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However, a limited number of nursing staff members had access to the systems and used them. However, due to the nurses' workload, which was expected to influence the response rate, the number of questions was reduced to 35, and each section consisted of five questions. The minimum and maximum score for each section was between 0 and The validity of the questionnaire was assessed through expert opinions.

The questionnaires were distributed to the nurses at the four hospitals through the systems. Data analysis was performed using SPSS ver. To analyze the data, the mean values and standard deviations were calculated, after which the systems were compared according to the usability criteria. Ninety-seven percent of the participants were female. The average age of the participants was 34 years SD 7. The average amount of work experience was In addition, for the majority of the nurses, the amount of experience with a nursing information system was between 1 and 5 years.

The average was 5. Systems A 1. In relation to system B, the highest mean score was found in relation to support for the user during their daily work routine 1. Systems C 2. In system B, the highest mean score was for ease of understanding messages displayed by the system 3. In system A, the lowest mean score was related to the ability to display general explanations and relevant examples 1. In system B, the highest mean score was for the ability to return to the main menu from any screen 3.

In relation to system A, the lowest mean score were related to stopping running procedures 2. Systems C 3. The highest mean score in system B was related to using the same designations in all parts of the system 3. The lowest mean score was given to system A 2. Systems D 2. Regarding system B, the highest mean score was for requiring user confirmation before performing an action, such as deleting information 3. The lowest mean score in system A was related to warning the user about potential problem situations 2.

For system B, the highest mean score was for the ability to change the terminology of the commands and actions based on the user vocabulary 3. In system D, the highest mean score was related to the lengthy amount of time required to learn how to use the system 3. A summary of the findings is presented in Table 3. As shown in Table 3 , among the seven usability criteria, the highest mean value 3.

Research suggests that the design of a health information system must fully match users' practices and must support them as they undertake their tasks; otherwise, the system will not be accepted by users or its uptake could face difficulties [ 21 ]. Another study indicated that displaying user-required information on different screens affected the efficient use of the systems and ultimately user satisfaction [ 22 ]. Similarly, research suggests that information about a given task should be displayed in a specific part of a system [ 23 ].

The provision of information considering user needs, progressing through short steps to accomplish tasks, ease of access to required commands, and the display of necessary information on a single screen will improve the satisfaction of the user with the system. However, the mean score obtained indicates that adequate attention was not paid to self-descriptiveness to the extent that it should when designing the systems.

Regarding the sub-criteria of self-descriptiveness, the nurses agreed mainly on the clarity of the terms used in the systems and in the ease of understanding the messages displayed. This finding is in good agreement with the findings of Rogers et al. However, the main area of disagreement was related to the capability of the systems to provide general explanations and relevant examples; these features should be considered in further developments of nursing systems.

However, in the systems investigated by Rogers et al.

Account Options

Research points out controllability as a key feature of a well-designed information system [ 24 ]. The capability of moving between screens, stopping running procedures when needed, and returning to the main menu from any screen could help to improve the controllability of systems. Such features in turn affect user satisfaction. Similarly, the majority of nurses agreed that the NISs conformed to their expectations. However, they expected to have more flexibility in terms of using identical keys for similar functions in all aspects of the systems.

Studies have demonstrated the significance of considering user expectations and the related impact on user satisfaction with information systems [ 25 ]. Research suggests that information systems which do not meet user expectations are at risk of failure [ 26 ]. Using designations consistently in all parts of the systems, displaying messages at the same screen location, and predicting the time required to perform a given task are among the approaches that could help to improve system conformity levels with regard to user expectations.

In relation to the capability of the nursing systems to prevent errors, i. This finding is supported by the findings of Viitanen et al. These findings suggest that an appropriate interface design and reduced complexity of the systems could improve the error prevention factor. Studies have also reported the importance of information systems which are capable of preventing errors [ 27 , 28 ]. This aspect should therefore be addressed in further studies of nursing systems, as it could help users to make more efficient use of the systems and could facilitate their work routines.

Studies have reported that information systems should be designed considering the knowledge and experience of their users. In addition, the systems should display information in an appropriate format to meet users' needs [ 29 ]. With respect to the last feature of usability, i. Nurses did not require much time to learn how to use the systems. In addition, it was easy for them to relearn how to use the systems after a lengthy interruption.

However, in a study by Viitanen et al. Knowing that suitability for learning can influence user satisfaction levels [ 30 ], the designs of these systems should allow users to navigate the systems conveniently and learn them with little effort. In this study, a modified version of the IsoMetric questionnaire was used to make it simpler to complete by the respondents.

Moreover, in the current study, only a quantitative method was used to evaluate the usability of the nursing information systems assessed here. Conducting a mixed-method evaluation study quantitative and qualitative is suggested for future researchers to gain better insight into the usability problems of these systems. In conclusion, this study evaluated the usability of four nursing information systems using the metrics recommended in ISO The findings showed that there are areas in need of further improvement.

Providing nurses with the capability of individualizing the systems according to their work routines could help them to use the systems more efficiently and effectively. In addition, the designs of these systems should enable nurses to find their own way with little effort when using them.

Moreover, the systems should guide users on how to perform their tasks conveniently. Finally, designing nursing information systems according to usability principles and considering user requirements can help to improve the effective use of these systems. Conflict of Interest: No potential conflict of interest relevant to this article was reported. National Center for Biotechnology Information , U.

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Find articles by Farkhondeh Asadi. Find articles by Negin Ostvan. Author information Article notes Copyright and License information Disclaimer. Corresponding author. This article has been cited by other articles in PMC. Abstract Objectives As the largest group providing healthcare services, nurses require well-designed information systems in their practice. Methods This cross-sectional survey was conducted in Results The response rate was Conclusions Addressing issues related to individualization and self-descriptiveness could improve the usability of nursing systems.

Introduction The recent advancements in information technology and computer science have led to the development of computerized information systems in different areas. Methods This was a cross-sectional study conducted in Table 1 Number of nurses in the target population and eligible nurses. Open in a separate window. Table 3 Frequency of responses for the seven usability criteria of isometric. Figure 1. Mean scores of seven ISO criteria for the systems under study.

Discussion Research suggests that the design of a health information system must fully match users' practices and must support them as they undertake their tasks; otherwise, the system will not be accepted by users or its uptake could face difficulties [ 21 ]. Footnotes Conflict of Interest: No potential conflict of interest relevant to this article was reported. References 1. A mobile Nursing Information System based on human-computer interaction design for improving quality of nursing.

J Med Syst. Designing an electronic patient management system for multiple sclerosis: building a next generation multiple sclerosis documentation system. Interact J Med Res. Health information technology in the knowledge management of health care organizations. Middle East J Rehabil Health. Rachmawaty R. This would give nurses more efficient access to information which the nurse actually uses when administering medications. Additional information, triggered by the bar code, might help the nurse to:. For example, if a low serum potassium value were to appear, it would prompt the nurse to request a supplement for the patient receiving a thiazide.

It is important to note that the nurse currently takes these steps manually in a time-consuming process, searching for the potassium values while preparing the drug for administration. The electronic process being recommended is both more efficient and safer. Electronic medication records eMARs should also include trending of medications along with clinically relevant laboratory values. Insulin administration in the eMAR should be trended with the most recent plasma glucose and serum potassium levels in a single view, so as to keep busy nurses from having to retrieve the labs from another flow sheet in the EHR.

In each of these examples, the data were already contained within the EHR; they simply needed to be connected in a nurse-and-patient-safety-sensitive manner. Programming of drug administration processes at the point of patient contact, with strategically placed tips and alerts, might lessen medication errors significantly. We authors support informatics research that moves in this direction. We also offer the following additional medication safety recommendations:. Finally, we encourage careful consideration of policies governing the use of pharmacy technicians in dispensing medications without direct pharmacist supervision.

Boards of Nursing and Pharmacy may want to take up this consideration from a regulatory or statutory viewpoint. EHRs need to reflect the credentials of the person dispensing and administrating the medications to compare medication error rates between and among licensed and unlicensed personnel. Appropriate quality care comparisons among and between providers and practices can only be made when standardized processes and products are used.

This section will explore three aspects of the patient safety implications of direct care nursing documentation and its unique characteristics from three aspects, including standardization of evidence-based care processes, transparency of the nursing process, and development of an electronic workflow tool to standardize and improve communication. Standardization of evidence-based care processes. The NPC recommended standardization of evidence-based care processes, including patient educational materials and actions plans, within and eventually across the care setting.

Appropriate quality care comparisons can only be made when such standardized processes and products are used. Registered nurses, including APRNs, may defend themselves by saying that their own personal materials are the most current and most evidence-based. If this is so, then it is imperative that specialty-specific nurses become involved in the selection and updating of computer-generated, patient-education materials to ensure the evidence base and the appropriateness of all materials.

In addition, documents generated by the EHR must be written clearly and simply, in keeping with sound health-literacy and evidence-based patient education strategies and tools Harvard School of Public Health n. Nurses may also voice concerns about newer electronic documentation methods interrupting workflow, in which case they need to become personally involved in workflow design with vendors or with IT department personnel.

In contrast to this misperception, it is important to recognize that evidence-based practices and standardization of care processes help to assure that the quality of care is optimized for each individual patient.

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The premises underlying evidence-based practice and standardized care do not negate, but rather heighten, individualization of care, including consideration of personal beliefs, values, and individual preferences. In brief, evidence-based practice and the standardization of care processes enhance the trust patients have in nurses to consistently function on behalf of their best interest. Prioritization of diagnoses and transparency of the nursing process. The Nursing Practice Committee recommended that nurses make the nursing process more transparent in the EHR for each patient problem requiring nursing care.

The Committee also recommended that nurses properly prioritize patient problems in their documentation. Proper prioritization of diagnoses and a more transparent process are two methods of evaluating nursing documentation. Analogously, nurses need to have the ability to manually order or sort by priority the diagnoses that drive their interventions.

Transparency refers to the clarity of the record for its users. Transparency, in more recent times, has come to mean the open sharing of information. For purposes here, we define electronic health record transparency as clear and open sharing of information among providers and with patients. While providers using the EHR have access to information inserted by interdisciplinary team members, access to this information is not always intuitive, nor is its presentation always clear.

Systems today do provide patients with electronic access to limited information in their EHRs. However, it is possible that even greater information sharing in the future will further improve the quality of care Delbanco et al. Development of an electronic workflow to standardize and improve communication. Additionally, the Nursing Practice Committee recommended that the nursing process steps be researched and developed into an abbreviated communication tool, one that would describe and prioritize each individual patient problem for use during handoff at change of shift and also when documenting planning of care during admission, transfers, and discharges.

A simple, electronic workflow helps standardize and improve communication of direct care in keeping with the ANA documentation standards , as in the following focused-care example. The purpose of nursing documentation is to record nursing care provided and patient responses. Because the current standard of care is the nursing process, the steps in the nursing process need to be evident in nursing documentation. When documentation is poor it is likely that both human and technologic improvements are needed.

Understanding the impact of big data on nursing knowledge

We authors find human-machine interaction to be interesting. When there is an issue with documentation, those closest to the world of informatics are quick to exculpate the EHR by saying it was never intended to fill a gap in practice. On the other hand, those closest to the clinical world are quick to exculpate themselves by blaming one or more technical features of the EHR. Reality most likely lies somewhere in the middle. It may be that standardization of care processes, including clinical decision-support processes, becomes more fully appreciated as the number of Doctor of Nursing Practice DNP graduates increase.

These graduates are prepared to use new quality improvement technologies; organize and analyze the evidence that flows from their own practice; and compare their practice parameters against those of others. The following paragraph provides an overview of DNP clinical projects designed to improve patient outcomes or reduce patient risk by improving care processes. APRNs, and especially DNP graduates, know that the ability to take advantage of EHR data to improve patient care first requires the proper entry of process and outcome data in the record.

Nurses use both synchronous and asynchronous methods to document care. Perhaps when voice activated, natural language processing methods are further developed and better integrated into the EHR, all nursing documentation will be synchronous. Clinical decision support CDS information depends on real time data.

Triggering an alert for sepsis is only beneficial if the alert comes as soon as the system inflammatory response system SIRS criteria are met. If the vital signs are written on paper and entered later, the alert is delayed and patient safety is impaired. Documentation studies indicate that factors to promote diagnostic reasoning and accuracy have been identified.

Researchers should work closely with EHR vendors and terminology developers to be assured that tools with known validity and reliability are correctly incorporated into the clinical workflow. These scales not only meet nursing and hospital system standards but are increasingly being incorporated into big data and population-health management. On the other hand, unintended consequences may flow from what a clinical ethicist calls EHR quality and documentation pitfalls.

Most vendors provide software with a variety of options for each assessment parameter e. Yet, well-intended but clinically inappropriate IT decisions may be made. When clinicians identify problems, such as ambiguous yes or no options, they are encouraged to correct them by explaining clinical and legal consequences of such decision-making to IT department staff or to healthcare system executives. Other technology issues may also need to be voiced to vendors. In the paragraphs below, we will first consider efficiency and EHR technology concerns.

Then we will offer HIT and nursing practice recommendation. Several studies have documented the lack of efficiency in current EHR documentation practice. Activities that interrupted documentation included: phone calls, patient requests, and frequent transitions between various types of documentation modalities. Researchers suggested that physicians rely on synthesis rather than composition to write progress notes.

Newer technologies that support synthesis are exemplified by highlighting and thus capturing single words or phrases from the chart to construct a new note descriptive of the patient at the current point in time. Research is needed to compare the quality of such charting and to determine if it is less vulnerable to fragmentation than current charting methods.

This research needs to include study of the documentation by both direct care nurses and physicians. A recent hospital-based study by Englebright et al. The researchers concluded that this newer method minimized or eliminated documentation that did not directly support patient care. These investigators recommended use of alternative options for recording non-patient-care-related information and use of EHR technology to help nurses document and communicate basic care elements.

The Nursing Practice Committee of the Missouri Nurses Association is committed to efficiency in the provision of care. These nurses recognize that efficiency, including efficient capture of meaningful data, helps to translate information and to communicate nursing-based knowledge to other members of the healthcare team, thus improving patient safety and care quality. Efficiency-related issues, if unaddressed, minimize electronic documentation.

Given a choice between providing high quality care and quality documentation within an inefficient EHR system, it is safer to provide the care required and minimize documentation time than to compromise on care to be sure that documentation is complete. Understanding and correcting the etiology of such documentation work-arounds, and all other work-arounds, is essential to improving the healthcare system Debono et al.

Members of the Nursing Practice Committee have recommended that, if current systems are inefficient or suboptimal, the goal for nurses, IT staff, and institutional administrators should be to improve the system not work around it. Direct care nurses report that EHR issues also affect the quality of their charting. These include, when using some products, rigidity in the number of available options for entering nursing data; a lack of pertinent patient information presented in a readily accessible and comprehensible manner to support critical decision making; drawbacks associated with over-dependence on the checklist quality of nursing documentation; and the relatively little attention given to diagnostic-specific interventions and their evaluation.

Such issues lead to poor visibility, presentation, and possible incorrect use of clinical information that may compromise patient outcomes. Issues related to electronic charting, however, may not always be the fault of the EHR. Documentation, electronic or otherwise, reflects the critical thinking of the nurse and the quality of the nursing care itself. In other words, correct or solid human reasoning is needed to interpret data collected correctly, make appropriate clinical judgements, act upon them competently, and document clearly. When such is lacking, the lack is evident in the documentation.

In addition to it being a vehicle that facilitates big data research, the EHR may be used to facilitate the regular review of randomly selected records for documentation case reviews and quality improvement purposes. For example, a random review may reveal findings like those indicated in Table 2 , which illustrate that the EHR is not a substitute for incorrect thinking.

In fact a well-constructed EHR reflects, as Table 2 shows, lapses in adhering to nursing standards. Conversely, a well-constructed EHR also reflects accurately how nurses think assess , arrive at clinical judgments diagnose , identify outcomes, plan, intervene and evaluate care Lang, An EHR documents practice and reflects the quality of underlying direct care nurse thinking; it does not replace thinking or serve as its substitute but reflects adherence to or lapses in adherence to nursing standards.

User case scenario: 68 year old female admitted to nursing unit with diagnosis of pneumonia and history of heart disease. Patient denies pain but complains of increasing fatigue, cough and shortness of breath. The admitting RN documents the initiation of intake and output; daily weights; and vital signs; including pulse oximetry, four times daily. Over the course of the next few days, the RN staff collects pertinent data.

Intake and output records reveal an alarming fluid volume overload. Vital signs reveal a decrease in fever but a steady increase in systolic and diastolic pressures, increasing heart rate, and slowly declining oxygen saturation. There is apparently no attempt to analyze the data or report it to the attending physician. RN identifies expected outcomes for a plan individualized to the healthcare consumer or the situation.

No expected outcomes are identified. RN develops a plan of care that prescribes strategies and interventions to attain expected outcomes. While the prior plan of care included appropriate surveillance activities e. In other words, electronic nursing documentation of surveillance activity was haphazard and findings did not lead to appropriate implementation.

This case scenario begins and ends with the collection of data. Patient outcomes pulmonary edema could have been prevented had assessment data been correctly analyzed and the diagnosis of fluid volume overload recognized. As it was, the patient was admitted to ICU, appropriate treatment was initiated, and patient was discharged home, but length of hospital stay had been extended and the patient now has a history of congestive heart failure, recent onset.

Lapses in reasoning, documentation, and actions were also present during the paper-chart era. The difference is that the extent of these lapses could not be readily evaluated with paper charts. The reasoning model we used also facilitated the expansion of our thinking and enabled us to arrive at a number of broad recommendations.

Nursing information systems in Jordan

In the following paragraphs, we discuss HIT practice recommendations, Health IT department concerns, and nursing practice recommendations. HIT practice recommendations. This section presents HIT issues raised by participants. We offer recommendations to address interoperability, vendor concerns, IT department concerns and the need to innovate. A foundational aspect of interoperability is the use of a core set of taxonomies to communicate between all disciplines interacting with the patient.

EHR interoperability concerns raised by participants included the lack of interoperability of computer systems between provider offices, hospitals, extended care facilities, home health agencies, community health centers, and schools McMurray et al.

[PDF] Building Standard-Based Nursing Information Systems - Semantic Scholar

Lack of interoperability leads to poor coordination of care and less than efficient care transitions between and among agencies, thus increasing the potential for error. The ANA currently recognizes 13 taxonomies. Nurse informaticists provide leadership in the development and application of these terminologies. They will be the experts who know that nurses are expected to document in accord with ANA nursing standards. Nurses need to be at the table when vendor-selection decisions are made.

The Nursing Practice Committee also addressed vendor concerns. On the other hand, responsive vendors employ nurses who are both experienced in the clinical workflows and possess advanced education in the sciences of nursing, informatics, and computers. They work with clinicians with the end result being significant improvements in workflow and user nurse friendliness of the system. Health IT department concerns. Sometimes vendors may be blamed for non-responsiveness when IT department personnel do not communicate nurse concerns to vendors.

Nurses identified such communication issues within two large and separate Missouri healthcare systems. IT departments blocked the flow of information from nurses to vendors. Instead of transmitting concerns, IT staff proffered such reasons as: the software did not allow such a change, the system was not designed to function in that way, and software updates permitting access to newer versions were not possible at this time. It is essential for clinicians to be engaged in all clinical IT projects. In terms of needed innovation, the Nursing Practice Committee believes there are multiple opportunities to improve clinical practice and, equally important, to embrace evidence-based practice through innovative HIT initiatives.

Suggested initiatives include:. Nursing practice recommendations. Each of the following directives enhances the power base of nurses within the field of informatics. A nursing voice may be lacking because nurses are not perceived as healthcare system decision makers or revenue generators. Hence, their input may be dismissed without due consideration. This major concern needs to be addressed in nursing. Physicians are vocal and evoke attention that motivates vendors to listen.

However, the nursing profession cannot wait for attention until more power is granted to nurses within an institution nor until cost-benefit analyses justify their value to the institution. Rather, resolution lies in nurses simply assuming that they have the power to articulate their value and to expect solutions that measurably improve electronic documentation and communication, patient safety and quality care.

We need to share stories about the Missouri nurses, and all nurses, who have exercised health IT power in meaningful ways and who have been responsible for improvements in practice. Although the American Association of Colleges of Nursing considers informatics essential nursing knowledge within baccalaureate, masters, and doctoral degree programs, the current lack of basic informatics education within nursing programs, coupled with the failure to expect graduates to exhibit informatics competencies, remains an issue. This deficit extends beyond learning how to document and communicate within an EHR, and leads to a reciprocal problem: lack of capacity to prepare clinical nurse informaticists in sufficient numbers to process needed requests in a scientifically sound and evidence-based manner.

This article is, therefore, a call to all nurses to become informed regarding nursing informatics and pursue additional informatics educational opportunities. The Nursing Practice Committee has recommended that the number of Missouri nurse informaticists be tracked and that methods of incentivizing nurses to become informaticists be considered. This is important for all states within the United States and for nurses around the world.

It is also important for nurses to review, study, and advance nursing sensitive EHR technology. Nurses need to join informatics or informatics-related organizations e. Advanced practice nurses are encouraged to join standards-setting organizations e. Deepening collaboration between health IT standards technology and nursing standards practice at point-of-care is also important. Standards-based health IT has been shown to facilitate communication and information flow among interprofessional team members caring for children receiving palliative care Madhavan et al.

Standards-based nursing practice is the norm and is written into each State Nurse Practice Act. Increased collaboration and closer coordination between HIT standards-based technology and standards-based nursing practice is indicated. Finally, we must make nursing practice more visible by closing the gap between nursing practice standards and EHR documentation of care. As authors, we realize that there is a direct patient care and physiological outcomes bias in this article.

It reflects the nursing background of the authors and Maslow's priorities, as well as Florence Nightingale's interests in the Crimean War e. However, the principles discussed to make nursing practice more visible are applicable to all aspects of care. Our main point is that all nurses from all backgrounds have a vested interest in increasing the visibility of nursing practice through use of the electronic health record.

Communicating effectively with informaticists and helping them develop documentation measures that reflect the full spectrum of evidenced-based and standards-based nursing practice advances this objective. Simultaneously, we need to position nurses to exert greater influence in the transformation of healthcare for the benefit of all.

This article categorized the concerns of nurses expressed to or by the members of the Missouri Nurses Association Nursing Practice Committee on the subject of electronic health record documentation. It is hoped that this information will enhance the informatics vocabulary of direct care nurses and build confidence in their ability to sit at the HIT table to address issues that directly affect patient safety, care quality and the documentation of care.

Broader informatics concerns were addressed as well, both from an HIT and a nursing perspective. Vendors and IT departments need to be rewarded for their responsiveness to this nursing concern. Conversely, those who remain unresponsive need to be held accountable. Innovation, including increasing use of big data and eMeasures, will continue to improve patient safety and care quality.

Nurse Knowledge Exchange: Critical Care

From a nursing perspective, we hope this article will help empower direct care nurses and the nursing profession to better articulate nursing informatics concerns and also to value and improve the role the EHR plays in making visible the practice of nursing. Therefore, we encourage you as a direct care nurse to identify where you are in this process. Plan how you want to best develop your own documentation and informatics skills.

We conclude with three possible development scenarios. If you know how to document the nursing process appropriately, work with vendors and IT staff to communicate your knowledge, observations and suggestions to them. If you know how to document the nursing process appropriately, but do not do so regularly, reflect on why and develop a plan to correct your own inaction or to identify and correct barriers within the system that hinder appropriate documentation.

If you lack the ability to document the nursing process in the care you provide, develop a continuing education plan that helps you build this skill. Regardless of the scenario in which you best fit, act smartly upon your reflections, with the objective of improving practice and education institutionally, locally, nationally, and globally.

Their health information technology recommendations in this article are an outgrowth of the issues and problems that they have heard members express. They are grateful to the Nursing Practice Committee for the wealth of information presented, as this has allowed for the categorization of the data. It is their hope that such a categorization will help nurses name and communicate their concerns more clearly, and contribute directly to the design decisions made.

Lavin is a graduate of St. She is an advanced practice nurse, board certified as an adult nurse practitioner, and a charter fellow in both NANDA International and the American Academy of Nursing. Lavin was an early leader in nursing diagnosis classification, co-coordinating the First National Conference on the Classification of Nursing Diagnosis in St. Louis, Missouri in In , she was inducted into the Missouri Nurses Hall of Fame. Until her retirement from Saint Louis University in June , she chaired Doctor of Nursing Practice capstone projects, taught advanced pharmacology and interprofessional patient risk reduction collaboration methods, and served as the nurse lead in the Southern Illinois University Edwardsville-Saint Louis University Center of Excellence in Pain Education.

She has more than 30 years of experience in healthcare, of which more than 20 years have been focused on using technology and informatics to automate evidence based, interdisciplinary, patient-centered workflows. She is a fellow of the American Academy of Nursing. Her research interests include: the development and testing of eMeasures to advance the science of nursing practice; evidence-based staffing; big data and the economic value of healthcare data and its implications for practice and research; and the evolution and growth of evidence-based science; and demonstration of the value of interprofessional inclusivity in maximizing patient-centric care.

Barr is a graduate of St. She is a clinical assistant professor at the University of Kansas School of Nursing, Her clinical involvement with the University of Kansas undergraduate nursing students requires a working relationship with several vendors of acute care electronic health records EHRs. Additionally, she uses an office-based EHR, which requires meaningful use as it was implemented via the federal guidelines for primary care providers in an office setting, one of the largest privately owned medical groups in the Midwest.

She is also active with the Missouri Action Coalition, and is responsible for some aspects of the implementation of the Affordable Care Act computer-driven enrollment. Agency for Healthcare Research and Quality. Medication errors. National quality strategy: Overview. Problem list guidance in the EHR. Nursing: Scope and standards of practice. Silver Springs, MD: Nursesbooks. Recognized terminologies and data element sets. Retrieved from ana. Apsey, H. Overcoming clinical inertia in the management of postoperative patients with diabetes. Endocrinology Practice, 20 4 , Atherton, J. The experiential learning cycle.