows you to influence how technology is designed or implemented, or how data might be used for analysis. That allows nurses, more than ever before, to have a  leadership role.

Cantrell made a concerted effort early in her career at Emory to seek out nurses, physicians and other clinical ancillary personnel who truly had a passion for informatics to fill positions on her team. "We need people who've been out there - who've been there, done it - to help influence informatics in the right way."

She makes sure to engage clinicians in major implementations. "I'm always looking out for people who really stand up and take a leadership role, and look at it from an enterprise view. I need to see that person in action and know they will appreciate that what we do makes a huge difference in the lives of patients and their families. This is all about the patients. This is not about us."

This sort of teamwork enabled Emory's computerized physician order entry ( CPOE ) implementation to move along successfully across the system's multiple facilities. A team of nurses, pharmacists, physicians, residents and fellows made up an informatics team of close to 30 personnel that supported end-users as the rolling CPOE go-lives occurred. "They were crucial in rounding; helping to resolve problems; and getting feedback to the technical team for enhancements, revisions and fixes." Cantrell's strategy worked, with CPOE adoption consistently hovering around 90%.

"It worked out so well that I hired some of them to come into the IS department," Cantrell says. "It really helped with adoption on the physician and nursing side, because CPOE can only be successful when nursing is engaged. Nurses make things happen."

Taking Informatics to the Patient
Emory's informatics team is "heavy into data analytics," according to Cantrell. "We have a wealth of data, so it's really great when you can take that data, make it information and translate it into knowledge that gets back to the bedside. Trying to speed up that loop is a key factor, particularly at an academic health system."

Cantrell is a firm believer that informatics can be a huge influencer on patient care. The Venous Thromboembolism ( VTE ) Prevention Team - made up of personnel from the Emory Section of Hospital Medicine, Information Services and Department of Nursing - received the Excellence in Teamwork in Quailty Improvement Award last year from the Society of Hospital Medicine.

The team received the award for its work on VTE prevention, a key indicator of hospital quality due to the fact that it is considered to be one of the most common, preventable causes of hospital death. The team developed a way to take VTE-related data from the EMR and present that to care teams in a real-time dashboard so that patient interventions can occur immediately. The technology, which can also track unit-level performance over time, has been successfully deployed in more than 50 units across six Emory hospitals.

"As a core quality measurement, VTE prevention is one of our strong areas now," Cantrell explains, "and that's all about being able to harvest the data, finding the workflow and presenting that information in a way that's meaningful to the clinician."

Tools Behind the Data
Emory has partnered with Cerner because its products offer an open architecture that allows Cantrell's team to personalize and develop programs to better support clinical research. The ability of physicians to document data online has also had a big impact on clinical informatics efforts at Emory, as well as the attestation process for Meaningful Use.

The Emory Healthcare IT team developed its own data warehouse, which includes financial and clinical data. "We have a decision support tool that layers on top of that, which allows us to harvest the information more easily, and present it via dashboards that enable the informatics folks and providers at the bedside to use that information as they look at patterns and trends for certain disease states," Cantrell says.

Continuing the Trend 
Informatics will continue to play a large part in advancing patient care at Emory. Cantrell's commitment to creating a team of informaticists that have bedside experience and a passion for translating data into actionable intelligence will bear the fruits of increasingly satisfied - and continually healthy - patients.

Source: Billian's Healthdata