Just as full enjoyment of an MP3 player depends on learning how to use it, so technology in the workplace will only achieve its full potential when properly incorporated into practice at the point of care.

Sometimes, our greatest gifts come from children. This last Christmas, my children watched with excitement, anticipating my reaction, as I carefully unwrapped the gift they had given me—the latest MP3 player with all the bells and whistles. Wow! I did not ask for this “techy” gift, but my mind raced as I considered how I could use it to accompany me on my travels; assist with my new commitment to working out in the New Year; or balance body, mind and spirit through music. It did not take me long to realize, however, how much help I would need to learn all the ins and outs of this technology, such as downloading songs, categorizing artists and accessing on-demand what I wanted to hear.

My children were once again my teachers as they enthusiastically taught me how to do all of the above, showing off their expertise in using today’s latest technology. The occasion demonstrated how technology is changing our world and how individual competencies vary, depending upon exposure and experience. It is a truth I know well, but I welcomed this simple reminder as I continued my quest of 20-plus years to integrate technology with professional practice at the point of care. 

Is technology a gift to nursing? It can be if it is intentionally designed to support professional nursing practice, interdisciplinary integration, evidence-based practice and clinical decisions at the point of care. Wow! That is a lot to put in a gift box. But it is possible, thanks to the many nurses, colleagues from other disciplines, and technology and clinical decision support partners who are committed to advancing practice with persistence and shared vision.

The first step that nursing, as a profession, must take in recognizing the gift of technology—a step critical to technology becoming ubiquitous in our daily practice—is to demand that we be clearly grounded in our professional scope of practice and other fundamental elements needed to create and sustain a healthy work culture. This realization has been advanced by the pioneering efforts of the Clinical Practice Model Resource Center (CPMRC) and its International Consortium, which I have had the privilege of working with since 1986.

Is technology a gift to nursing? It can be if it is intentionally designed to support professional nursing practice, interdisciplinary integration, evidence-based practice and clinical decisions at the point of care.The CPM Resource Center has been at the forefront of identifying the fundamental elements that must be present in any health care organization if it is to achieve the goal of being the best place to give and receive care. These elements include individual and integrated scopes of practice as well as clinical tools and resources, inclusive of technology (Wesorick, 2002). Using a professional practice framework, CPMRC has designed a system that supports the practice of all practitioners at the point of care and promotes workflow and practice transformation through intentionally designed automation, or IDA (Wesorick, Troseth, & Cato, 2004).

This system can bring pre-configured, evidence-based content and tools to each discipline to enhance its unique scope of practice and make interdisciplinary integration and evidence-based practice come alive in the electronic health record (EHR). It literally shifts nursing and other disciplines from task-dominated practice (task list functionality) to integration of professional services with clinical decision support that:

• Provides standardization of practice based on the latest evidence
• Supports professional processes of assessment, planning, interventions, evaluation and education
• Demands interdisciplinary integration of practice and documentation to eliminate duplication and fragmentation
• Identifies potential complications—aka “failure to rescue” or “never events”—the team should be working together to prevent, from point of entry to discharge
• Embeds professional scope of practice and accountability into daily documentation
• Focuses on patient values and situations that change the course of care, for individualization and improved outcomes
• Enhances critical thinking and clinical reasoning as delineated in evidence-based clinical practice guidelines (CPGs) embedded in the workflow
• Complements computerized physician order entry (CPOE) and documentation as implemented, with the whole in mind
• Facilitates professional exchange using the framework and technology to assure continuity of care and safe patient hand-offs 

Today, the CPMRC International Consortium includes more than 260 clinical settings—in rural, community and academic venues, as well as large, multihospital systems—across the United States and Canada. The consortium actively engages in scholarly work to advance all components of practice and contributes to the design and enhancement of the framework within health care information technology (HIT) systems. With the CPM framework embedded in major HIT vendors’ software, many of these consortium sites incorporate computerized documentation organization-wide.

Clinical outcomes include 100-percent presence of an individualized, interdisciplinary plan of care; statistically significant reduction in preventable complications such as patient falls and pressure ulcers; and improved interdisciplinary collaboration. Learn more about CPMRC at www.cpmrc.com. A biographic profile of Bonnie Wesorick, the founder of CPMRC, now a subsidiary of Elsevier, was published in the Fourth Qtr. 2008 issue of Reflections on Nursing Leadership.

Another collaborative effort to enhance practice and increase competency through informatics is the Technology Informatics Guiding Education Reform (TIGER) Initiative. The TIGER Initiative was launched in 2005 at Johns Hopkins School of Nursing by a group of diverse nurse leaders and advocates who realized the critical need for nurses to band together to transform practice by advancing evidence and informatics within nursing education and at the point of care. I had the distinct honor of serving as program chair of the TIGER Summit in late 2006, held at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, USA. The Honor Society of Nursing, Sigma Theta Tau International contributed significantly to the summit by creating and disseminating a three-year plan and 10-year vision to integrate evidence and informatics—the stethoscope of the 21st century—into daily nursing care and workflow. This summit resulted in a published TIGER Summit Report (2007) and nine collaborations to further advance nursing and informatics:

• Standards and interoperability
• Health care IT national agenda/HIT policy
• Informatics competencies
• Education and faculty development
• Staff development and continuing education
• Usability and clinical application design
• Virtual demonstration center
• Leadership development
• Consumer development and personal health records 

The result of this effort will be nine published reports on each of these topics in early 2009. This initiative represents the input and collective wisdom of hundreds of nurses from government, academia, informatics, industry and practice who have volunteered their time and effort to ensure that technology and the impending mandate of electronic health records support nursing, interdisciplinary colleagues, patients, faculty and students for safe, quality care. Learn more about TIGER at www.tigersummit.com.

I look forward to traveling to Helsinki, Finland, this summer for the 10th International Congress on Nursing Informatics (www.ni2009.org), where nurses from every continent will gather to learn how technology can further connect health and humans. From there, I will travel to Cancún, Mexico, for Sigma Theta Tau International’s 20th International Nursing Research Congress Focusing on Evidence-Based Practice. There, nurses from around the world will gather to share global health care trends and implications for nursing practice, including the role of evidence-based practice and technology. There is no doubt that technology will be an essential tool for us to advance nursing and global health in the future.

As I travel, I will, no doubt, have my high-tech MP3 player with me. Lovingly pre-loaded by my children with new music and movies for long trips, it is a gift I have come to love. On these journeys, I will dream of new and better ways to co-design and pre-load HIT systems and devices with the best evidence and functionality to assure that technology is a gift well-loved by every nurse at the point of care.

Michelle Troseth

Michelle R. Troseth, RN, MSN, is executive vice president and chief professional practice officer for Elsevier. Troseth has been an executive leader since 2001 with the Clinical Practice Model Resource Center (CPMRC), a business unit of Elsevier, headquartered in Grand Rapids, Michigan, USA.

References:
Mattson, J. (2008). Bonnie Wesorick: Nurse on a mission. Reflections on Nursing Leadership. Retrieved February 6, 2009, from http://www.nursingsociety.org/
pub/rnl/pages/vol34_4_mattson_wesorick.aspx

Technology Informatics Guiding Education Reform (TIGER). (2007). The TIGER Initiative Report: Evidence and informatics transforming nursing: 3-year action steps toward a 10-year vision.

Wesorick, B. (2002). 21st century leadership challenge: Creating and sustaining healthy, healing work cultures and integrated services at the point of care. Nursing Leadership Quarterly, 26(5). 

Wesorick, B., Troseth, M., & Cato, J. (2004). Intentionally designed automation creates best places to work and receive care. Healthcare Technology, Vol. 2. San Francisco: Montgomery Research.