A qualified super user is experienced within their healthcare specialty, knowledgeable about their unit and is recognized as an expert resource that will prove invaluable in helping others to understanding the work processes of the unit (Hunt, et al).  In an optimum situation, the super user should have a deep interest in the project.  Unfortunately at our organization, due to labor shortages of nurses, the default super user becomes, whoever is drafted by the department manager.  The unintended consequence is now the SIT is working with an unwilling participant that is not interested with doing the task at hand and provides minimal effort at best.  In some situations, you may get a very willing participant, but they are typically the younger clinicians, who may not have enough tenure to overcome resistance from a more seasoned staff.    Compound the problem with an organizational goal to deploy a super user ratio based on project scope size and proven published methodologies (McNeive, 2009).  The other intent with the super user deployment was for these identified staff to maintain their post after activation, with each department managers assessing the needs of users to maintain super users support model.  Again, due to labor shortages department management were forced to pull the plug on the proposed super user model prematurely due to pressures to meet patient care demands.  Therefore, there was a leveling off in the engagement of our super users to a point they have dwindled off from the department’s workflow.  There was now a perception issue that super users are no longer needed and that they were super users only when it was convenient for the identified super users.  The SIT team now faces the challenge of having a user base with varying degree of experience with the application.  Boudreau (2003) studied a state institution’s successful implementation of an enterprise system and found some employees who became functional, experienced users while other employees were struggling with using the new system – with some just able to perform their job responsibilities and lacking an understanding of the systems capabilities. Consequently our current help desk model, which is staffed by analyst type, that is essentially equipped to handle day to day software issue such as password resets and security issues and not the very specific workflow processes that patient care entails.  The help desk model did not prepare for this unintended consequence due to the original strategy to rely on departmental super users to field these types of issues.  Because the super users are practically non existent, in review of the help desk tracking system, there has been a significant increase in training request.  On average the organization receives approximately 250 help desk request a month for our application.  Findings further indicate that 60% of these were training related that should a good super user model been established one can conclude would make this issue nonexistent.

To solve this inequality with the super user engagement, and the increasing help desk request for additional training on software features and functionality, what I would propose as a solution is what I call a “shared staffing model.” The key difference in this model would be the fact that the staff reports to the Software Implementation Team.  The shared staff is carefully hand selected to ensure proper fit, as opposed to hand selected by department managers who may not know what the right qualities a super user should possess.  By nature of the shared staff reporting to the SIT, there is now a much better control and a more directed approach at the distribution of the resource.  With the shared staffing model, the SIT can concentrate their efforts on future development projects and not be slowed down fielding an increasing need for more education on how to properly utilize the application.  The new model would also employ a day and night shift personnel which is a deviation from standard SIT working hours of day shift only.  To be fiscally responsible, the ideal candidate for the position is a clinician that has part time status.  Since most hospital employees work 12 hour shift (3 shifts a week for full time designation and 2 shifts a week for part time designation), the ideal candidate would be a part time staff, who can continue to work their typical 2 shifts a week, but will now pick up an additional 2 days / 8 hour shift working with the SIT not to exceed 40 hours a week.  This will be a win-win situation for both parties, organizationally not incurring any overtime and the staff being given the opportunity to work extra hours and be introduced to a growing specialty – Healthcare Information Technology.

As a status update to date, this model has been proposed and escalated up to the executive level of the organization for approval.  The original proposal was to hire 6 shared staff (3 for days and 3 for nights) but the leadership decided to take a more conservative route to pilot this new model for effectiveness first, and approved the hiring of 2 shared staff (1 for day and 1 for night).  There will be a formal review in 6 months to evaluate effectiveness at which point it will be decided if this model will continue.  In further review of the same benchmarks used to propose this new model, in 1 month since implementing this new shared staffing model, there has been a significant decrease in training request from 60% down to 48%.   

 References

Hunt, E., Sproat, S., & Kitzmiller, R. (2004). The Nursing Informatics Implementation Guide. New York, NY: Springer-Verlag

McNeive, J. E. (2009). "Super users  have great value in your organization." CIN: Computers, Informatics, Nursing 27(3): 136-9.

Boudreau, M.-C. and Seligman, L. (2003) A Learning-based model of quality of use: Insights from a case study of ERP implementation, Pre-ICIS DIGIT Workshop, Available at http://mis.uah.edu/sigadit/workshops/files/DIGIT_2003_Boudreau.pdf.

While I am unaware of specific laws to reference that are against capitalizing generic drug names, although they may exist.   I do believe however, it is a community standard not to do so.  That is, I believe it is a community standard to use lower case to indicate generic compounds, and capitalization to indicate the Brand or Proprietary names for those compounds.    It’s use is ubiquitous.  Training books for healthcare workers from transcriptionists to pharmacy techs reference this practice.    I have personally never seem an Electronic Medical Record (EMR) or CPOE portion of the system; nor a Pharmacy system to be configured without using lower case for generic names and title case for brand names.   

While not as formal  as law, ISMP has a set of helpful guidelines for pharmaceutical  labels formats that may apply:  http://www.ismp.org/Tools/guidelines/labelFormats/default.asp    Each of these guidelines recommends to “List all products by generic name using lower-case letters as the primary drug nomenclature (unless employing tall man letters as a safety strategy), ensuring that each matches FDA-approved nomenclature.”

Most importantly, using capitalization on generics may inhibit the effectiveness of the ISMP–recommended tall man lettering.    When applied well, the only capitalization would be found on Brand Names and those look-alike and sound-alike areas of the drug names that are accented by this practice.   In fact, the only additional thing I would recommend is for our organization to agree to at least adopt ALL the ISMP-recommended tall man recommended matches found at: http://www.ismp.org/tools/tallmanletters.pdf , and then to add more that prove to be useful here.

This issue defies logic for me.  Why would someone not want to follow a set of proven standards?  Please feel free to chime in and leave your thoughts in the comments!

Of the funds, HHS will award about $220 million as grants to 15 not-for-profit community groups or government entities representing diverse geographic areas. About $15 million of the funds will go toward technical assistance and program evaluation (Gruenwald, "Tech Daily Dose," National Journal, 12/2).

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Now I am open to any topic.  You can be a nurse from a different specialty looking to for advise on how to get in this highly completive industry.  You may be a nurse who by default have been asked by your administration to help launch and implement an Electronic Medical Record (EMR) project.  You might be in sales and want advice on how to market a product.  You may be the CIO of an organization wanting to find other ways to get better end-user adoption.  I want to be open to any topic…

Now let me give you a little bit of my background.  I am a Registered Nurse, and my nursing background has provided me a myriad of experiences.  From my humble beginnings as a Critical Care Nurse, I have done Public Health Nursing (more specifically Parish Nursing), Travel Nursing, Critical Care Transport Nursing and now Nursing informatics.  I have been working in the HIT industry for 5 years now starting in the vendor side and now on the provider side.  My implementation experience is in the inpatient arena.  I am open to discussions related to other disciplines (i.e. ambulatory, financial, ancillary, etc…) because I feel the process is the same.  I am not PMP certified, nor do I hold prestigious letters after my name from HIMSS.  I am not even Board Certified in Nursing Informatics.  All my experiences have been OJT (on the job training).  Depending on your opinion, I personally feel I am gaining the experiences based on real life situations, just like I felt I learned more during my nursing new grad program, than I did in nursing school.  Nursing School definitely gave me the fundamentals, but the critical thinking skills were developed while on the job. 

So, just as I have learned from great people on the job, together we can broaden this experiences through this great medium – The Internet. 

Looking forward to your questions…

Here I am at the gym. I just finished working out, trying to relieve some of the days stress. I just got into a situation, where in I am fixing a mess an employee of mine created for me. What it boiled down to, is the inability to communicate and pay attention to details. This was an employee who pratically begged me for a position, because he was hungry to be given an opportunity to be in a nursing informatics position. Well I took a risk, and he failed me miserably today. On a different note…he embarassed me.

I kept thinking, where did I go wrong, and where did I fail to communicate. As I thought about the situation even more, I personally deduced it to several factors:

1. When implementing an EMR, simply hiring a nurse is not the key. As a matter of fact, being involve in an implementation just highlights how bad of a nurse at the bedside a person was. If you can pay attention to little details that an EMR implementation requires of you, then you must not have been a tune to the suttle changes a patient goes through which highlights whether you were a proactive nurse or a reactive nurse.
2. How dedicated you are at producing a product the clinicians will use is a direct reflection of how good your bedside manners were.
3. Ability or inability to realize as implementers of EMR’s we are acting as care extenders. The product we produce has direct relationship to how safe our patients will be as recipients of care from clinicians who utilize the tool we provided.

These are my thoughts at least…

Your comments appreciated

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