Description
In a 4- to 5-page project proposal written to the leadership of your healthcare organization, propose a nursing informatics project for your organization that you advocate to improve patient outcomes or patient-care efficiency. Your project proposal should include the following:Describe the project you propose.Identify the stakeholders impacted by this project.Explain the patient outcome(s) or patient-care efficiencies this project is aimed at improving and explain how this improvement would occur. Be specific and provide examples.Identify the technologies required to implement this project and explain why.Identify the project team (by roles) and explain how you would incorporate the nurse informaticist in the project team.Use APA format and include a title page and reference page.Use the Safe Assign Drafts to check your match percentage before submitting your work.
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JONA
Volume 49, Number 11, pp 543-548
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
THE JOURNAL OF NURSING ADMINISTRATION
A Systems-Level Method for Developing
Nursing Informatics Solutions
The Role of Executive Leadership
Sammie Mosier, DHA, MA, BSN, NE-BC, CMSRN, BC
Wm. Dan Roberts, PhD, RN, ACNP
Jane Englebright, PhD, RN, CENP, FAAN
Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of
their broad understanding and oversight of nursing
care. We describe a systems-level method for creating
nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on
the guiding principles of clear lines of responsibility,
respect for expertise, and commitment to project
aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions.
Data about nursing care have become a critical component of operational and patient care decisions.
These data can potentially affect the productivity, efficiency, performance, effectiveness, cost, and value
of nursing care when properly collected and used.
The management and processing of data into knowledge for use in nursing practice have become an important specialty within the last decade.1
Nurse executives are dependent on data for effective decision making. The American Organization of
Nurse Leaders has identified essential competencies
in informatics that are necessary for effective leadership of this technology and data-informed environment.2 In the age of big data, nurse executives are
responsible for creation of the framework that allows
for nurses and other experts to apply their knowledge,
Author Affiliations: Vice President and Assistant Chief Nurse
Executive (Dr Mosier), Vice President of Care Delivery and Performance (Dr Roberts), and Senior Vice President and Chief Nurse
Executive (Dr Englebright), HCA Healthcare, Nashville Tennessee.
The authors declare no conflicts of interest.
Correspondence: Dr Englebright, HCA Healthcare, One Park
Plaza, Nashville, TN 37203 ([email protected]).
DOI: 10.1097/NNA.0000000000000815
such as through the creation of a data culture, the development of data competencies, and the establishment of data infrastructure.3
Together, nurse executives and nurse informaticists
are forging new solutions to improve nursing processes
and patient care. The challenge is in determining how
best to coordinate the efforts of subject matter experts
from nursing, informatics, and information technology to design, develop, and deploy solutions to very
complex problems. Nursing leadership is well poised
to influence these processes by virtue of their broad
understanding and oversight of nursing care. While
not usually engaged in the development of nursing informatics solutions, we propose that executive leadership is necessary to this process.
Here we discuss our development of a systems-level
method, with clearly defined structure and leadership
from nursing executives, to create nursing informatics
solutions that enhance patient care. This article will
describe the method and provide case examples of
2 successful applications.
Methods
This project was conducted within a large network of
hospitals with affiliated facilities across the United States
and United Kingdom. The goal was to develop a method
for aligning leadership, clinical experts, informaticists,
and information technology experts to design, develop,
and deploy nursing informatics solutions.
The chief nurse executive (CNE) developed the
framework to harmonize the work efforts of disparate groups of clinical and informatics experts that
were necessary to design, develop, and deploy nursing
informatics solutions. The framework was based on
3 guiding principles: clear lines of responsibility and
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
543
authority, respect for each type of expertise necessary
to the project, and clear commitment to the aims of
the project.
Figure 1 depicts the structure. Clear lines of responsibility consisted of dedicated leadership for each
component of the process, starting with executive sponsorship and guidance. A steering committee of nursing executives set the vision, objectives, scope, and
guiding principles. The steering committee served as
a resource for the other teams and an arbitrator of
disputes between conflicting priorities. Teams of content experts and end-users were tasked with defining
good practice and ideal workflow to generate technology requirements. Technical experts were charged
with designing the technology solutions that could meet
requirements, support the workflow, present content
optimally, and incorporate decision support when possible. The clinical and technical teams work iteratively
to develop and test aspects of the proposed solution.
Subject matter experts provided critical input on
regulatory requirements, answering questions and
providing audit and review services. Project management resources ensured the appropriate flow of decisions
and work products among the teams in the appropriate
sequence and ensured that any issues were escalated
to the steering committee expeditiously.
Respect for different types of expertise ensured
that each of the above responsible parties was able to
operate fully within their area of expertise. Technical
experts deferred to clinicians on content and workflow.
Clinical experts deferred to informatics experts on the
best way to design input and output and the use of decision support. Regulatory experts deferred to clinical
experts on content and workflow while providing
guidance on regulatory requirements, including evaluation of the final product.
Commitment to the vision and guiding principles
established by the steering committee was a requirement for all colleagues participating in the project. A
clearly articulated set of guiding principles was used
in each work session to guide team members as they
designed, developed, and deployed the new solution.
Final success was measured on how well the solution
adhered to these guiding principles.
This framework was used to develop 2 distinct
nursing informatics solutions within a large hospital
system: Evidence-Based Clinical Documentation (EBCD)
and the Nursing Data Portal (NDP). These informatics solutions were designed to meet the operational
goals of: 1) minimizing nursing documentation into
an evidence-based story of the patient; 2) creating a
more useful and usable patient-centric record that
guides and informs the provision of safe, effective,
and efficient care by the interdisciplinary team; and
3) rendering standardized and normalized data for
the purpose of performance visibility and evaluation
of nursing care of individuals and population at both
the process and outcome levels. Through adherence
to the framework, the resulting informatics solutions
constructed to contribute to the healthcare learning
environment through the continuous generation of
knowledge and feedback to clinical practice.
Figure 1. Structure.
544
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Results
Evidence-Based Clinical Documentation
In the development of EBCD, clear lines of responsibility began with the chief nursing officer (CNO) Council (Figure 2). The CNO Council served as the steering
committee for EBCD, overseeing the progress of the
project teams. This group served as a champion of
the organization’s nursing agenda and provided guidance and input into decisions related to patient care,
including operational issues and prioritization of clinical projects. The CNO Council defined the guiding
principles for the process and product, ensured adherence to the overall vision, and acted as an arbitrator
of conflicting viewpoints.
The Content Team was led by clinical leaders and
included ad hoc committees of clinical experts organized by specialty. Each ad hoc committee focused
on the specific tasks and questions relevant to their
area of expertise. Clinical experts with current patient
care experience were able to define the data flow
needed to support the previously developed ideal
workflows,4 use evidence reviews to develop content,
and identify the desired decision support.
Development of the decision support, creation of
a style guide, and review of existing screen designs
were the responsibility of technical experts. Regulatory subject matter experts addressed questions about
regulatory compliance, billing compliance, and risk
management and performed on-site assessment for
regulatory compliance. Throughout the entire process,
the project management team managed to timeline,
maintained communication, designed implementation and education strategies, and assisted the collaboration between teams to resolve issues.
With the clear lines of responsibility defined and
respect for expertise established, the development of
EBCD progressed in alignment with the vision for this
project. The overall vision for this project was to create a patient-centric record that guides and informs
the provision of safe, effective, and efficient care by
the interdisciplinary team and produces data to valuate care of individual and population of care (Figure 3).
To achieve this vision, guiding principles were developed in regard to design and content.
The guiding principles of EBCD design were established to ensure that the final product enhanced
and supported the process of patient care documentation, such as strict adherence to the style guide for
consistency and alignment with the previously defined
ideal workflows.4 The guiding principles of EBCD
content ensured that documentation entered through
this system would be meaningful to patient care or
necessary for regulatory or billing requirements and
that the resulting documentation would support the
ethical and competent clinician.
Nursing Data Portal
In the development of the NDP, the steering committee consisted of the CNO Council with representation
from CNEs and unit directors, the 2 primary endusers for the product. Responsibility for content was
Figure 2. Evidence-based practice clinical documentation project team.
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
545
Figure 3. Flow of information for patient centric record.
designated to corporate clinical leaders and data
owners. Technical responsibility was shared between
the nursing analytics, data science, and information
technology teams. Other defined responsibilities were
assigned to subject matter expert teams, including patient experience, human resources, and financial and
executive leaders. Strong project management processes facilitated the iterative flow of decisions and
tool development (Figure 4).
The focused expertise of these teams was key to
the success of this project. The steering committee identified 4 domains of performance (clinical outcomes,
patient experience, efficiency, and nursing engagement) and provided final approval of the indicators
that would be used in the completed product. Technical experts were the backbone of all the data needs for
the final project. They created the data visualization
plan, transformed data to usable scoring methods,
harmonized time frames from disparate data sources,
and aligned the data to other reports with the same
metrics. The various subject matter experts suggested
common metrics that were to be included in the final
product. These teams also validated all data posttransformation prior to the creation of data visualizations. In essence, the subject matter experts verified
the work of the technical experts before any data were
released for viewing. Project management team members designed the implementation and education strategies for this project and also managed communication
and issue resolution among the teams to meet the project timeline goals.
With the clear lines of responsibility established
and experts assembled for the various project components, the development of the NDP progressed toward
its singular unifying vision: one common platform for
sharing nursing performance data (Figure 5). Through
the careful design of source system screens and data
pathways and requirements, nursing performance
Figure 4. Nursing data portal project team.
546
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Figure 5. Platform to share nursing performance data.
metrics from multiple systems could be concisely
displayed on 1 page for maximum accessibility. The
vision of the NDP was achieved through adherence
to the guiding principle of easily understood data
and visualizations.
Discussion
Through the creation of a systems-level framework
that clearly defined responsibility, roles, and vision,
we successfully designed and implemented 2 largescale nursing informatics solutions. These informatics
solutions were different from each other—1 clinically
focused and 1 focused on leadership—but were built
upon the same systems-level framework. In this method,
there was a clearly defined role and responsibility for
nursing executive leadership from the beginning of
the project to the end.
Multiple contemporaneous articles have demonstrated the supportive role of nursing leadership and
informatics.5,6 Specific leadership roles, such as chief
nursing informatics officers and nursing informatics
executives, have emerged as central to the support of
transformation and the use of appropriate technology
solutions in clinical practice.7,8 Outside these specific
roles, there is a need for nurse leaders, including CNEs,
to have knowledge about informatics and its role in
patient care.9 Nurse leaders should be allowed opportunities to both gain these competencies and apply
their knowledge to decision making regarding informatics system and nursing care.9-11
Our systems-level method demonstrates the role
of specific leadership in guiding the ideation, design,
development, data mapping and visualization, and
application of the products developed during the informatics and technology life cycle. Each of these
components is integral to the functionality, adoption,
and use of the final solution. Nursing executive leadership must not only develop a clear structure, timeline, and goals for the entire process but also provide
valuable insight into product development. This leadership contributed to the effectiveness of these solutions as part of the continuous feedback loop within
a learning healthcare environment. The knowledge and
understanding of clinical practice gained through these
solutions can be applied to subsequent applications
and efforts to refine and innovate within nursing care.
Furthermore, our method maximizes the expertise of those most knowledgeable about individual
components. The clarity of roles ensured that critical
input was provided by the appropriate team members. For instance, technical experts and informatics
professionals focused on the best way to design input
and output and the use of decision support while clinicians were responsible for content and workflow.
An added benefit of this method is improved adoption of the resulting solutions. Leadership engagement is
a key component of implementation processes.12-14 In
our method, leadership are engaged early and often in
the design process, ensuring that the solutions also met
the needs of leaders. Leadership engagement allowed
for local needs and workflow considerations to be incorporated into the design, improving end-user uptake.
In summary, we have developed a systems-level
method that allows nursing executive leadership to
organize, set up, and own processes related to the development nursing informatics solutions. Our organization has used this structure for several projects with
positive results. Use and adaptation of the strategies
of this method may offer a way for nursing leadership
to guide and influence future solutions.
References
1. Murphy J. Nursing informatics: the intersection of nursing, computer, and information sciences. Nurs Econ. 2010;28(3):204-207.
2. American Organization of Nurse Executives. AONE Nurse
Executive Competencies. Chicago, IL: AONE; 2015. https://
www.aonl.org/sites/default/files/aone/nurse-executivecompetencies.pdf. Accessed July 25, 2019.
3. Englebright J, Caspers B. The role of the chief nurse executive in
the big data revolution. Nurse Lead. 2016;14(4):280-284.
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
547
4. Mosier S, Englebright J. The first step toward reducing documentation: defining ideal workflows. Comput Inform Nurs.
2019;37(2):57-59.
5. Remus S. The big data revolution: opportunities for chief nurse
executives. Nurs Leadersh. 2016;28(4):18-28.
6. Liebe JD, Hüsers J, Hübner U. Investigating the roots of successful IT adoption processes—an empirical study exploring the
shared awareness-knowledge of directors of nursing and chief information officers. BMC Med Inform Decis Mak. 2016;16:10.
7. Institute of Medicine. The Future of Nursing: Leading Change,
Advancing Health. Washington, DC: The National Academies
Press; 2010.
8. Hussey PA, Kennedy MA. Instantiating informatics in nursing
practice for integrated patient centred holistic models of care:
a discussion paper. J Adv Nurs. 2016;72(5):1030-1041.
9. Simpson RL. Chief nurse executives need contemporary informatics competencies. Nurs Econ. 2013;31(6):277-287; quiz 2887.
10. Healthcare Information and Management Systems Society
(HIMSS). Transforming Nursing Practice Through Technology
and Informatics: A Position Statement. Chicago, IL: HIMSS;
2011. https://www.himss.org/position-statement-transformingnursing-through-technology-and-informatics. Accessed July 25,
2019.
11. Oakes M, Frisch N, Potter P, Borycki E. Readiness of nurse executives and leaders to advocate for health information systems
supporting nursing. Stud Health Technol Inform. 2015;208:
296-301.
12. Sandström B, Borglin G, Nilsson R, Willman A. Promoting the
implementation of evidence-based practice: a literature review
focusing on the role of nursing leadership. Worldviews Evid
Based Nurs. 2011;8(4):212-223.
13. Aarons GA, Sommerfeld DH. Leadership, innovation climate,
and attitudes toward evidence-based practice during a statewide implementation. J Am Acad Child Adolesc Psychiatry.
2012;51:423-431.
14. Gifford WA, Davies B, Edwards N, Graham ID. Leadership
strategies to influence the use of clinical practice guidelines.
Nurs Leadersh. 2006;19:72-88.
The Journal of Nursing Administration
Instructions for Authors
Instructions for Authors can be found online at the address
below. To ensure that your manuscript is in compliance
with new submission procedures, you should read this
document carefully before manuscript preparation. All
manuscripts must be submitted electronically through this
system.
Please visit http://JONA.EdMgr.com.
548
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Running Head: NURSING INFORMATICS
1
Nursing Evolution and Informatics
Name
Tutor
Course
Date
NURSING INFORMATICS
2
Nursing Evolution and Informatics
Informatics methods and tools offer seamless means for supporting interprofessional
collaborations. Critical informatics features like digital infrastructure facilitate the potential for
care professionals to capture clinical data, delivery processes, patients’ protected health
information, insurance records, and other critical information necessary for care improvement
(Alanazi, 2023). Apart from supporting the creation of new knowledge, the informatics can be
shared with various authorized parties to improve case management and treatment outcomes. For
example, nurse informaticists can facilitate the collection of patient’s clinical data in cancer
centers, which can be shared with other professionals like oncologists, dietitians, physicians, and
occupational therapists to ensure optimal treatment, rehabilitation, and lifestyle changes in the
patients. Such an approach to care through informatics can improve treatment outcomes and life
qualities in the patients.
The interactions between informaticists and other care professionals can be improved by
integrating robust and specific interactive technologies (Kolla et al., 2021). An example is a
communication management system that should be integrated with informatics. This technology
can include users’ dashboards, short message communication channels like SMS, and Electronic
Health Records (EHRs) to bring together all relevant professionals to manage a specific patient’s
case. The messages should be end-end encrypted and saved for possible future reference.
The continued evolution of nurse informatics in specialties of interprofessional
interactions is expected to streamline further and improve these interactions (Kolla et al., 2021).
For example, a study on the significance of informatics on interprofessional engagement
revealed that the evolution of informatics disciplines like Interpersonal Education in Health
Informatics (IPEHI) would result in optimal utilization of existing informatics technologies like
NURSING INFORMATICS
3
Health Information Systems (HIS) with seamless interprofessional engagements (Alanazi, 2023).
The progress would also dismantle collaboration barriers with the potential for better
interdisciplinary approaches in care delivery and overall improvements in care quality and
efficiencies (Alanazi, 2023). Interprofessional Education (IPE) is a collaborative approach to
learning that is highly adaptable to informatics. It facilitates teamwork, participative decisionmaking, and communication among professionals.
NURSING INFORMATICS
4
References
Alanazi, T. A. (2023). Interprofessional education in health informatics (IPEHI) for health
sciences programs. Advances in Medical Education and Practice, 2023(14):1177-1182.
Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10591686/#:~:text=Most%20of%20the
%20survey%20participants,delivery%2C%20and%20efficiency%20of%20healthcare
Kolla, A., Lim, S., Zanowiak, J. & Islam, N. (2021). The role of health informatics in facilitating
communication strategies for community health workers in clinical settings: A scoping
review. Journal of Public Health Management and Practice, 27(3): E107-E0118.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994181/
JONA
Volume 49, Number 11, pp 543-548
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
THE JOURNAL OF NURSING ADMINISTRATION
A Systems-Level Method for Developing
Nursing Informatics Solutions
The Role of Executive Leadership
Sammie Mosier, DHA, MA, BSN, NE-BC, CMSRN, BC
Wm. Dan Roberts, PhD, RN, ACNP
Jane Englebright, PhD, RN, CENP, FAAN
Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of
their broad understanding and oversight of nursing
care. We describe a systems-level method for creating
nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on
the guiding principles of clear lines of responsibility,
respect for expertise, and commitment to project
aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions.
Data about nursing care have become a critical component of operational and patient care decisions.
These data can potentially affect the productivity, efficiency, performance, effectiveness, cost, and value
of nursing care when properly collected and used.
The management and processing of data into knowledge for use in nursing practice have become an important specialty within the last decade.1
Nurse executives are dependent on data for effective decision making. The American Organization of
Nurse Leaders has identified essential competencies
in informatics that are necessary for effective leadership of this technology and data-informed environment.2 In the age of big data, nurse executives are
responsible for creation of the framework that allows
for nurses and other experts to apply their knowledge,
Author Affiliations: Vice President and Assistant Chief Nurse
Executive (Dr Mosier), Vice President of Care Delivery and Performance (Dr Roberts), and Senior Vice President and Chief Nurse
Executive (Dr Englebright), HCA Healthcare, Nashville Tennessee.
The authors declare no conflicts of interest.
Correspondence: Dr Englebright, HCA Healthcare, One Park
Plaza, Nashville, TN 37203 ([email protected]).
DOI: 10.1097/NNA.0000000000000815
such as through the creation of a data culture, the development of data competencies, and the establishment of data infrastructure.3
Together, nurse executives and nurse informaticists
are forging new solutions to improve nursing processes
and patient care. The challenge is in determining how
best to coordinate the efforts of subject matter experts
from nursing, informatics, and information technology to design, develop, and deploy solutions to very
complex problems. Nursing leadership is well poised
to influence these processes by virtue of their broad
understanding and oversight of nursing care. While
not usually engaged in the development of nursing informatics solutions, we propose that executive leadership is necessary to this process.
Here we discuss our development of a systems-level
method, with clearly defined structure and leadership
from nursing executives, to create nursing informatics
solutions that enhance patient care. This article will
describe the method and provide case examples of
2 successful applications.
Methods
This project was conducted within a large network of
hospitals with affiliated facilities across the United States
and United Kingdom. The goal was to develop a method
for aligning leadership, clinical experts, informaticists,
and information technology experts to design, develop,
and deploy nursing informatics solutions.
The chief nurse executive (CNE) developed the
framework to harmonize the work efforts of disparate groups of clinical and informatics experts that
were necessary to design, develop, and deploy nursing
informatics solutions. The framework was based on
3 guiding principles: clear lines of responsibility and
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
543
authority, respect for each type of expertise necessary
to the project, and clear commitment to the aims of
the project.
Figure 1 depicts the structure. Clear lines of responsibility consisted of dedicated leadership for each
component of the process, starting with executive sponsorship and guidance. A steering committee of nursing executives set the vision, objectives, scope, and
guiding principles. The steering committee served as
a resource for the other teams and an arbitrator of
disputes between conflicting priorities. Teams of content experts and end-users were tasked with defining
good practice and ideal workflow to generate technology requirements. Technical experts were charged
with designing the technology solutions that could meet
requirements, support the workflow, present content
optimally, and incorporate decision support when possible. The clinical and technical teams work iteratively
to develop and test aspects of the proposed solution.
Subject matter experts provided critical input on
regulatory requirements, answering questions and
providing audit and review services. Project management resources ensured the appropriate flow of decisions
and work products among the teams in the appropriate
sequence and ensured that any issues were escalated
to the steering committee expeditiously.
Respect for different types of expertise ensured
that each of the above responsible parties was able to
operate fully within their area of expertise. Technical
experts deferred to clinicians on content and workflow.
Clinical experts deferred to informatics experts on the
best way to design input and output and the use of decision support. Regulatory experts deferred to clinical
experts on content and workflow while providing
guidance on regulatory requirements, including evaluation of the final product.
Commitment to the vision and guiding principles
established by the steering committee was a requirement for all colleagues participating in the project. A
clearly articulated set of guiding principles was used
in each work session to guide team members as they
designed, developed, and deployed the new solution.
Final success was measured on how well the solution
adhered to these guiding principles.
This framework was used to develop 2 distinct
nursing informatics solutions within a large hospital
system: Evidence-Based Clinical Documentation (EBCD)
and the Nursing Data Portal (NDP). These informatics solutions were designed to meet the operational
goals of: 1) minimizing nursing documentation into
an evidence-based story of the patient; 2) creating a
more useful and usable patient-centric record that
guides and informs the provision of safe, effective,
and efficient care by the interdisciplinary team; and
3) rendering standardized and normalized data for
the purpose of performance visibility and evaluation
of nursing care of individuals and population at both
the process and outcome levels. Through adherence
to the framework, the resulting informatics solutions
constructed to contribute to the healthcare learning
environment through the continuous generation of
knowledge and feedback to clinical practice.
Figure 1. Structure.
544
JONA Vol. 49, No. 11 November 2019
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
Results
Evidence-Based Clinical Documentation
In the development of EBCD, clear lines of responsibility began with the chief nursing officer (CNO) Council (Figure 2). The CNO Council served as the steering
committee for EBCD, overseeing the progress of the
project teams. This group served as a champion of
the organization’s nursing agenda and provided guidance and input into decisions related to patient care,
including operational issues and prioritization of clinical projects. The CNO Council defined the guiding
principles for the process and product, ensured adherence to the overall vision, and acted as an arbitrator
of conflicting viewpoints.
The Content Team was led by clinical leaders and
included ad hoc committees of clinical experts organized by specialty. Each ad hoc committee focused
on the specific tasks and questions relevant to their
area of expertise. Clinical experts with current patient
care experience were able to define the data flow
needed to support the previously developed ideal
workflows,4 use evidence reviews to develop content,
and identify the desired decision support.
Development of the decision support, creation of
a style guide, and review of existing screen designs
were the responsibility of technical experts. Regulatory subject matter experts addressed questions about
regulatory compliance, billing compliance, and risk
management and performed on-site assessment for
regulatory compliance. Throughout the entire process,
the project management team managed to timeline,
maintained communication, designed implementation and education strategies, and assisted the collaboration between teams to resolve issues.
With the clear lines of responsibility defined and
respect for expertise established, the development of
EBCD progressed in alignment with the vision for this
project. The overall vision for this project was to create a patient-centric record that guides and informs
the provision of safe, effective, and efficient care by
the interdisciplinary team and produces data to valuate care of individual and population of care (Figure 3).
To achieve this vision, guiding principles were developed in regard to design and content.
The guiding principles of EBCD design were established to ensure that the final product enhanced
and supported the process of patient care documentation, such as strict adherence to the style guide for
consistency and alignment with the previously defined
ideal workflows.4 The guiding principles of EBCD
content ensured that documentation entered through
this system would be meaningful to patient care or
necessary for regulatory or billing requirements and
that the resulting documentation would support the
ethical and competent clinician.
Nursing Data Portal
In the development of the NDP, the steering committee consisted of the CNO Council with representation
from CNEs and unit directors, the 2 primary endusers for the product. Responsibility for
