The Intersection of Technology and Health Care: Policy and Practice Implications

The Intersection of Technology and Health Care

Policy and Practice Implications

Linda Burnes Bolton, Pamela F. Cipriano and Carole Gassert

“Technology…is a queer thing. It brings you great gifts with one hand, and it stabs you in the back with the other.”

—C.P. Snow

The dissemination and utilization of health information has been lauded as a key strategy in achieving the health reform goals of improved access to safe, reliable, efficient, and effective care for all and the elimination of waste, including unnecessary costs and overuse of services. In this chapter, we provide commentary on the demand for value-based health care,1 the potential for technology to enhance nursing practice, and the role of nursing and its senior leaders in the acquisition and deployment of technology, including the opportunities to work with other clinicians to advocate for appropriate use of technology.

The Demand for Value-Based Health Care

One of the hallmarks of the twenty-first century is the explosion of technological devices and systems that touch every part of our lives. Nowhere is this more apparent than in health care. As a result, an enormous strain has been placed on the shoulders of those who make business decisions for health care organizations. Capital budgets are already at the breaking point, even though there is an amazing number of emerging technologies to consider purchasing (e.g., imaging, monitoring, communication devices, information management systems, pharmacological products, and implants)—all of which promise improved therapies, care delivery processes, and patient safety. Sorting these out can be quite time-consuming and often requires a level of knowledge that many executives simply do not possess. Moreover, consideration of this vast array is frequently complicated by the many disappointments that have accompanied the introduction of earlier versions of the technologies under consideration.

As a result, it has become increasingly important that each institution have its own means of confronting decisions related to technology, and that these questions always be addressed within a clear framework of policies and procedures. In fact, a helpful approach is one that represents a combination of evidence-based practice (something demanded of all clinicians but seldom expected of administrators) and informed consumer behavior. Value analysis and technology assessment are parts of the process, but the techniques to do this can be imprecise, and other business imperatives (e.g., maintaining a competitive edge and retaining physicians) may take precedence. Nonetheless, careful and deliberate consideration of technology purchases has become essential because of the magnitude of both the cost and potential impact, whether good or bad. In the future, robust comparative effectiveness research may shed more light on the effectiveness and efficiency of the most expensive technologies.

There is an urgency to understand the benefits of health care investments. In a 2009 Institute of Medicine report, “Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation,” health information technology was noted to be a prerequisite for attaining greater value in health care. The benefits were improved quality, ability to monitor outcomes, clinical decision support, collecting and developing evidence, tracking costs, streamlining paperwork, improving care coordination, and facilitating patient engagement. Although perspectives on the value of care differ for each stakeholder (i.e., the consumer, provider, and payer), the lack of uniform definition of value does not diminish the belief that outcomes can improve while reducing costs. Value-based payment approaches by payers such as Medicare link payment to performance in order to stimulate improvements in systems of care and, thus, better care coordination and reduction of unnecessary costs.

Use of technology is a key strategy for harnessing the power of data at the point of care and using these data for managing disease, identifying patient trends, and intervening on health problems earlier. Transforming technologies such as telehome care and telemonitoring are already showing reduced hospital admissions and lengths of stay, as well as decreased unplanned visits to health care providers. Devices that eliminate redundant nursing tasks can increase the nurse’s time spent in direct care of patients, improving safety through direct observation and early interventions.

Technology Enhanced Nursing Practice

Health care organizations are making significant investments in technology to improve clinical care and slash error rates. Technology has been used extensively in the hospital for decades, but now it provides new capabilities for remote monitoring in homes, offering connectivity to portable devices such as cell phones and personal digital assistive devices. In this way, technology is becoming an effective tool for chronic disease management, prevention of hospitalization, and keeping people in their homes.

Nurses have begun to embrace the use of technology in all aspects of their practice. They perceive it as a means to improve the accuracy of care delivery, reduce redundancy of activities such as data collection and documentation, reduce physical strain from moving patients, and improve workflow efficiencies. Nurses may also find that some technologies present barriers to efficient care if not developed to complement the nurse’s workflow and human behavior. As a result, nurses may develop “workarounds” that circumvent the correct use of devices. Early bedside barcode medication administration scanners and complicated intravenous pumps with safety software required redesign and testing to ensure that nurses could use the technologies easily and efficiently.

The Effect of Technology on Nursing Practice: The TD2 Study

In 2000, the Workforce Commission of the American Academy of Nursing (AAN) focused on ways to decrease the demand on registered nurses’ time as a solution to the impending workforce shortage. Facing a different kind of shortage characterized by the aging population of nurses, a dwindling supply pipeline, an increase in demand for nurses, and a paucity of individuals prepared to fill the ranks of nursing faculty jobs, the Commission focused its attention on how the demands of patient care could be met in part by technology. It was thought that the growing availability of technology—devices, instruments, appliances, and information systems—offered important opportunities for reducing the demand on nurses’ direct and non-direct care time. Likewise, technology was thought to have the potential for easing the physical burden of nurses’ work through a variety of devices such as those used for moving patients. In short, the AAN Workforce Commission believed that innovative technology could be used to enhance patient care, improve efficiency, and make care safer for patient and provider.

To that end, the Commission convened an invitational conference in 2002 that was attended by nurses, physicians, pharmacists, health care provider organizations, government agencies, equipment suppliers, engineers, architects, futurists, and medical record system vendors to consider how technology might be deployed in an ideal care delivery system within the next decade. They proposed a redesigned future nursing work environment that effectively used technology to improve practice and patient care outcomes.

The “Technology Drill Down”

As a result of this invitational conference, the Workforce Commission, with funding from the Robert Wood Johnson Foundation, embarked on a project to develop a process for identifying potential technology solutions needed to support the redesign of practice environments in medical-surgical units of hospitals. A pilot study at three hospitals led to the design of the “Technology Drill Down” or “TD2” process whereby multidisciplinary participants described the current workflow for patient care activities, envisioned the ideal future state, identified gaps between the current and the ideal state, and proposed potential (real or imagined) technology solutions to close the gaps (American Academy of Nursing Drill Down, n.d.; Burnes Bolton, Gassert, & Cipriano, 2008) (Box 59-1).

BOX 59-1

The TD2 Process

The Technology Drill Down (TD2) process is a critical strategy to achieving the following goals:

The TD2 process applies the following steps:

Step 1: Hospital system executives identify a medical/surgical unit that could benefit from a TD2.

Step 2: An internal TD2 facilitator is identified who uses the training materials from the American Academy of Nursing.

Step 3: Approximately 20 to 30 unit and interdepartmental representatives come together for image days to map the gaps between current workflow and an idealized workflow and, most importantly, to identify potential technological applications that could close the gaps. (The TD2s engage not only RNs, assistive personnel, and unit clerks but also members of other departments whose work processes interface and are interrelated.)

Step 4: Group participants envision how the work would flow under ideal circumstances. As they talk, the facilitator uses a laptop computer to diagram the discussion, and the diagram appears on a screen for all participants to see. Participants then analyze and discuss their current environment, identifying how to bridge gaps between current state and ideal environment. Technologies to bridge gaps in processes are identified; participants identify specific requirements for new technologies and discuss how these technologies could reduce waste, add value to nurses’ time, and create efficiencies in overall workflow and work processes.

Step 5: Hospital administrators, unit managers, and nursing staff use the information gathered to assist with making technology decisions.

Stay updated, free articles. Join our Telegram channel

Mar 18, 2017 | Posted by in NURSING | Comments Off on The Intersection of Technology and Health Care: Policy and Practice Implications

Full access? Get Clinical Tree

Get Clinical Tree app for offline access