1. 1 The Holistic Approach to the Design and Meaningful Use of Electronic Health Records: A Nursing Experience Frances Beadle, MSc Health Informatics Nurse Manager Nursing Informatics Clinical Applications Advisor SEHA

2. Introduction Immature electronic health systems have been identified by nursing management to create inefficient working processes (Lammintakanenb, Sarantob, & Kivinenb, 2010) Research over the last 10 years has placed an emphasis on clinician involvement in design decisions does impact the successful implementation of digital health technologies (Black, Et Al, 2011)

3. SEHA Organisation Government Hospitals within the Emirate of Abu Dhabi known as SEHA Comprises of 12 hospitals and 42 Ambulatory Health Care Centers 11 hospitals at HIMMS 6 Geographical location over 200 kilometers Over 8000 Nursing staff employed within the SEHA network Multicultural workforce comprising of over 62 nationalities One fully implemented electronic health record “Malaffi” my file in Arabic

4. Identified Challenges English as a second language Multiple sites No standardisation Inappropriate change requests Long change control processes Inability to benchmark locally and nationally Documentation process too extensive Reduced patient contact Reduced patient safety Lack of real-time documentation

5. Why Address the Challenges Improve adoption and meaningful use Provide opportunities for nurses to have input into appropriate documentation practices Improve patient safety Improve real time documentation Ensure risk assessment tools are fit for purpose Increase nurse time at the bedside

6. How to Address Challenges Implement a new process for change control Involve all key stakeholders Bi Directional Approach Clinician driven design Standardisation to improve benchmarking Appropriate clinical decision support Improve patient safety Nursing driven KPI reporting

7. Aim of Collaborative Approach The overarching aim of the identified process is to ensure that technology and related processes are fit for purpose with the least amount of impact into nursing day to day activities.

8. Stakeholders Corporate Nursing Leaders Business Entities Nursing Leaders (CNO, DON) Nurse Mangers Nurse Educators Nursing Informatics Clinical Application Specialists Nursing End Users Vendor Support

9. SEHA Nursing Change Structure

10. Roles and Responsibilities of Stakeholders Analyse clinical and financial data to support nursing Facilitate resources and reference access Deliver standardised nursing language Improve continuity of care Support cost savings and nursing productivity Enhance relationships between provider and customers Support nursing in working processes by the use of technology

11. Roles and Responsibilities of Stakeholders Redesign clinical workflow Improve change management process and decision making Education and training Promote the provision of evidence based care Inclusion of Clinical decision support Promote interdisciplinary care Data integration Report writing

12. Roles and Responsibilities of BE Stakeholders Compliance management Clinical transformation Policy development Consultation Issue resolution Implementation of new tools Clinical Champion nursing Advocate

13. Examples of Implemented Change Standardised nursing documentation Standardised risk assessment tools Improved medication documentation Bed capacity dashboard Introduction of technology to support nursing Medication history Productivity data

14. Benefits Realisation

17. Time saved in documentation Improved KPI data capture Nursing related KPI not IT Standardised approach Greater nursing adoption Improved patient safety Collaborative approach to care provision More time back at the bedside Improved satisfaction with nursing staff and patients Benefits Realisation

18. Conclusion The SEHA nursing team has proactively sought to optimize their electronic health record with proven positive outcomes. The outcomes have identified that clinician driven change control processes do improve the meaningful use and adoption of electronic health records.

19. References American Nurses Association (ANA). (2008). Nursing informatics: Scope and standards of practice. Silver Spring, MD: Nursebooks.org. Black, A. D., Car, J., Pagliari, C., Anandan, C., Cresswell, K., Bokun, T.,... Sheikh, A. (2011). The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS medicine, 8(1), e1000387. Goossen W. Nursing information management and processing: a framework and definition for systems analysis, design and evaluation. Int J Biomed Comput. 1996;40:187–95 Healthcare Information and Management Systems Society (HIMSS): www.himss.orgwww.himss.org Lammintakanena, J., Sarantoa, K., & Kivinenb, T. (2010). Use of electronic information systems in nursing management. International journal of medical informatics, 79 (1), 324-331.