| Nursing and computers have not always
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| | in the healthcare setting adversely
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| been a perfect mix. Typically, nurses try
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| | affecting patient care has also been a
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| to get away from new computer systems as
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| | concern. However, the opposite is true.
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| much as possible. However, it is an
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| | According to the Institute of Medicine
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| inevitable workflow evolution in today's
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| | (IOM) in a report called To Err Is Human:
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| hospitals.
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| | Building a Safer Health System (2000),
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| "It was so easy before when all I had to
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| | "98,000 Americans die in hospitals each
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| do was give it (orders) to the clerk."
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| | year as a result of medical errors. Even
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| "This new computer system is such a mess.
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| | when using the lower estimate, deaths in
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| Why can't we keep our old system?"
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| | hospitals due to preventable adverse
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| "It takes time away from my patient
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| | events exceed the number attributable to
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| care."
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| | the 8th-leading cause of death. Deaths
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| "This is never going to work."
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| | due to preventable adverse events exceed
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| As an RN working on the informatics side
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| | the deaths attributable to motor vehicle
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| of healthcare, such comments are
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| | accidents (43,458), breast cancer
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| commonplace when I travel on site to
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| | (42,297) or AIDS.
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| different facilities.
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| | In her report, Key Capabilities of an
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| Why I wanted to do it
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| | Electronic Health Record System July 31,
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| With billions of dollars allotted to
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| | 2003, Dr. Carolyn Clancy, Director,
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| deploy this project to multiple
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| | Agency for Healthcare Research and
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| facilities nationwide, I wanted to be a
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| | Quality stated, "There is a great deal of
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| part of it. "It's never been done before
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| | interest within both the public and
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| in this scale," stated Vicki Levario, the
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| | private sectors in encouraging all health
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| Director of System Solutions & Deployment
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| | care providers to migrate from
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| at Kaiser Permanente Southern California
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| | paper-based health records to a system
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| Region. When I was offered this job, I
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| | that stores health information
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| didn't hesitate. Here was a marriage of
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| | electronically and employs computer-aided
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| two things I feel comfortable with -
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| | decision support systems. In part, this
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| clinical content and computers.
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| | interest is due to a growing recognition
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| The magnitude of this project can be
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| | that a stronger information technology
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| appreciated when you take into
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| | (IT) infrastructure is integral to
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| consideration the 8 million Kaiser
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| | addressing such national concerns as the
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| members it will affect. By 2007, all
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| | need to improve the safety and quality of
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| 12,000 physicians and 150,000 employees
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| | health care."
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| in the Kaiser organization are expected
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| | National Mandate
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| to be fully trained and use the software
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| | Automation of records in healthcare is
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| in their workflows. After a few weeks of
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| | not only a step in modernization, but a
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| involvement in this project, I began to
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| | national mandate. The following is
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| see what a Herculean undertaking this
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| | excerpted from the United States
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| will be.
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| | Department of Health Services.
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| Resistance
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| | Mission statement:
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| "Good luck with that job. They're just
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| | "... to guide the nationwide
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| wasting their money. It's never going to
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| | implementation of interoperable health
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| happen, " a physician said to me one day.
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| | information technology in both the public
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| Healthcare automation is an inevitable
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| | and private health care sectors that will
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| progression, but not met with resistance.
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| | reduce medical errors, improve quality,
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| There are those who are so defiant to the
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| | and produce greater value for health care
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| change that they would rather retire than
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| | expenditures, and coordinates outreach
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| work under these conditions.
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| | and consultation by the relevant
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| This sentiment is not unique to this
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| | executive branch agencies with the public
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| organization. Cedars-Sinai Medical Center
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| | and private sectors."
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| in Los Angeles met with such resistance
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| | Vision:
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| from physicians that the implementation
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| | "...Clinicians will have a patient's
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| phase failed despite the system being
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| | complete medical history, computerized
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| two-thirds online.
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| | ordering systems, and electronic
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| I can understand where the overtone of
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| | reminder."
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| paranoia comes from. Working on the units
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| | The implementation of electronic health
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| to support the software, I observed some
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| | records (EHR) is integral to this
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| users who are obviously using the
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| | national mandate and it's just a matter
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| computer for the first time. I saw them
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| | of time when all hospitals in the US will
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| having difficulty using the mouse and
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| | be fully electronic in their workflow
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| typing their user names and passwords
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| | systems.
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| with painfully slow pecking style.
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| | With this daunting task ahead, I'm
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| I try to encourage users by showing them
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| | reminded of the words of the National
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| the positive side. With the nation's
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| | Coordinator for Health Information
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| healthcare trend of medical record
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| | Technology National Coordinator, David J.
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| automation, this will make health care
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| | Brailer, MD, PhD when he addressed the
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| givers more marketable as electronic
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| | System Solutions and Deployment
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| health record (EHR) experienced
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| | personnel. "All eyes are on you." As an
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| professionals. And, in time they will
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| | RN and healthcare provider, it's
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| master the system, and their workflows
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| | breathtaking to see through the telescope
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| will be more efficient.
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| | to look beyond the horizon and be part of
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| Safer Practice
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| | the mission.
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| The issue of electronic system workflows
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|
