Nursing and Medical Peer Leadership in Electronic Medical Record Adoption

There is no denying that health care and technology are coming together in amazing ways. In my 15-yr nursing career, I have seen paper “SOAP” notes turn into spreadsheets, and notepads into personal digital assistants (PDAs). The information technology (IT) world and the health care world do not always marry together in perfect harmony.  In fact, many would argue that it never happens that way. After all, we are talking about a very concrete and rather impersonal IT field coming together with a very people centered and dynamic health care system.

Most of us have heard about provincial plans for a seamlessly integrated Electronic Health Record (EHR) system. Although we are years away from achieving that, Ontario has made great strides in implementing stepping stones towards that goal.  Nursing, as a driving force and key group of stakeholders, has embarked on a unique collaborative initiative. This initiative is one that combines the resources of OntarioMD and the Registered Nurses’ Association of Ontario (RNAO) in a Peer to Peer Network project.  This project will facilitate the marriage of IT and healthcare in clinic settings.

OntarioMD was established by the Ontario Medical Association and the Ministry of Health and Long-Term Care to manage the EMR Adoption Program, which funds and assists physicians to acquire, implement and adopt IT. The RNAO is the provincial nursing association. The RNAO has been leading many projects and peer programs with regards to supporting nurses to adapt and champion eHealth initiatives across the province. The strengths of both these influential entities will be harnessed in this new project.

The purpose of this initiative, in collaboration with eHealth Ontario and the Ministry of Health and Long-Term Care, is to expand and enhance the OntarioMD Peer Leader Programs and the RNAO eHealth network to assist in the engagement and use of Electronic Medical Records (EMRs) in Medical Offices and Nurse Practitioner Led Clinics. The target professionals in this project include physicians (primary care and specialty), family practice nurses, and Nurse Practitioners. To clarify, an EMR is the electronic charting software used to collect and store data at point of care. The EHR refers to a bank of complete client data that can be accessed across a variety of settings.The EMRs in individual settings will eventually be used to link information in creation of the provincial EHR system.

Healthcare consumers enter the system at many points of entry – either through an unplanned visit to an emergency/urgent care centre or a planned visit for primary health care services.  With the expected increase in primary health care services and the adoption of EMRs supported by Canada Health Infoway’s EMR funded investment project, mentoring of Physicians, Nurse Practitioners, Nurses, Clinic Managers and other members of the care team by peer leaders will help ensure clinicians are better prepared to adopt and use EMR in practice.  This team of peer leaders will also assist health care teams in using EMR systems to their maximal potential.

Building upon the key successes and lessons learned from both previous Peer Leader Programs, this collaborative initiative will achieve the following objectives. The peer leader team with continue building awareness and achieve a state of readiness to enable EMR implementation (pre-implementation) in primary health care settings including family practice clinics and NPLCs. The team will accelerate EMR adoption by linking experienced physicians, family practice nurses, nurse practitioners, and clinic managers with their colleagues to support and mentor in the use and integration of EMR into the practice setting and other required change management support. The peers will develop tools and support services that contribute to the use and optimization of the EMR to achieve clinical value and promote clinical quality standards, decision support and optimization of use. Peer Leaders will also work with practice settings and Practice Advisors in developing mitigation strategies to improve targeted areas of EMR maturity within the practice, including coding, chronic disease management, practice management improvements, etc.

The total Peer Leaders engaged will consist of 30 MDs (including one Senior Peer Leader), 14 clinic managers and 22 Registered Nurses and Nurse Practitioners (myself as Senior Peer Leader). The potential impact of the project will focus on inter-professional practice at the clinic level where nurses and physicians both consider the impact of EMR adoption on their practice. The project will enhance the professional practice of office nurses by increasing adoption of EMR in clinical settings, as well as focus on sustained and enhanced use. Peer leaders will have the added potential to champion the EMR adoption plan to patients. There is great benefit to patients and professionals alike in consistent use of EMR systems. Eventually, a provincial EHR would mean that the correct healthcare data and information could be accessed at the right time no matter where and when the client presents to the healthcare system in Ontario.  While still in the early stages, this project has huge impact potential and opportunity to be at the forefront of major improvements to the provincial healthcare system.  For more information, please contact the RNAO or OntarioMD.