At UCLA Health, the electronic health records system has all the bells and whistles it needs to be the useful tool and care diary it’s intended to be, with one major bonus: the patient story is in the spotlight, in large part due to the ingenuity of RN Ellen Pollack and her team.
A patient story in the EHR provides clinicians with important clinical information, such as the patient’s problem list, active care plans, expected discharge date, safe patient handling and mobility information and more.
“The patient story report helps put the patient at the center of what we are doing,” said Ellen Pollack, MSN, RN-BC, chief nursing informatics officer, at UCLA Health System.
At UCLA Health, the EHRs have banners that run across the top of the patient story to quickly notify caregivers of important information such as fall risk, skin risk and core measures. Another banner appears if patients happen to be in the hospital on their birthday so staff can recognize them on their special day. The patient story also displays which ancillaries are involved in the patient’s care and key information those clinicians wish to share with the rest of the care team.
An idea is born
Pollack knew she wanted to develop and implement a patient story program as soon as she and her team began their EHR journey in December 2010.
During the EHR vendor selection process, the team spoke to a number of hospitals that said care coordination between the disciplines became more challenging. “The facilities realized that it became difficult, when switching to an electronic system, to quickly identify key pieces of information, for example, why the patient is in the hospital, what must be done before the patient can be discharged and what are the goals of care. We knew we needed to focus on ensuring that the strong interdisciplinary collaboration and patient-centered care at UCLA would not be affected by this implementation. We needed to create solutions that would eliminate or at least minimize the problems we were hearing about from others,” Pollack said.
Pollack and her team hoped to find a way for all disciplines to share information about the patient, and they wanted to retain documentation from their legacy systems that added value. For example, for a number of years prior to the Epic implementation, nursing staff began documenting a goal at the beginning of each shift and documented progress toward the goal at the end of each shift. “We liked this concept a lot because it helped us personalize care and focus more on the patient,” Pollack said. “This information was important to the medical and nursing staff so we knew we wanted to incorporate this in our patient story.”
“We wanted the patient story to be front and center and the starting point when a clinician opened the chart.”
A vision becomes a reality
Pollack and her team knew each discipline would document on their own notes and flowsheets within the EHR. The team worked with members of each discipline to identify key pieces of information they wanted other disciplines to know — such as physical therapy, nutritional and respiratory therapy goals — and figured out how to display them in the patient story.
“Lucky for us we had dedicated analysts and nurses who worked with our assigned nurse lead from the EHR vendor to work through the technical challenges, and since this had not been done before there was lots of trial and error,” Pollack said.
Once they got through the major technical challenges, they focused on aesthetics, Pollack said. They added colors to make it more visually appealing and section headers to make locating key pieces of information easier.
Pollack said probably the most important part was figuring out how to make the patient story the default home screen when someone opened the record, because it was essential to making the patient story useful. “We didn’t want clinicians to have to navigate to it,” she said. “We wanted the patient story to be front and center and the starting point when a clinician opened the chart.”
Pollack said the team was fortunate to have lots of support from the vendor, nursing leadership, the medical staff and IT analysts. Over time, the patient story has evolved at the facility. For example, when safe patient handling became a big focus at UCLA Health early in 2016, the team created a section in the patient story to include this information.
Pollack is passionate about using technology to provide efficient, intuitive solutions for clinicians at UCLA. “We know how hard clinical nurses work,” she said “Our team constantly focuses on how we can better support them so they can provide better patient care.”
Her entry into the informatics world began almost 20 years ago when she helped the CNO with large projects for the nursing department. After a couple of years the projects became focused on technology.
“We slowly developed a nursing informatics team by adding one nurse at a time,” Pollack said. “We were like the little engine that could — we implemented electronic nursing documentation, bar-code medication administration, a bed management system, an emergency room system and more,” Pollack said. The team continued to grow until UCLA begin its EHR journey in December 2010, when the team added many more informaticists to the team.
Pollack said she loves nursing informatics because it provides an environment that is ever changing and always challenging. “When done right, technology can enhance our experiences and provide efficiencies,” she said. “We understand the clinical pieces and strive to implement technology solutions that provide value, and support the extraordinary care our nurses provide every day.”
Pollack and team hope to expand the concept of the patient story to the ambulatory setting to help ensure continuity of care. “Continuity of care is especially important for care planning and patient education which do not end when the patient is discharged, and the patient story will help us in the process,” Pollack said.
This year the nursing informatics team is working on ways to improve efficiencies for their nurses through mobile solutions. They are purchasing smart phones for the nurses and will be implementing secure text messaging this year. In addition, they are going to enable notifications from the nurse call system, from physiological monitors and from the EHR to route directly to nurses’ phones, based on priority and care team assignments.
They also are working on implementing an inpatient portal for their hospitalized patients. “This gives patients the ability to view pictures of the care team on iPads and to view educational material nurses recommend,” she said. “The patients can indicate their level of understanding of the content, which then updates the education record in the EHR.”
Patients also can use the portal to request items like ice water and pain medication or to request assistance with hygiene or a visit from their nurse, she continued. “One of our guiding principles for our EHR implementation was to make decisions that are in the best interest of our patients,” Pollack said. “If you focus on this, you can’t go wrong. Creating a patient story was a challenge, but knowing we were doing this to enhance patient care gave us the support we needed to see this project to completion,” she said.