Selection and Implementation of a Simulated Electronic Medical Record (EMR) in a Nursing Skills Lab David G. Curry, PhD, APRN Associate Professor of Nursing SUNY Plattsburgh May 26, 2010

Why an EMR in the skills lab? IOM’s “To Err is Human: building a safer health system” (2000) showed need for better systems to prevent errors Better systems include EMRs Robert Wood Johnson Foundation, through QSEN project (2007) and NLN Board of Governor’s Position Statement (2008) both recommend integration of informatics in nursing curricula Students don’t get much informatics experience in their clinical rotations… Why an EMR in the skills lab?

Nursing students generally don’t get practice with admission assessments or order entry, for example. Since simulation is becoming an integral part of student clinical experience, a simulated EMR gives students the opportunity to practice these activities in the safety of the skills lab So how to find the simulated EMR that fits your needs? We initially thought we could simply access the test database of our local hospital’s EMR. Can’t do that for many reasons. Closing the loop

The Plattsburgh experience We used “evolving scenarios” in skills lab and wished to add e-documentation We had acquired Laerdal’s SimMan, had integrated him in our med-surg courses and wished to add e-documentation with SimMan simulations as well Research for a solution began in Summer, 2008 The solution included an application for a campus technology grant of $25,000 Evolving scenarios develop around a set group of “patients” that can be used from Nursing Fundamentals through med/surg as the students learn and mature. The Plattsburgh experience

What systems to choose from? Three systems were considered: Elsevier’s Simulation Learning System (SLS) Cerner’s Academic Education Solution (AES) Nursing Data System’s NurseSquared (N2) Criteria for evaluation: Functionality Flexibility Price We wanted bedside charting for entire skills lab PLUS integration with SimMan PLUS documentation of hospital clinicals Why only 3? Those were the ones we could find… Elsevier’s SLS was brand new: Cerner was basically only at U of Kansas, and N2 was a start-up as well…. What systems to choose from?

Evaluation of the criteria Functionality – all the systems had fairly comparable functions and features Flexibility – only NurseSquared allowed scenario creation. N2 also supported documentation of hospital clinicals We wanted to integrate with SimMan, so writing our scenarios was highly desirable Price – SLS was least expensive, then N2, with AES most expensive NurseSquared was chosen We did NOT get done for $25,000 - - for 3 years it totaled $32,000 Evaluation of the criteria

Acquisition and Planning Summer, 2009 – N2 folks made site visit to provide orientation to faculty Plans were made to include N2 in Nursing Fundamentals and Med/Surg in Fall, 2009 Used for clinical documentation During late Fall, plans for using N2 in Spring Med/Surg SimMan lab began Students would do order entry in advance, as well as real-time documentation of vital signs, medications and assessment during scenarios Acquisition and Planning

Implementation Fall semester began slowly Challenge of getting all affected students and faculty online with personal computers Most challenges were easily overcome with experience Spring semester was bigger challenge with some adjunct faculty affected Again, with experience things got smoother We are now evaluating our first-year experience… I believe students must wear uniforms to SimMan clinicals – others don’t… some think students should walk into skills lab ‘cold’ and manage the scenario without preparation – I disagree. Implementation

This is a work-in-progress with challenges and successes one might expect when combining two technologies – SimMan and N2 – and moving an entire curriculum toward more informatic content Please stay for my colleagues’ presentation that follows mine Tami Pobocik and JoAnn Gleeson-Kreig have focused on students’ perceptions of the technology… Results

To Err is Human – summary of the landmark IOM report from 1999 Preparing the next generation of nurses to practice in a technology-rich environment: an informatics agenda. NLN Position Statement, May 9, 2008 A Summary of the October 2009 Forum on the Future of Nursing: Acute Care Resources