Cleveland Clinic's Office of Nursing Informatics is a dynamic group that supports evidence-based nursing practice and quality patient outcomes through technology-based solutions to improve nursing communication, aid in electronic medical record documentation, and increase the efficiency of nursing care to our patients.
Patient care drives the technology that is implemented and the nursing informatics team partners with nursing and information technology staff to successfully implement and continually optimize these technological solutions at the bedside.
Nursing Informatics is not new, but it certainly is now. Technology is dramatically altering the ways in which we diagnose, treat, care for and manage patients. It is our past and it is our present.
Our Mission is to support evidence-based nursing practice and improved patient outcomes with technology solutions that enhance nursing communication, documentation and efficiency. We pursue our mission endlessly and passionately.
Nursing leadership at Cleveland Clinic has long recognized that superior quality of care depends on the alignment of people, processes and technology. The Department of Nursing Informatics, within the Zielony Nursing Institute, plays an essential role in defining and implementing the strategy for innovative technological systems and processes to support the delivery of quality patient care and to enhance nursing practice.
Nursing Informatics participates in multidisciplinary strategic planning to determine system solutions that support patient care, set standards for clinical applications, conform to accreditation standards and regulatory requirements, and transform clinical practice. The department also facilitates the development of automation policies, procedures and guidelines for nursing and is the primary liaison between Cleveland Clinic Information Technology Division and the Zielony Nursing Institute.
At the onset of the department, information technology needs within the Zielony Nursing Institute were focused on supporting mainframe applications, developing databases, maintaining desktop applications and deploying office computers. During this time, when various clinical systems were beginning to evolve and a clinical nurse manager interested in how technology could affect nursing practice and patient care, the first manager of the department was named. With the advent of an automated order entry/results reporting system, the role of the department quickly expanded along with the staff.
Initially referred to as Nursing Information Systems at its inception in 1988, the area was officially established as a department in 1993, one year before the American Nurses Association recognized Nursing Informatics as a specialty with ANCC Certification. The name change to Nursing Informatics was implemented in 2006 to coincide with current standards of practice and scope at that time.
The Nursing Informatics department is now comprised of registered nurses, educators, systems analysts, a web analyst, a security coordinator and system administrators whose focus is to enhance nursing practice through the creative use of technology, maximizing nursing productivity, improving the work environment infrastructure and further supporting the Clinic’s world class excellence in patient care.
We support change, but not just for the sake of change. How can we ensure patient satisfaction, safety and outcomes? How can nursing staff leverage technology to improve the environment for providing exceptional nursing care? Providing unique solutions to these questions is our passion.
Clinical Analysts in the Department of Nursing Informatics are Registered Nurses who assess opportunities for innovative technology to improve clinical practices – by first analyzing clinical workflow to determine current practices. Based upon these observations, they facilitate the design and development, testing, implementation, training and evaluation of automated clinical systems. Informatics Clinical Analysts facilitate work groups from the nursing staff to validate the application design and to study and quantify technology impact on improvement of specific nursing practices and processes.
Clinical Instructors in the Department of Nursing Informatics, are also nurses providing centralized application training to nursing staff in support of new or revised clinical applications implemented on the nursing units. Working collaboratively with the nurse managers, nursing staff, and the Department of Nursing Education & Professional Development, Clinical Instructors provide instruction and user support to ease the introduction of new technology into nursing care workflows. Classes favor independent learning with directed computer lab environments as well as self-directed exercises, but also incorporate computer-based training, a component still evolving from yearly competencies and training in federal regulations to clinical applications training with competency assessment. Unit nursing staff responds positively to the computer-based training, which can be taken at times most convenient to them even from home.
The progressive evolution to electronic documentation of the medical record not only improves access to patient information at the point of care, it also greatly enhances nursing abilities to benchmark, monitor, audit and report quality measures in support of CMS, the Joint Commission and MAGNET initiatives. Additionally, collaborative nursing-led research is enhanced by the ability to support these projects with patient data that is more easily extracted electronically.
Supporting these efforts and initiatives is a dedicated team of clinical and system analysts who provide support for the development and management of information databases, systems and processes to bring efficiency to nursing-driven quality and research endeavors through informatics. Maintenance and support of all databases and desktops is provided with a team of system administrators within the department of Nursing Informatics whose efforts are driven by a strong sense of ensuring employee satisfaction through greater efficiency.
We bring our passion for nursing and our passion for innovation together to improve the way nurses communicate with one another, with other caregivers and with patients.
Informatics nurses see technology as a tool to support, rather than hinder, their love of nursing as well as impact future nursing practices. For this team, technology is leveraged for the benefit of nursing practice and improved excellence in patient care systems and processes. Informatics nurses routinely support staff in using automated applications in their daily assignments on the units and play an important interdisciplinary role that combines their passion for nursing with their love of technology, bringing a nursing perspective into the evaluation of innovative systems so that positive patient outcomes are achieved on all levels.
Technology and the effective use of it is our future. The future of nursing and Nursing Informatics is in alignment with the future of healthcare – growth in the use of technology to ensure safety, positive outcomes and satisfaction of patients. Nursing is at the forefront of this wave of technology innovation.
A visionary nursing project currently in place at Cleveland Clinic is the Nursing Unit of the Future. This is a collaborative project between the Zielony Nursing Institute and Information Technology Division. Established on a foundation of defining the ways in which people, processes and technology can improve patient outcomes and nursing practice, the Nursing Unit of the Future staff evaluates the feasibility of innovative mobile devices, applications and other communication technologies that have the potential to support enhanced workflow, documentation of patient care and the satisfaction of patients and staff.
The Nursing Unit of the Future provides nurses with an opportunity to experience, assess benefits and provide feedback regarding new information technologies prior to implementation house-wide. As the nurses evaluate the clinical efficacy of devices and applications, the Nursing Informatics team also evaluates technical and clinical outcomes criteria including:
- How devices withstand normal wear and tear
- How easily information is gathered and recorded
- User friendliness
- Clinician satisfaction
- Time efficiency versus existing methods
- Impact on patient safety
- Impact on patient satisfaction
- Impact on caregiver satisfaction
Taking Patient Care to New Levels
The implementation of the electronic medical record, as with other Cleveland Clinic approaches to clinical medical practice, sets a high standard for innovation, collaboration and interoperability.
Nursing Informatics, in collaboration with the Information Technology Division, is implementing an electronic medical records system from Epic Systems of Madison, WI. Electronic documentation of the patient’s medical record is transforming clinical practice for nursing, allied health and medical practitioners at Cleveland Clinic. After using EpicCare successfully in ambulatory outpatient services for two years, the Clinic is currently undergoing a phased implementation of the Epic system in the inpatient setting enabling health care providers to examine any patient record across the entire continuum of care in all Cleveland Clinic facilities. The current implementation includes Provider order entry (CPOE), nursing care documentation, medication dispensing and administration, and results reporting. Cleveland Clinic patients may even access their own records and request prescription renewals via the internet with MyChart.
Innovative Use of Technology
The Department of Nursing Informatics encourages nursing staff, patients and their families to suggest ideas for greater patient satisfaction. The department supports the resulting suggestions as much as is feasible and to that end, has made computers available for patients who have extended hospital stays. Dedicated solely to patients and their families, the computers provide access to the Internet for emailing friends and loved ones, interaction with support groups, researching information or playing computer games.
All Cleveland Clinic nursing staff have an email account in addition to access to the Zielony Nursing Institute Intranet site complete with Cleveland Clinic policies and procedures, clinical references, announcements of educational classes and opportunities for professional growth, hospital and nursing award opportunities. Everything the nursing staff needs to know is in a comprehensive, easy-to-access site.
In 2006, wireless Voice-over-IP (voice carried over internet protocol networks) phones were implemented in all nursing units to facilitate ease of communication and coordination of patient care between staff, physicians, ancillary departments and patients. Voice-over-IP technology is the most state-of-the-art telecommunications methodology available commercially today and is fast becoming the standard for voice communications globally. The results improved communication and enhanced efficiency to improve patient care and satisfaction.