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As a nurse, Robin Raiford has seen the health care challenge
from the trenches. “I would do an eight-hour shift
and finally had time to chart,” she said. “It’s
incredibly common.”
In a world where computerized decision-support systems
are supposed to help health care providers provide safer,
faster care, an eight-hour lag in charting can mean
that decisions are based on out-of-date information.
The world of nursing yearns for a data-entry revolution.
Raiford may just help spark that revolution. As the
health care business productivity enterprise adviser
for Microsoft Corp., Raiford is conducting research
and meeting customers whose information technology budgets
can bring about faster, safer and more economical health
care, and improve nursing productivity.
“The amazing benefit of grabbing knowledge—not
just data—happens when you can start to query,
sort, filter, analyze and reuse information,”
Raiford said. “People generate data. If they can
reuse it, it can become information. If that information
can be applied to a trend, they can have knowledge.
If they can bring that to the bedside, they bring wisdom
to the point of care.”
A fresh angle
Raiford’s nursing career took a dramatic turn
after she became head nurse at the Smithsonian Institution
in Washington, D.C.
“I literally fell into informatics when I broke
my leg in 1989,” Raiford said. “I just crushed
my ankle and went into being a phone advice nurse at
Kaiser Permanente.”
She missed the environment of ICU nursing a couple
of years later and began doing home life-support nursing.
It was then that she noticed that homebound patients
on life-support equipment could have their health care
home assistance benefit dropped after 30 days—leaving
the family to care for the person on the ventilator
24 hours a day. This was before actor Christopher Reeve
injured his spinal cord and the public became aware
that people lived on ventilators for years in the home.
When President Clinton set out to reform health care,
he asked the public to write the White House with reform
issues. Out of a million responses, Raiford’s
home life-support concerns rose to the top and she became
one of 25 people selected to meet the president. “It
was unforgettable to see the president of the United
States have his eyes filled with tears as the horror
stories were told about health care in the United States,”
she said.
She became so fascinated about how her letter did not
get lost that she went on to volunteer at the White
House to help read letters from citizens and code them
according to subject so they could be manually entered
into a White House database. Every letter to the White
House is entered into a database that can be queried
by ZIP code by members of Congress so representatives
know exactly what their constituency is writing the
president about.
“At the time,” Raiford said, “I did
not know about databases and was not about to touch
a computer that belonged to the president of the United
States.” She took Microsoft Office training during
a 10-week course from ExecuTrain. “It absolutely
changed my life, to know what a database could do,”
she said.
From there, she moved on to become one of many consultants
supporting the Department of Defense worldwide computerized
patient record project. She also performed market survey
analysis for an ambulatory care solution, looking to
improve patient safety, clinical and financial outcomes,
including enhancing return on investment, but always
focused on improving the quality of life for patients
and their families.
Technophobia
With the average age of U.S. nurses being 47, “there
is a huge fear of change,” Raiford said. “There’s
a huge tug-of-war going on. Vendors are challenged to
build something that’s not fearful. We cannot
afford to lose another senior seasoned nurse [from the
profession] due to fear of automation.”
“So much of health care is still paper,”
Raiford said. “If agencies such as hospitals don’t
have a forms committee in place, individual departments
start creating pieces of paper. If there’s no
collaboration or strategy across departments, it’s
not patient-centric.”
She gives the example of an expectant mother going
into preterm labor, yet care providers do not have information
copied forward about previous miscarriages and so that
history must be gathered again. “It’s a
crime to do that to people, to continually ask about
a previous pregnancy loss,” Raiford said. “If
you can automate that, there’s huge potential.”
At last summer’s American Academy of Nursing
summit, these recommendations emerged: decrease patient
errors, improve operational efficiency and improve workflow
productivity. Part of her role at Microsoft, Raiford
said, is to walk the halls in health care facilities
to try to spot where these productivity gains can be
achieved.
“In one client site, they gave us their forms,
and you can see that they enter the same data five times,
on a piece of paper that gets faxed to somebody, then
gets entered again,” she said. “There’s
huge productivity loss, and the potential for error
can be huge.”
Productivity can be measured by looking at efficiency,
cycle time and effectiveness. Once the steps to the
process are defined, elimination of steps or ways to
speed up the cycle time can be realized. Ultimately,
this frees the nurse to spend more time at the bedside.
These problems are compounded when hospitals or other
health care facilities merge. Nurses can easily become
frustrated when they’re moving between two hospitals
in what is now the same organization, perhaps to accommodate
a change in their own work preferences, but each hospital
still runs its own information silos, Raiford said.
“You can’t ask these nurses to work any
harder than they already are, you can only help them
work smarter,” she said.
Rx accuracy
Getting a better handle on medication delivery is another
challenge facing nursing. “It’s all about
the patient’s five rights,” Raiford said.
“The right medicine, at the right dose, for the
right patient, at the right time, via the right route.”
With today’s bewildering range of medicines, just
making sure it’s the right medicine can be a challenge.
Raiford recounts her own horror of a medical error
when she picked up a prescription on her way out of
town. She was supposed to receive 4 mg of Avandia for
insulin resistance to help her absorb the insulin her
body had already made. But a pharmacy tech, by mistake,
dispensed 4 mg of Amaryl, which drops the patient’s
blood sugar. When she called the pharmacy, she was erroneously
told Amaryl was what her insurance had approved. Thinking
it was a generic substitute, she took the wrong medication.
“I was in a taxi out of town when it happened
and almost ended up needing an ambulance when my blood
sugar dropped to 40,” she said.
Raiford, of course, is part of a larger movement focused
on bringing the best of informatics into nursing. Night
and day, nurses also are using resources such as the
e-mail discussion list of the Capital Area Roundtable
of Informatics on Nursing [www.caringonline.org].
Recently, Raiford shared information with the group
on progress being made on InfoPath, a new Microsoft
software being used to quickly build electronic equivalents
of paper forms.
As a nurse at one of the central places where innovation
is happening fastest, “it’s almost too exciting
to sleep at night,” Raiford said. “There
is no more exciting place to be in nursing than in nursing
informatics in the year 2003. No more time for whining
that ‘we are too old to change.’
“People are dying from medical mistakes from
nursing and health care professionals literally drowning
in data. It is our responsibility to do something about
that by turning data into wisdom at the point of care,
and technology is the key driver to do that.”
Contact Scott Mace at scottmace@wiredmuse.com
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