Registered Nurse Care Coordination: Creating a Preferred Future for Older Adults with Multimorbidity
Unfortunately, nursing documentation in electronic health records (EHR) has become a house with data “treasures” piled to the rafters—much of it “just in case” it might be needed. In a study of nursing documentation at Bon Secours Health System, CNO Patricia Sengstack (personal communication, 2016) found that just completing the nursing admission assessment required that nurses access 14 different screens and complete 153 “required fields,” using a total of 539 key clicks to do so.
Data-rich, information-poor…because each health care organization implements an EHR system without the ability to leverage lessons learned from organizations that have gone before them or access a “best practice” central repository that holds examples of data sets complete with clinical terms mapped to standardized terminologies such as clinical LOINC and SNOMED-CT.
Imagine if, at the end of a shift, every nurse wrote out a bill for the care he or she just delivered. What would be on the bill and how much would each nurse charge? It is a provocative question and gets to the heart of how to measure the added value nurses bring to the health care system. I have asked that question many times over the years. One place I recall was a hospital cardiac care unit where I was touring the unit with the nurse manager. I asked the billing question to a preceptor orienting a young nurse.