By Cathryn Domrose
Medicaid expansion. Changing systems of payment. Electronic health record conversion. The phrases float at the bottom of a TV screen or flash in headlines, but what do they really mean? To help keep readers informed, Nurse.com highlights some important healthcare policy issues for nurses to watch. Part two of our ongoing series looks at interoperability among medical devices and electronic health records, and full-practice authority for nurse practitioners.
What’s happening: By this time, many believed healthcare systems would be interoperable — able to connect with other systems and share data seamlessly. But numerous glitches, from privacy protection to a lack of standardization, have prevented this from happening. In February, the Office of the National Coordinator for Health IT presented a 10-year plan to get systems working together. A Senate committee also is looking at barriers to interoperability, including high costs and competition among healthcare providers and vendors.
How it affects nursing practice: Nurses not only have to spend too much time monitoring machines, but they also often must transcribe data by hand because the devices are not designed to share information, said Patricia H. Folcarelli, PhD, RN, senior director of Patient Safety at the Silverman Institute for Health Care Quality and Safety at Beth Israel Deaconess Medical Center in Boston. A lack of coordination among devices can put patients at risk, she said. Her remarks accompanied a poll by West Health Institute in which half of about 500 nurses surveyed said they saw a medical error caused by lack of coordination among hospital medical devices, including infusion pumps, ventilators, pulse oximeters, blood pressure cuffs and electronic health records.
EHRs were never meant to serve as documenting tools, said Linda Harrington, DNP, PhD, RN-BC, CNS, CPHQ, CENP, CPHIMS, FHIMSS, vice president and chief nursing informatics officer at Texas Division of Catholic Health Initiatives in Houston. They are supposed to be databases, collecting and sorting electronic information and having it readily available for patients and healthcare providers. When everything works the way it’s supposed to, the devices should free clinicians from documentation duties, she said, and provide an accurate record of patient health available to all caregivers.
When Harrington studied the impact of infusion pumps integrated directly into EHRs — from physician orders to the pharmacy to the pump to the patient record — she found it eliminated 93% of the steps it would have taken to do the process by hand. But hospitals waste a lot of money on IT devices that don’t communicate or document properly, in part because those designing the technology don’t get input from those who use it, she said. “We have to get (clinicians’) input on what content they want to see in the EHR.”
What to watch for: Healthcare technology is moving fast, Harrington said, and she is encouraged by improvements in voice recognition, robotics and biosensors, and integration among mobile devices. She believes eventually healthcare will follow other industries and move away from data entry as devices start to gather and share information among themselves. In 50 years, nurses may move away from hands-on healthcare entirely, she predicted, with robots taking over jobs such as lifting and turning, and biosensors collecting vital signs and other patient information. “I think they’ll be the designers of healthcare rather than the actual givers,” she said.
Full practice authority
What’s happening: Recently Nebraska passed legislation allowing nurse practitioners to practice without a collaborative agreement with a physician, becoming the 20th state (including Washington, D.C.), to do so, according to the American Association of Nurse Practitioners. Currently 18 states require collaborative agreements with an outside health agency and 13 require supervision, delegation or management by a physician or other outside health discipline, according to AANP. Nationally, NPs are currently unable to order home healthcare for Medicare patients — recent legislation introduced in Congress aims to change this and the Veterans Administration is considering a proposal to allow full practice authority for its NPs.
How it affects nursing practice: Without full practice authority, NPs must find physicians to supervise or sign collaborative agreements with them, which can be difficult, especially in rural areas where primary care providers are scarce. Even before Medicaid expansion and increased access to insurance, states were looking at shortages of primary care providers, an aging patient population and a growing need for care of chronic conditions as reasons to lift restrictions on NP practice, said Taynin Kopanos, DNP, NP, AANP’s vice president of state government affairs. Research has shown states allowing full practice authority have more NPs, she said, and lawmakers from New Mexico have started recruitment campaigns aimed at NPs from states with more restrictive laws.
What to watch: Seven states — Illinois, Kansas, Maryland, South Carolina, Texas, Pennsylvania and West Virginia — are considering laws allowing full practice authority, Kopanos said. Others plan to introduce or re-introduce legislation to do so. Some states also are considering law changes allowing NPs to prescribe certain medications and insurers to reimburse for services provided by an NP, she said. But full practice authority still faces opposition from physicians groups, Kopanos said, and at least three states — Kansas, Tennessee and South Carolina — were supporting legislation that specifically limits NP practice authority. “One of the biggest gains (for APRNs) is we’re getting more interest and more stakeholders” in the process, including patient organizations, lawmakers, business groups, and consumer groups, Kopanos said. “More voices are saying this is the direction we need to go.”
Cathryn Domrose is a staff writer.