Nurses stand to gain a lot from health digitisation, if trained the right way
By Jen Bichel-Findlay FACN
After having worked in the health care sector for nearly 45 years, I can honestly say that the best time for nurses is now – as health finally becomes digitised. Digital initiatives in health have the potential to affect every aspect of care delivery, delivering significant results in assisting patients to make smarter choices, improving the utilisation of time and resources, assisting in the coordination of services across the care continuum, enhancing real-time communication, supporting continuous patient monitoring, expanding access to evidence-based resources, and increasing the time available for patient interaction at the point of care.
Early indications also point to the potential to improve safety in some areas of care delivery such as medication and documentation errors, if nurses are equipped with smartphones, tablets and mobile devices that have remote access to electronic patient records.
Challenges of digitising health
Unlike other industries, the customer (patient) journey in health is continuing, rather than a discrete purchase or experience, and can also literally result in life or death.
Another issue facing health is the changing expectation of patients, with people who want immediate access to clinicians and results and are also reasonably intolerant of traditional processes and paperwork. The growing number of people living with co-morbidities, non-communicable diseases, and complex care pathways means that providing a person-centred approach that is both tailored to the patient and clinician needs is difficult.
Finally, the focus on value-based care delivery within an environment experiencing nursing workforce retention challenges, generational shift, and limited administrative support and resources requires major transformational change.
To ensure that the nursing profession receives the maximum potential of these technologies, nurses need to be digitally proficient, data-enabled, and innovation aware.
Digital proficiency, according to Lepofsky (2014), comprises two vectors – skill level and comfort level with technology.
A further challenge in creating a digitally proficient nursing workforce is that we currently have a mixture of digital immigrants and digital natives. Digital immigrants were born before the advent of digital technology (before 1980s), whereas digital natives were born after the 1980s and grew up using technology from childhood (Cut, 2017). Digital immigrants need to be reminded that they cannot break the systems, and that nurses need to be at the table when decisions are being made about digital options. Digital natives, meanwhile, need to understand that health is not entirely digitised, and that paper and faxes are still in use. It will be interesting to look forward a decade or two, when all employees will be digital natives.
Becoming digitally proficient also means that nurses need to appreciate that digital formats make it easier to process, transmit, store and display data. Unfortunately, digitisation is often mistaken for automation – it is not just about improving what is already being offered but creating and delivering new value to the recipients of care. Replacing a clipboard or notepad with a tablet is not digitisation, however, extending that tablet to connect to the Internet of Things, so that it monitors and records data directly into an electronic medical record, is digitisation.
This assists nurses to work better and faster, focusing attention on patients instead of administrative tasks – avoiding paperwork and systems data entry. It is vital, however, that nurses are given time to learn how they can benefit from a different approach – doing things differently – rather than deploying the technologies and expecting staff to learn as they perform the activities.
Nurses also need to be data enabled, or in other words, be able to appreciate the criticality of data quality. Collecting dirty or incomplete data is a complete waste of time and often results in more time being devoted to cleaning the data, rather than quality data producing reliable results. There are multiple touchpoints and sources of data in health care, and nurses need to see its inherent value and how relying on data is much more precise than relying on anecdotal reasoning.
Data gathered from traditional sources can now be combined with data from new sources (structured and unstructured data) to help manage complex care projects. Data, once analysed, can reveal so much. Aggregated data, in particular, which provides us with more information about population health, can enhance preventive care, improve clinical decision making, and can result in collaborative reporting.
Nurses need to be exposed to a variety of data tools that allows them to concentrate on specific cohorts of care recipients – such as those frequently readmitted to acute care facilities. Knowing certain attributes about these people can lead nurses to intervene early, thereby negating the need for hospital readmission. Not only does this benefit the recipient of care, but also the health care organisation in reducing costs and bed demand.
Lastly, it is imperative that health creates an innovation culture, achievable by automating business processes, enhancing collaboration and decision making, and having real-time insights. Innovation can be categorised as non-disruptive (evolutionary, incremental, linear) or disruptive (radical revolutionary, transformational) in relation to its impact on stakeholders (Haughom, 2017). The current difficulties facing health care and the wave of impending technologies generally lead us to perceive innovation as being disruptive, and it is hoped that this disruption will improve preventative and personalised care.
Innovation aware nurses can identify patient data important to their nursing practice and tap into that data to improve processes. By fostering innovation in nursing, organisations can constantly develop new services and new capabilities. Nurses often lack confidence in their ability to innovate, yet they are in a perfect position to understand the blockages and inefficiencies in care delivery.
Management must support innovative nurses and link them with technologists to develop smartphone applications, medical devices and other digital initiatives that will not only benefit patients, but also the nursing workforce and the organisation. The Australian College of Nursing (ACN) in collaboration with the Health Informatics Society Australia (HISA) and Nursing Informatics Australia (NIA) have developed a Nursing Informatics Position Statement to give nurses in all settings the priorities to have the confidence to lead in their workplace. Having a clear and consistent set of nursing informatics guiding principles, nurse leaders can display these consistently in their behaviour and colleagues come to value what is important to them and why.
One must also remember that technology can never substitute the emotional intelligence of humans. Moreover, digitisation is nonlinear, with most health care organisations advancing several projects simultaneously. It is anticipated that digital disruption will be good for health, however, living in the disruption can be challenging. Nurses must not lose sight of their important contribution in this area and must ensure that they contribute to decisions about digitisation at the local, state, national and international level.
Australian College of Nursing, Health Informatics Society Australia & Nursing Informatics Australia. (2017) Nursing Informatics Position Statement. https://acn.edu.au/wpcontent/uploads/2018/02/nursing_informatics_position_ statement_28092017_-_hisa_acn_nia2.pdf
Cut, M. (2017) Digital Natives and Digital Immigrants – How Are They Different? Digital Reflections, Nov 15.
Deming, W. (1994) The New Economics: for Industry, Government, Education (2nd ed.). Massachusetts Institute of Technology, Cambridge, Massachusetts.
Haughom, J. (2017) Innovation in Healthcare: Why It’s Needed and Where It’s Going. Health Catalyst.
Lepofsky, A. (2014) Digital Proficiency – What are the Implications of 5 Generations of Digital Workers Not by Age? Constellation Research, San Francisco, California.