As our population ages the importance of one’s ability to remain independent as long as possible will become even more important than it is today. One of the leading causes for the placement of a frail adult in a nursing home is due to non-adherence to medication regimes. In fact, 10 to 25 percent of hospital and nursing home admissions annually are because of an individual’s lack of adherence.

The American Academy of Nursing working with the Agency for Healthcare Research and Quality has published practice guidelines for nurses working with the older adults in the community on the management of their medication. There are many risk factors that affect the individual’s adherence from physical ability to depression and beyond.

We know that nursing interventions and evidenced based transitional care innovations where an advanced practice nurse leads an interdisciplinary team can help the patient and their caregivers prevent non-intentional and/or intentional non-adherence of medications.

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As the President and CEO of the American Academy of Nursing, I am very interested in the direction and potential of HIT. Of course, the issue of meaningful use is at the center and of tremendous importance. But the definition as it currently stands does not go far enough.

What follows are recommendations put together by a working group of the Academy’s technology and informatics experts for The Department of Health and Human Services.

To Meet the Needs of Patients, the American Academy of Nursing
Says we need to go Beyond Meaningful Use

The American Academy of Nursing (AAN) is an advocate for improved patient safety, cost-effective care management of acute and chronic conditions, and the effectiveness of nursing and interdisciplinary care. The Academy strongly supports health care reform that goes beyond the prevention, diagnosis, and treatment of disease to include assisting persons to manage their own and their family’s health as well as possible. Such reform must capitalize on the contributions of all health care disciplines. This aggressive approach to broad health care reform will only be achieved and sustained if information systems are collaboratively designed by the “meaningful users” to address data elements that reflect the work of all health care disciplines.

The AAN recommends that future electronic health records (both EHR’s and PHR’s) not only provide for documentation of the services provided by all disciplines but also address the shifting of care from acute and ambulatory care settings to home and community-based settings. To achieve its intended role in health care reform, comparative effectiveness research (CER) must include accurate data collection and data exchange, address health as well as illness content, and be interdisciplinary versus physician-centric.

To assure meaningful use of health care information and information systems by all health care disciplines, the AAN therefore respectfully requests the following:

1. The “Meaningful User” Definition should specifically include advanced practice registered nurses (APRNs), registered nurses (RNs), and other interdisciplinary health care clinicians as providers, particularly in hospital settings, but also in most ambulatory and home care [or community-based] settings where the nurse may collect key demographic data, conduct the initial screening, and support implementation of the medical regimen, and whose documentation will largely determine if the overall encounter meets the various mandatory guidelines for effective and efficient patient care. In creating the definition of “meaningful user”, CMS must include all essential contributors to the care episode documentation if those contributions provide critical evidence of the effectiveness of care.  (See Sample Definition Matrix at end)

2. The “Meaningful Use” definition should include inpatient documentation by nurses and other patient care providers. Likewise, ambulatory care including community and home based settings where nurses and other key patient care providers deliver services that will impact the quality and outcomes the care should be included in the definition. The use of the EHR by nurses and other key providers is essential in supplementing and expanding the meaningful use by physicians. In the majority of situations, especially in the inpatient sector, physician design of the EHR and the population of the information fields will be incomplete and the data collection not comprehensive without the meaningful involvement and contributions of nurses and other key providers.

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What Nurses Can Teach Senators About Medicare:

Medicare took center stage earlier this week at a roundtable hearing held by the Senate Finance Committee to discuss reforming America’s health care delivery system. Because care for chronically ill older adults accounts for a disproportionate share of health care spending, Senate members were seeking solutions that could demonstrate Medicare savings for this population.

Dr. Mary Naylor, the Marian S. Ware Professor in Gerontology at the University of Pennsylvania School of Nursing and director of NewCourtland Center for Transitions and Health testified at the hearing and recommended the establishment of a Medicare benefit covering a program of transitional care to help coordinate care from hospital to home in the management of chronic illness. Mary’s main point: “There is an opportunity to reform our health care system using a rich base of evidence that demonstrates that nurse-led, team-based, transitional care can improve the health outcomes of at risk chronically ill elders, reduce avoidable hospitalizations and decreased health care costs.”

I was glad to see there was a great deal of interest in the transitional care model. I think the Senators get it that a significant portion of the Medicare population is costing the system dearly and models like Mary’s are innovations that need to be considered.

I heard some serious tension between the ideas of being bold with the reorganization of health care while others were saying too much disruption would scare purchasers and patients away. I heard Senators and former CMS Director Mark McClellan as well as the Director of MEDPAC say there will be upfront costs to do things differently such as scaling up primary care services. There were more conservative Senators who didn’t want to hear this.

Senator Hatch wants to create a Commission of the Health Care Workforce in response to the call from several physician groups present that we have a shortage of primary care docs, general surgeons. Others added nurses and nurse practitioners. I didn’t hear much support for his idea. The additional bonuses for primary care docs led to the discussion about medical homes and the admission from the MEDPAC director that this isn’t just about a payment to docs but evidence based practice, health IT integrations, and so on. The importance of nurse case managers for medication management, care coordination and patient compliance was a theme especially from health systems CEOs. Good to hear.

What next? Mary Naylor recommends the following: (more…)

On March 18th I represented the American Academy of Nursing (www.aannet.org) at The Women’s’ High-Tech Coalition Luncheon that took place on Capitol Hill. The title of the Panel was Health Information Technology: Addressing Privacy and Security Concerns to Bring Healthcare into the 21st Century. The other panelists were: Kate Gross from Senator Jay Rockefeller’s office, Lisa Gallagher from HIMSS and Eva Powell, Health IT Director for the National Partnership for Women and Families. With all the momentum around Health IT I was pleased to have this opportunity to participate in this important discussion and present the nursing perspective.

Here are the thoughts I shared…

1. The Academy is supportive of the investment in smart health IT as it has the potential to be a useful tool that can assist patients, families and health professionals in reducing errors, improving care coordination, patient safety, quality and outcomes. However, we want to ensure there is discussion surrounding how to sustain the technology so it can continue to meet both patient and provider needs happens during the initial implementation stages.

2. We believe there needs to be a balance between privacy and the realities of health practice and the need to share timely information.

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Chronic diseases are the number one cause of death and disability in the U.S.—accounting for 70% of all deaths and more than 75% of the $2 trillion the US spent on health care during 2005.

Most of us know personally the devastation caused by chronic diseases like cancer, heart disease and diabetes. It’s overwhelming—but there is something everyone can do.

Take a look at this video produced by the Partnership to Fight Chronic Disease (PFCD)—pass it on to everyone you know—and VOTE.

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Since becoming CEO of the American Academy of Nursing, I have been inspired by the nurses and other health care providers that have seen health care challenges in their communities and created cost-effective solutions that improve health outcomes.

For example, under the direction of Margaret Grey, DrPH, RN, FAAN, nurses associated with the Yale School of Nursing have provided coping skills training to youths and their families suffering from type 1 diabetes and at risk for type 2 diabetes for more than 12 years.

Or take for example, the Eleventh Street Family Health Services, which serves families who live in public housing developments in the Philadelphia area. Fifty-seven percent of patients are covered by Medicaid and 33 percent are uninsured.

Or in Kentucky, Kay Roberts, EdD, MSN, FAAN offers weekly hypertension management clinics and classes for self management of chronic illness. Since opening its doors in 2003, the clinic has prevented unnecessary hospitalization in approximately 25 percent of its clients with chronic illness and reduced the cost of primary care by more than 50 percent for each client.

Americans are known for their creative and innovative spirit, and as policymakers reform our health care system, they should closely examine what is being done by various health care providers across this country. When they see models that work policymakers should examine why they are successful and encourage the implementation of these models in communities facing similar problems.

True health care reform has already been set in motion by nurses and other health care providers on the ground and in the field working tirelessly to help Americans stay healthy. It is now time to scale up and spread these initiatives.