In 2010, Tenet Healthcare I launched an aggressive roll-out of electronic health records (EHRs) at 49 hospitals in 12 states, to be completed by spring 2014--only 4 short years. Although federal meaningful use incentives contributed to our desire to accelerate the schedule, the main driver was to improve patient care through technology, achieving both meaningful use and meaningful care.
To reach this goal, we knew our project, called IMPACT (IMproving PAtient CAre through Technology) had to be clinician driven. We needed to design a repeatable methodology that targeted sustainment, not implementation, as the success criteria. Our challenge was to involve clinicians at all levels of the organization in planning and implementing the EHR so they would own the "care and feeding" of the clinical system beyond the go-live date. As a result, nurses have played, and continue to play, critical roles at all levels, including project and hospital leadership, standards and governance, and training and support.
As Tenet's vice president of applied clinical informatics, author Liz Johnson is the executive leader for IMPACT. Her focus is on maximizing use of the electronic record environment to improve care, rather than just implementing clinical systems. A registered nurse, Johnson is co-chair of the implementation workgroup of the federal Health Information Technology Standards Committee. In 2010, she received the Nursing Informatics Leadership award from the Healthcare Information and Management Systems Society (HIMSS). She brings both clinical and public policy perspectives to the project. One-third of Johnson's senior directors and half of her directors are nurses, providing a balance of clinical and technical talent to the leadership team.
Every Tenet hospital has a clinical informatics director--a nurse who serves as the clinical leader during EHR implementation and acts as clinical guardian for post-implementation system and workflow optimization. Each hospital's chief nursing officer (CNO) leads the multidisciplinary clinical-process improvement committee that defines new workflow, policies, and procedures to improve efficiency in the electronic environment. In many Tenet hospitals, the CNO also serves as the hospital executive sponsor for IMPACT, providing the drive and sense of urgency to the organization.
Standards and governance
To realize the full benefits of the EHR, our organization recognized the importance of developing and maintaining the clinical standards that are used across our hospitals. As EHR implementations reach a critical mass, this will enable us to mine the data in a meaningful way, identifying opportunities to improve patient safety and gain efficiencies.
Nurses play a key role in defining these clinical standards. They participate in clinical advisory teams with other clinicians to set the standards embedded in the EHR. Hospital nursing representatives collaborate with regional and national nursing leaders on the nursing advisory team. Nurses also participate in the clinical leadership council, comprising chairs of all advisory teams, to approve standards that cross multiple disciplines. In addition, teams of nurses are responsible for translating clinical standards into clinical system designs that are built into the EHR. …