1. Nelita Zytkowski, DNP, MS, BSN, NEA-BC, RN-BC, FHIMSS Associate Chief Nursing Officer, Office of Nursing Informatics The Cleveland Clinic Health System Nursing’s Future-The Workforce, The Expectations, and The Technology

2. Common Technology Gaps of the Past Potential Benefits Faster Gain Clinical Efficiencies Cost Savings Improved Outcomes Enhanced Connectivity/ Communication Interoperability Clinical Reality Compared to paper? Optimize & Practice Changes Required First Significant Investments Improved Transparency for Areas of Opportunity Missed Communications Vendor/Industry Readiness

3. Current Gap

4. Automation Journey for Nursing… 2000-2004 Introduction of Electronic Health Records at bedside. Decentralized PCs & Devices. Move towards “going paperless” 2004-2008 Nursing Documentation Electronic Medication Administration Records (eMAR) Computerized Provider Order Entry 2008-20122012-2014 Additional Mobile Devices Device Integration / Interoperability Standardizing Documentation Specialty Documentation Wireless technologies Meaningful Use / Optimized Documentation Telemedicine/Remote Monitoring Analytics / Business Intelligence

5. Patient Tracking Nurse Technology Relationship Physiologic Monitoring Smart Pumps Workflow Management Clinical Documentation Departmental Systems SingleSign-OnSingleSign-On Barcode Medication Administration Administration CPOECPOE Communication Devices Remote Access & Telemedicine Device Integration Scorecards & Dashboards Mobile Devices Wireless Applications & Networks Nurse Call System Point of Care Testing Devices Telemetry Monitoring Hemodynamic Monitoring Barcode Specimen Collection Patient Portals Barcode Transfusion Administration Administration

6. Closing the Technology to Practice Gap Quality & Patient Safety Implications 1.Documentation 2.Relationship with technology 3.Clinical Intelligence

7. Documentation Implications on Quality & Patient Safety What You Document One & Done – follow through Devil in the Details – accuracy, descriptors, relationship to other entries Same documentation, different patient – type-enter-repeat – copy and paste Batch jobs – timeliness of data entry

8. Documentation Implications on Quality & Patient Safety How You Document Upstream/Downstream Impact – Who’s taking point – Communication and Handoff Meaningfulness – Who’s reading this, not reading this – Does it meet the standards What you didn’t document

9. Technology Relationship Implications on Quality & Patient Safety Technology Relationships Silence Please Remind Me Please – overreliance on technology – alarm fatigue I want more vs. No more please The silent member of the care team

10. Clinical Intelligence Implications on Quality & Patient Safety Clinical Intelligence Move from data capture to data analysis – tell the story Care across the continuum Population Health Standards of Care – care paths, documentation guides, bundles, protocols Patient & device entered data

11. How to close the gap… Give data meaning Establish a different type of relationship with technology Learn to synthesize knowledge for better understanding of the clinical picture and predictions for how to best impact outcomes

12. CONTACT INFORMATION: NELITA ZYTKOWSKI, DNP, MS, BSN, RN-BC, NEA-BC, FHIMSS ASSOCIATE CHIEF NURSING OFFICER, OFFICE OF NURSING INFORMATICS CLEVELAND CLINIC HEALTH SYSTEM ZYTKOWM@CCF.ORG 216-986-4881 ZYTKOWM@CCF.ORG Thank You!