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Kaiser/Department of Veterans Affairs (VA)

Kaiser/Department of Veterans Affairs (VA)

Nurses from the Department of Veterans Affairs (VA) and Kaiser Permanente have collaborated on a framework to standardize evidence-based nursing practice in support of information exchange across disparate EHRs utilizing pressure ulcer risk assessment and prevention (KP-VA Nursing Collaborative, 2011). The information model supports defined steps that enable the sharing of relevant content between organizations with different EHRs. These repeatable steps can be adapted to other key quality outcome measures that are sensitive to nursing care. The project serves as an exemplar, developed in collaboration with the ANA and the National Quality Forum, to develop quality measures for Meaningful Use Stage 3. What was learned from this development process is that there are core common repeatable steps of a standardization framework that can be shared and replicated. Table 1 presents those repeatable steps in a standardization framework, including a simple definition of each step. These steps provide the nursing community with evidence to contribute to the process of enhancing information exchange and improving the quality of care to consumers.

View Table 1

Table 1. The Repeatable Steps of a Standardization Framework with a Simple Definition of each step.

Each of the three exemplars demonstrate that in order to achieve quality consumer outcomes based upon clinical guidelines/evidence, consumer data had to be aggregated to standards in order to determine if quality consumer outcomes were met. The efforts followed the process depicted in Figure 1 and the repeatable steps of a standardization framework in Table 1 to collect and report data in a standardized fashion in order to discern best practices in clinical care leading to improved care and outcomes.

Capabilities and Infrastructure Requirements for Addressing the Shortcomings of Current Systems

Data sharing and reuse that address the effectiveness and efficiencies of nursing care are greatly enhanced when data are defined using common ontologies and terminologies. Just as important is how the data are stored in the healthcare record/system. The ability to have retrievable and computable data definitions stored in the individual patient record to support retrospective study and concurrent decision support, is a prerequisite for data analysis and ongoing evaluation of evidence-based practice.

Current EHR systems do not consistently support the ability to retain the data definitions; in other words, the mappings between an interface terminology (clinically relevant terms used for nursing documentation) and standardized terminologies such as LOINC® and SNOMED CT® cannot be retained in most systems today. The nursing perspective should be represented in order to influence the design and development of EHR architecture. This will improve the ability to rationally store standardized nursing data in the health record beginning at the point of care.

The nursing profession should establish protocols that assure the nurse user perspective is reflected in current systems. It is essential that common standards-based definitions of nursing terms and data capture systems are used and ultimately support and inform broader policy recommendations.