Taking EMRs to the Next Level: Collaboration Tools for Providers

Taking EMRs to the Next Level: Collaboration Tools for Providers

Nowadays, you don’t have to go very far to look at your medical records; you can probably pull them up on your phone right now. Though the use of electronic medical records (EMRs) is pretty widespread, providers still face some major challenges, and health systems aren’t yet taking full advantage of the technology. One way this is obvious to patients and practitioners is through the absence of collaborative tools — if patients’ EMRs are so easy to access and share, why aren’t doctors collaborating with their other providers for the best possible care?

As professionals, we have to ask ourselves if it’s worth the investment. It’s clear that physician to specialist or physician to psychologist collaboration would benefit clients. Arun Gupta, the CEO of Quartet Health, argues that this is especially true in the behavioral health realm. Technology that could close communication gaps between physical and mental health — Gupta argues that, in these two areas, “a mountain of evidence to suggest that a bidirectional relationship exists” — could make care more effective and more affordable.

But how do we find smart, secure tools to link all of our patients’ providers? Adoption should be a three-step process. First, and perhaps last, we need to embrace the collaborative approach. Understanding why provider-to-provider or department-to-department communication is so useful will help justify the expense. And for doctors and specialists who take a value-focused approach, that might be particularly difficult. Next, we have to look into actual tools that have been developed for this very purpose and figure out how to integrate them into our practices.

Embracing the Collaborative Approach

Let’s take a look at some reasons why making EMRs more collaborative can benefit patients and result in improved outcomes. In a 2014 study published in the AMIA Annual Symposium Proceedings Archive, researchers compiled data from five American electronic health record (EHR) systems and observed provider interactions for 60 hours.

The study determined that the EHR itself played four roles in collaboration: as a repository, a messenger, an orchestrator, and a monitor, but that due to poor quality documentation, there was decreased trust among patients. The study concluded that “both organizational and technical innovations are needed if the EHR is to truly support collaborative behaviors.” So, indeed, there’s no denying the need for a collaboration-focused EMR. But what about this bidirectional business?

As Gupta points out in his essay, the most glaring missed opportunity for collaborative health care comes in the gap between physical and behavioral health providers. Gupta cited a recent study showing that people with asthma are almost two and a half times more likely to screen positive for depression, and that those with type 1 or type 2 diabetes are more likely to suffer from depressive disorders.

But collaboration can be good for addressing the logistics and disconnection within health care, too. You may know that the Department of Defense instituted the Bidirectional Health Information Exchange (BHIE) in an effort to close the communication gap between the DoD and the Department of Veterans Affairs, primarily to study pre- and post-deployment physical and mental health.

The Louisiana Public Health Information Exchange (LaPHIE) is a similar program that links providers between emergency rooms, primary care departments, inpatient units, and specialty ambulatory clinics to help address a broken HIV/AIDS care continuum in that area. A 2017 study showed that in the first two years of the program, LaPHIE saw an incredible improvement in the HIV care continuum.

Upgrading to Smart Medical Devices for Every Visit

We all know that high-tech medical equipment is a necessity of contemporary care, but we often don’t consider how much even the smallest, most commonly used devices can contribute to a better patient experience and a more collaborative approach. Streamlining data, and making it effortless to record and share, is the most important way to create secure, collaboration-ready EMRs.

Take, for example, the humble stethoscope. Once limited only to whoever was in the room, audio recorded from a digital stethoscope can now be effortlessly recorded and transmitted via Bluetooth to a smartphone or tablet. Gone are the days of describing the audio with the written word. If you’re a primary care doctor who needs to share your patient’s results with a specialist or surgeon, all it takes is a simple tap of the touchscreen.

For patients where monitoring vital signs over a long period of time is key, recording data sets through a digital patient monitor that measures ECG, heart rate, blood pressure, blood oxygen, breaths per minute and temperature, can help tie large data sets up in a nice, little bow. They now make smart attachments for stethoscopes and other medical devices that turn them into connected, collaboration-ready tools, so you can still use your preferred model.

Weaving in Software and Apps

The last piece of the puzzle is the hardest one, especially for large medical systems. Implementing new software is a challenge for any business, whether it be a family medical practice or a massive hospital system. But finding the right collaborative EMR software is an important step in implementing this methodology. It’s arguably the most important one, because it, as the previously mentioned study suggests, acts as a repository, a messenger, an orchestrator, and a monitor.

But finding software that fits the bill isn’t all that much of a challenge; Even Google has its own tools for health care providers. Theirs is unique in that it emphasizes the collaboration factor by allowing health care systems to easily and securely share X-rays, CT scans, and voice and video files through Google Cloud. Of course, if you haven’t yet migrated your EMRs to the cloud, it’s an important step to ensuring that records don’t get lost.

But what about HIPAA? Naturally, this is an issue that has held the industry back from certain technologies for decades — it’s why you still see so many pagers in health care facilities! But HIPAA shouldn’t be a roadblock. Make sure that you’re partnering only with HIPAA-compliant software providers and medical tools (those providers willing to assume liability for any HIPAA violations for failures on their behalf), using secure messaging and file sharing apps, and taking all the necessary consent steps before sharing any of your patient’s data.

Why Specialize in Oncology? Advice for Nursing Students

Why Specialize in Oncology? Advice for Nursing Students

Oncology is a challenging but rewarding nursing specialty. With May being designated as Oncology Nursing Month, it’s a good time for nursing students to learn more about becoming an oncology nurse and connect with oncologists who have made the great big specialty leap.

Is Being an Oncology Nurse Right for You?

All nurses should be compassionate, precise, and resilient. That said, oncology is a particularly challenging subset of nursing due to the nature of the disease. As an oncology nurse, your days may include monitoring a patient’s physical condition, handling medication, and administering chemotherapy and other treatments.

Alene Nitzky, a certified oncology nurse and author of Navigating the C: A Nurse Charts The Course for Cancer Survivorship Care, emphasizes that the work can be very demanding. “Make sure you are really driven to do this work and that you have a true passion because it is extremely physically, mentally, and emotionally demanding,” she says.

Since oncology can be so emotionally exhausting, it’s important to practice good self-care. Stepping back and focusing on rest and rejuvenation will help you return to the job with even more sensitivity, empathy, and emotional resilience. Nurses of all sorts need to be able to dig deep emotionally, physically, and mentally to persevere through tough shifts.

A small mistake in medication dosage or timing can have devastating effects for an oncology patient, so attention to detail is important. Good oncology nurses will notice even small changes in their patients’ charts and are the first line of defense if something is amiss.

Diving into the world of oncology nursing also means that you’ll have to be comfortable with end-of-life issues, including grief and loss. Oncology nurses have to hone the psychosocial side of their role in addition to the highly technical aspects of monitoring their patients. Knowing when to listen to patients and their families versus offering consolation or advice is a key challenge for oncology nurses.

Keep in mind that pediatric oncology comes with the additional emotional challenge of helping young children and their families. A keen ability to navigate emotionally-charged groups is a must.

If you think that you have the emotional resilience, technical precision, and compassion to pursue oncology nursing, this field is incredibly rewarding.

Words of Wisdom from Oncology Nurses

If you’re thinking of pursuing a specialization in oncology nursing, you’ll want to explore the various types of positions available.

As an oncology nurse, you may find work in a variety of settings. You can get outside the hospital to work in a nursing home or health care center. This is ideal for nurses who may enjoy getting out to work in the community.

Oncology nurses can also work in the private sector or be nurse entrepreneurs to expand their horizons beyond the traditional health care setting. Nitzky adds, “Nursing students should seek opportunities to talk with oncology nurses who have left traditional health care and work in the community or public health settings, because they will give you a much more well-rounded look at the value you bring to your patients and clients.”

It’s always smart to reach out to a variety of experienced individuals in your chosen field. Track down several oncology nurses who work in traditional health care, in the community, and in public health settings. This will give you a better idea of the field you’re pursuing.

You’ll do a far better job of helping patients if you’re comfortable. Take care of yourself with good compression socks and comfortable nursing shoes.

The same goes for your mental health. Compassion fatigue or emotional burnout is a real challenge for many health care professionals. Since oncology nurses often work with very sick patients, they need to take extra care to not take work home. It’s easy to constantly think about that particularly charming patient or worry about parents who are on shaky emotional ground.

Just remember that you can’t do your best work if you’re emotionally and physically exhausted. Find ways to disengage from your patients and their families when you’re away from work and ensure that you have healthy self-care routines of diet, exercise, and rest.

The Joys and Challenges of Oncology Nursing

The oncology nurses we spoke to all named the patients as their favorite part of the job. Even when a patient’s cancer is quite advanced or a prognosis is poor, oncology nurses love making a difference in quality of life. Every day that you work with a cancer patient is another opportunity to make their lives better, which makes the job worthwhile.

When asked about the hardest part of being an oncology nurse, Nitzky said, “The most challenging part of the job is not what you’d think. It is difficult to lose patients after you’ve gotten to know them and bonded with them and their families, but the most challenging thing about the work is that you don’t have enough time to do all the things you know would make much more of a difference because you have too many administrative demands on you coming from your employer. Nursing is more about computer screens and documentation than it is about patient care, unfortunately.”

How to Become an Oncology Nurse

Becoming an oncology nurse requires extra schooling after nursing school, like any specialty. After getting an RN license, a prospective oncology nurse will need to meet specific eligibility criteria and pass an exam. The exact parameters vary state by state, but advanced certifications generally require a master’s degree or higher in nursing as well as hundreds of hours of supervised clinical practice.

The Oncology Nursing Certification Corporation offers a variety of certification options that you can pursue to stand out in a hiring pool and to further your knowledge of cancer care. Most certifications last for four years before they must be renewed with a recertification test or continuing education credits. To qualify, you have to spend at least one year working as an RN, work 1,000 hours in an oncology setting, and pass an exam. You can rotate into oncology units in many hospitals without extra certifications, but the knowledge gained with continuing education is worth its weight in gold to help patients further.

Checklist of Traits of a Great Oncology Nurse
  • Compassionate
  • Precise
  • Detail-oriented
  • Emotionally resilient
  • Passionate
  • Adept at reading social situations
  • Good at discerning when to listen and support
  • Competent at self-care skills
  • Comfortable with end-of-life issues, grief, and loss
Pediatric Nurse Practitioner: 8 Reasons to Consider this Career

Pediatric Nurse Practitioner: 8 Reasons to Consider this Career

If you want many of the same benefits and responsibilities of doctors without losing the things you love the most about nursing, then you’ll definitely want to consider becoming a pediatric nurse practitioner. These pediatric pros are unlike registered nurses because they have an advanced degree — typically a Master of Science in Nursing (MSN) — and are able to prescribe medication, diagnose illness, and mentor patients and their parents. Because of this, NPs are stepping up as primary care providers in many corners of the globe, providing a solution to the primary care shortage and bringing quality care at a fraction of the cost.

1. Obviously…. The Kids!

According to the American Association of Nurse Practitioners (AANP), only about 5% of NPs specialize in pediatric acute and primary care, while 60% specialize in family practice. That’s a pretty small number when you consider all the great benefits of working with kids. It also means that there’s a demand for NPs who specialize in pediatric care. But the best part about being a pediatric NP is that you get to make a difference in the lives of kids and their families. Oh yeah, and you get to wear fun scrubs!

In a patient satisfaction survey, nurse practitioners outscored physicians, suggesting that patients are happier with care administered by NPs. ­– Source

2. You’ll Be a Master

If higher education is your goal, then the NP route is for you! Nurse practitioners in any setting, whether they work in women’s health, mental health, or pediatric environments, must obtain an MSN, but pediatric nurse practitioners must also be certified by the Pediatric Nursing Certification Board. So not only will you have an advanced degree, you’ll have a specialized certification that will earn you respect in any health care setting. These credentials also earn you the privilege to prescribe medications, diagnose patients, and perform evaluations that are vital to pediatric care.

Nurse practitioner is ranked as one of the top 20 best-paying jobs for women, with a median yearly wage of $80,000 and a mean yearly wage of over $100,000. – Source

3. Money, Money, Money

Naturally, with a higher level of education and specialization comes a higher pay. According to the AANP, the mean salary for a full-time nurse practitioner in 2017 was $105,546. These competitive wages mean that the return on investment (advanced education) is pretty high compared with other medical professions. Because there is a shortage in primary care in the United States, many hospitals and medical systems will pay for full-time employees to become nurse practitioners.

4. It Keeps You on Your Toes 

The average nurse practitioner sees three or more patients an hour, so if you get bored easily, this field is for you. Just make sure you invest in some super-comfortable nursing clogs, because there’s a good chance you’ll be running around almost all day. Pediatric nurse practitioners are constantly seeking additional training and certifications since the field is ever-changing. There are also a wide range of environments where you can work and several different ways to advance in the field, so it never becomes stagnant.

According to U.S. News and World Report’s Best Job Rankings, nurse practitioners ranked number two for top health care jobs in 2017, just behind pharmacists. – Source

5. You Could Be Your Own Boss

As far as nursing careers go, nurse practitioners as a whole arguably have the most autonomy. But how much autonomy you have really depends on which direction you take your career — and there are many! Pediatric nurse practitioners are able to start their own private practices in some states. Currently, 22 states allow full practice authority, meaning NPs are able to practice without the supervision of a physician. The medical community is pushing for more autonomy for nurse practitioners throughout the U.S. to help address care shortages.

6. The Benefits Are Great

In addition to higher wages, nurse practitioners get some great additional benefits compared with registered nurses. If you choose to start your own pediatric practice, work as a school nurse practitioner, or work under a physician in a pediatric doctor’s office, then you’ll be able to take advantage of a regular 9 to 5 schedule. Of course, if you decide to start your own practice, you’ll have to pay out benefits to yourself and your employees.

The total tuition costs required to prepare a primary care nurse practitioner are less than the cost of one year of medical school. ­– Source

7. There’s a Great Demand

Did we mention the shortage of primary care in the United States? The AANP reports that the demand for pediatric nurse practitioners is constantly rising and that the role could help address a forthcoming physician shortage. The Bureau of Labor Statistics reports that the professional will grow much faster than others, with an expected growth of 19% by 2020. Like any career in the medical realm, nurse practitioners are needed more in some areas than others. California, Texas, New York, Florida, and Pennsylvania have the greatest demand and hire the most nurses.

8. Job Security? Guaranteed

Of course, any profession that has a high demand will likely have a higher job security. That’s definitely the case for pediatric nurse practitioners. The most secure jobs in the current employment market are those that can’t be automated. Nurses as a whole are some of the most robot-proof jobs; As of right now, no robot or automated system would be smart enough, safe enough, or thorough enough to do the work that human caretakers do. So, for now, taking this career route is a totally safe bet.

How Medical and Nursing Schools are Teaching Bedside Manner Today

How Medical and Nursing Schools are Teaching Bedside Manner Today

Bedside manner is a broad phrase used to describe a health care professional’s attitude towards a patient. At its core, it describes the doctor- or nurse-patient relationship, but the right approach to care goes much deeper than that. According to the David Geffen School of Medicine at UCLA, bedside manner is one of the most crucial parts of a patient’s recovery, as it helps build trust in the patient and leads to better care after the patient has left the hospital. In other words, universities are now emphasizing good bedside manner right alongside teaching CPR and how to use stethoscopes.

They’re Making Empathy a Priority

Today’s medical and nursing students are taught to put themselves in the patient’s shoes. As easy as it is for a health care professional to write off a patient’s concerns as routine, caretakers must remember that for many people, being in the hospital is one of the most stressful times of their lives. Why? Because being empathetic and courteous helps gain a patient’s trust and boosts their confidence, which can equal greater levels of success after discharge.

Med schools throughout the country have struggled with finding unique ways to help students understand the importance of empathetic medical care. But some have found success. At Virginia Commonwealth University, faculty members developed a unique program to help students delve into their ability to empathize: a collaboration between the school’s theater department and medical school. Internal Medicine students get a theater-based approach to learning empathy.

According to the pioneers of the program, the approach helps counter-balance the science-focused curriculum on medical school.

“Essentially, medical schools have crammed so much into four years of study that science has squeezed out the humanistic aspects of medicine. In theatre, we teach how to be authentically present in inauthentic moments. We thought we would see if we could take some of those skills and teach them to physicians,” said the vice chair of the school’s theater department, Aaron Anderson.

They’re Emphasizing Communication Skills

Communication is key to helping build a solid doctor-patient relationship. But you don’t only communicate with patients by the words you choose. You also communicate through what you wear. For example, you might choose to wear cute scrubs and accessories to convey a bright, cheerful disposition. The David Geffen School of Medicine recommends the following tips for good communication with patients:

  • Use words that patients can understand, not medical jargon.
  • Make eye contact with a patient while talking to them.
  • Eliminate body language that demonstrates haste or dishonesty.
  • Always introduce yourself every time you enter the room.

Good communication skills are achieved not only through what you do at the bedside, but also what you don’t do. A paper published by the University of Rochester Medical Center (URMC) links multitasking with poor bedside manner, suggesting that older medical professionals were taught to separate technical expertise from compassion. The paper highlights the significance of separating these two equally important care components in order to enhance bedside manner.

They’re Giving Students Real-Life Experience

There’s a reason why a big part of medical training is the residency or clinical hours. Health care professionals simply won’t understand the value of good bedside manner until they’re exposed to fieldwork, but many medical students don’t see a single patient until their third year. Real-life experience doesn’t have to come from traditional channels like residencies and internships. Some health care professors are working bedside manner training into students’ curriculum through volunteering and mentorship.

Second-year medical students at Florida International University in Miami are encouraged to go out into the community and help local families in order to help them interact with real patients sooner. Bedside manner curriculum is now starting to focus more and more on other channels to introduce students to real-life scenarios earlier. For example, students at URMC are trained in “mindfulness” — the center’s answer to the multitasking debate — through good mentoring.

They’re Teaching Continued Learning

So how do medical professionals address the issue of those well-established nurses and physicians who didn’t get their degree at a time when bedside manner was so strongly emphasized? It all comes down to continued learning. Like they do with medical advancements, clinicians must stay abreast of new approaches to bedside manner. Re-training established physicians to be more empathetic, caring and kind is possible, according to a study conducted by the Emory University School of Medicine in Atlanta.

The study sought to determine whether medical professionals who have been working in the field for years could be re-inspired to be more humanistic. In other words, it wanted to figure out whether you could teach old dogs new tricks, or re-teach them the ones they forgot. The results were promising: after 18 months of twice-monthly meetings on compassion, empathy, and other bedside manner skills, all the established physicians outscored their controls.

They’re Teaching Humor

Patch Adams may have been onto something. They say that humor is the best medicine, but is that actually true? When it comes to improving the patient-caretaker relationship, absolutely. Medical schools across the globe are gravitating towards new humor-focused approaches to bedside manner.

Students at Northwestern University’s Feinberg School of Medicine are taught ways to implement humor into their practice by taking improvisation theater classes to help them learn how to convey humor in a way that’s appropriate at the bedside.

They’re Using Technology and ‘Webside Manner’

When we think of bedside manner, we often think of a more holistic and polite approach — face-to-face time, minimal medical jargon, empathetic conversation, and no smartphones — but there are some situations where bedside manner can be improved through technology. For example, students may be encouraged to enter an interaction with a patient armed with a tablet that allows them to record or notate conversations, which will help them produce more humanistic, personalized care on the next visit.

And as most medical and nursing students know, more and more health care providers are offering “virtual visits,” where patients can message or video chat with their clinician so they don’t have to come into the office. These new technologies have sparked a whole new debate on bedside manner, dubbed “webside manner” in these scenarios. Can you practice good bedside manners over an app? Yes, according to the experts, and it should be covered alongside traditional bedside manner techniques in medical and nursing schools.

5 Things No One Ever Tells You About Nursing School

5 Things No One Ever Tells You About Nursing School

Thinking about going to nursing school? You’re headed for a great career, one that’s rewarding, challenging, and always exciting. But nursing school is notoriously difficult. Most nursing programs require high GPAs and impressive scores in math, chemistry, biology, psychology, and other demanding subjects. It’s also extremely fulfilling. These are things most people already know about nursing school, but what about the things no one ever tells you? Here are a few of those things.

1. You Will Pull All-Nighters

Nursing school isn’t for the faint of heart. In fact, it can be extremely challenging. Just take a look at the curriculum for the Johns Hopkins School of Nursing—a school that, by the way, is consistently ranked in the top three nursing schools in America. Master of Science in Nursing (MSN) candidates at Johns Hopkins must complete nearly 50 credits and 500 clinical hours to finish their master’s program.

Bachelor’s candidates take longer to graduate than ever before, with most nurses spending more than four years earning their undergraduate degree. Because nursing programs tend to be more demanding in terms of credits, many students are forced to fast-track their degrees by taking multiple hard classes at once. If you’re in nursing school, that means several of the most stressful mid-terms and finals at the same time.

Because of these factors, all-nighters are inevitable. But nursing students know better than everyone else that staying up all night to cram isn’t good for your health. Getting a good night’s sleep before a big exam will help you retain memory and stay focused. Make sure that when you go into nursing school, you don’t bite off more than you can chew. Try to alternate those tough classes so you don’t have competing exams.

2. You Will Experience Burnout

Nursing school burnout is real. But don’t take it from us. There have been numerous studies indicating that nurses-in-training feel burnout at a higher level than students seeking other career paths. One study found that nursing students in the U.K. felt increasing levels of stress and used negative coping methods as their programs progressed.

The same study found that as nursing programs got harder, students experienced physiological morbidity, meaning they developed health issues as a result of their stress. But don’t let the prospect of burnout deter you from pursuing a nursing degree. Researchers are working to develop new programs that deter fatigue and burnout.

With the risk of burnout and fatigue higher for nurses, how do they stay positive? It all comes down to focusing on the end goal. Nurses enjoy myriad benefits compared with other career paths, including greater job stability, stronger personal satisfaction, the ability for career mobility, and the potential for higher salaries.

3. You’ll Have to Spend Money Out of Pocket

With the average cost of a bachelor of nursing science (BSN) degree quickly creeping up well into six figures (the average cost of a BSN is somewhere between $40,000 and $200,000), it’s important to remember that nursing students also have to spend more out of pocket than many other students seeking a bachelor’s degree. In addition to the cost of tuition and housing, nursing students incur additional costs associated with licensure exams, text books, and medical supplies.

When you prepare for your clinicals, internship, or lab courses, you may also be required to invest in nursing scrubs or uniforms. This isn’t such a bad thing, though. Think of your scrubs, stethoscopes, and everyday equipment as an investment in your future. And when you look the part, you’re more likely to succeed. Make sure that you invest in high-quality medical uniforms and durable shoes (we recommend Dansko) so that your wardrobe will stay with you until you’ve graduated and passed your licensure exam.

4. You Will Become Cynical

Here’s the thing: nursing and nursing school are stressful, and part of that feels out of your control. When you’re doing your internship or certification hours, you’ll be faced with a wide range of scenarios that feel utterly impossible: a patient with an illness that has no clear treatment track, the notoriously difficult bureaucracy of hospital administration, the inequalities of health care. All these things can contribute to cynicism over time.

Another phenomenon among nursing students and professionals is the experience of becoming desensitized to people’s trauma and suffering. Ask any child of a nurse and they’ll tell you that their parent rarely panicked over a bloody injury or a particularly gross illness. That’s because the more you’re exposed to medical conditions, the more normalized they become. Over time, it may feel like nothing shocks you anymore.

Studies show that this phenomenon occurs because nursing students are forced to “compartmentalize” their emotions. In other words, they separate the natural human reaction to a person bleeding from their immediate need to provide life-saving care. Newer nursing pedagogies put a serious focus on empathy to help deter nursing students and professionals from becoming desensitized on the job.

5. You Will Make Friends for Life

Nursing school is a unique environment. There will be few times in your life when you’ll engage so closely with people of the same career path, especially in scenarios where you’re forced to work together and lean on each other so often. Making friends in nursing school isn’t inevitable for everyone, but it can certainly benefit those who prioritize friendships. Close friends will help you succeed when you study together, network together, and confide in each other.

But there’s a flip side to this, too. In any social situation, there’s likelihood for drama and disagreements. Small, insular nursing programs may require you to live, work, and study with your classmates, which can lead to an environment that encourages cliques and bullying. Going into nursing school with a friendly, positive, and focused attitude can help ensure that you stay on the outside of any distracting confrontations. It’ll also help you make friends that you’ll keep for a lifetime.

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