Sarah A. Collins

Objective: To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Materials and Methods: Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Results: Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Discussion: Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Conclusion: Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a “road map” for future work related to acute care patient portals.

Due to rapid advances in technology, HIT competencies for nursing leaders require frequent attention and updating from experts in the field to ensure relevance to nursing leaders' work. This workshop will target nursing informatics researchers and leaders to: 1) learn methods and findings from a study validating a Self-Assessment Scale for Nursing Informatics Competencies for Nurse Leaders, 2) generate awareness of the Self-Assessment scale, 3) discuss strategies for maintenance of competencies overtime and 4) identify strategies to engage nursing leaders in this pursuit.

Due to rapid advances in technology, HIT competencies for nursing leaders require frequent attention and updating from experts in the field to ensure relevance to nursing leaders' work. This workshop will target nursing informatics researchers and leaders to: 1) learn methods and findings from a study validating a Self-Assessment Scale for Nursing Informatics Competencies for Nurse Leaders, 2) generate awareness of the Self-Assessment scale, 3) discuss strategies for maintenance of competencies overtime and 4) identify strategies to engage nursing leaders in this pursuit.

Clinicians currently use electronic health records (EHR) which have often not been designed with the user in mind. Participatory design requires a thorough evaluation of the system using mixed methods. When different methods yield conflicting results, synthesis is challenging. This panel will present four cases of triangulation approaches to evaluate EHR usability and usage in multiple institutions. The audience will have a better idea how to triangulate results from multiple innovative methods such as the use of eye-tracking techniques and mixed methods approaches to evaluation.

Context There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation. Objectives To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. Design, Setting, Participants We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects. Results We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders. Conclusion Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians.

Background Maintaining continuity of care (CoC) in the inpatient setting is dependent on aligning goals and tasks with the plan of care (POC) during m

Health information technology (health IT or HIT) holds the potential to transform the quality of care and to establish linkages between nursing care and patient outcomes. This article defines eMeasurement and describes Quality of Care Definitions and Metrics for Evaluation. The authors explore the role of health IT to improve quality, barriers to eMeasurement, and health IT interventions by considering linkages between nursing care and patient outcomes for a select set of nursing sensitive indicators including patient falls, pressure ulcers, and the patient experience. We discuss specific challenges, such as barriers for routine data capture to populate nursing sensitive indicators and the use of health IT to promote positive outcomes. The conclusion addresses the implications of the current state of health IT and identifies areas for further nursing research.

Background Nurses alter their monitoring behavior as a patient’s clinical condition deteriorates, often detecting and documenting subtle changes before physiological trends are apparent. It was hypothesized that a nurse’s behavior of recording optional documentation (beyond what is required) reflects concern about a patient’s status and that mining data from patients’ electronic health records for the presence of these features could help predict patients’ mortality. Methods Data-mining methods were used to analyze electronic nursing documentation from a 15-month period at a large, urban academic medical center. Mortality rates and the frequency of vital sign measurements (beyond required) and optional nursing comment documentation were analyzed for a random set of patients and patients who experienced a cardiac arrest during their hospitalization. Patients were stratified by age-adjusted Charlson comorbidity index. Results A total of 15 000 acute care patients and 145 cardiac arrest patients were studied. Patients who died had a mean of 0.9 to 1.5 more optional comments and 6.1 to 10 more vital signs documented within 48 hours than did patients who survived. A higher frequency of comment and vital sign documentation was also associated with a higher likelihood of cardiac arrest. Of patients who had a cardiac arrest, those with more documented comments were more likely to die. Conclusions For the first time, nursing documentation patterns have been linked to patients’ mortality. Findings were consistent with the hypothesis that some features of nursing documentation within electronic health records can be used to predict mortality. With future work, these associations could be used in real time to establish a threshold of concern indicating a risk for deterioration in a patient’s condition.