Infoway's EHR User Engagement Strategy
Canada Health Infoway (Infoway) was launched in 2001 following an agreement by Canada's First Ministers to strengthen a Canada-wide health infostructure that would include the development and benefits of electronic healthcare solutions. With a goal to have an electronic health record (EHR) for 50% of all Canadians by population by 2010, Infoway is investing in some key areas of health information management (i.e., drug information, telehealth, laboratory and diagnostic imaging systems).
Investments in systems to support the management of health information has necessitated a parallel investment in strategies to ensure that health professionals embrace these tools. The need to address the engagement of nurses, physicians and pharmacists in the use of EHR tools led to the creation of a Clinician Advisory team within Infoway. The mandate of this team is to liaise and work with relevant stakeholder communities to advance Infoway's mission. More specifically, the team's work is directed to
- building bridges with professional organizations towards accelerated use of electronic health records;
- identifying existing and emerging barriers and issues;
- developing strategies and tactics to address barriers and issues;
- providing advice and input to Infoway management on health provider acceptance and use of electronic health records.
Following the completion of several focus groups across Canada in 2003, a number of actual and potential barriers to clinicians' adoption of EHRs were identified. The focus groups included representative groups of nursing, physician and pharmacy stakeholders. The primary goal of these sessions was to identify the key issues of concern about EHRs among clinicians. Overall, there was consistency within and among the professional groups as many common issues were articulated. Those most germane to the engagement of the nursing community included the following:
- insufficient engagement of nurses in EHR initiatives;
- usability issues - solutions not sufficiently meeting users' needs or expectations;
- limited integration of EHR concepts into nursing education programs;
- privacy and data stewardship issues;
- competing priorities for limited funds; and
- need to increase nurses' understanding of the value of EHRs.
Consequently, in the interest of advancing the adoption of information technology solutions by nurses, physicians and pharmacists, Infoway developed a multifaceted end-user strategy. Specific application of the strategies to the nursing profession includes efforts to
- increase the engagement of nurses in EHR initiatives;
- address the educational needs of future graduates and nurses in practice;
- demonstrate the value of EHR solutions; and
- connect nurses and other health professionals who are involved in EHR initiatives.
Recognizing the need to engage nurses in all areas of practice, one of the initial strategies included the establishment of a National Nursing Advisory Group. Meeting on a biannual basis, this group is made up of individuals representing a number of key nursing organizations in the country (i.e., Academy of Canadian Executive Nurses; Canadian Association of Schools of Nursing; Office of Nursing Policy, Health Canada; Canadian Nurses Association; Canadian Nursing Informatics Association; and the Canadian Federation of Nurses' Unions). The mandate of this group is to provide advice to Infoway and identify ongoing opportunities to connect with the nursing community. In my role as Senior Nursing Advisor, I have spent the past year travelling across Canada meeting with and presenting to a variety of jurisdictional nursing stakeholder groups. The goal of these sessions has been to raise awareness of Infoway's EHR mandate and to continue the dialogue about end-user strategy development.
A key end-user strategy that Infoway is currently unfolding is the development of pan-Canadian and regional peer-to-peer networks. These networks will be virtual and will include nurse, physician and pharmacist participants. Since one of Infoway's primary goals is to leverage jurisdictional successes, a goal of the peer-to-peer networks will be to provide a forum for exchanging lessons learned, success stories and best practices. Using an online communication vehicle, nurses will be able to connect with other nurses within their jurisdictions and beyond. These virtual communities will also have access to a repository of toolkits to support work efforts related to EHR implementation. Such tools might include (a) information to support the communication of the core elements and value of an EHR to prospective users, (b) education and training strategies, (c) methods to redesign workflow with the integration of EHR applications and (d) demonstrations of benefits evaluation. In sum, the peer-to-peer networks will expand and evolve over time and be evaluated for utility from intra- and interprofessional perspectives.
Of equal importance to educating clinicians in practice about the use of EHRs is the need to begin to embed EHR concepts into the basic education programs of the health professions. To this end, Infoway has formed a Learning-Academic Advisory panel. The mandate of this group is to advise Infoway as to what is needed to support the integration of EHR content into health professions' core curricula and to address the training needs of clinicians in practice. In this work, there is an assumption that many of the core competencies related to the use of EHRs will be consistent across the health professions. Educational tools and strategies to support the provision of core EHR competencies and understanding are currently being examined for use with nurses and other health professionals.
In general, the Infoway strategies to engage nurses and other health professionals are focused on (a) raising awareness within stakeholder communities, (b) education about the value and use of EHRs and (c) connecting individuals within and across jurisdictions to leverage collective learnings.
As you reflect upon your own community of practice, education or research, consider its needs and the opportunities available to play a role in this very important work. The relevance of EHRs to all health professionals is emerging, and the engagement of nurses is essential to the successful and appropriate integration of these 21st-century tools.
About the Author(s)
Lynn M. Nagle, RN, PhD
Senior Nursing Advisor
Canada Health Infoway
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