Implementing Essential V (Informatics) – A Project Proposal to Reduce Heart Failure ICU Mortalities by Fostering Interprofessional Collaboration Using EHRs

Introduction

The increasingly dynamic nature of today’s healthcare system emphasizes the need for
nursing professions and faculties to equip graduates with competencies, skills, and knowledge to
lead the change processes, promote quality outcomes, develop innovative nursing practices using
cutting-edge technology, build and head collaborative interprofessional healthcare teams, and
translate evidence into practice when they are absorbed into the field. For Masters of Nursing
students, the faculty provides a list of nine “Essentials” that all graduates must acquire and use in
the field. Essential V (Informatics and Healthcare Technology) is one of these critical
knowledge-based elements that all graduates must possess and implement. This essential require
that master’s-prepared student design and use innovative technologies like electronic medical
records (EMRs) to deliver and promote care and apply communication apps and technologies to
coordinate and integrate care (American Association of Colleges of Nursing, 2011).
In that regard, this paper describes a scenario where I was part of an interprofessional
team attempting to improve clinical processes (entering patient records, requesting labs, ordering
and prescribing drugs) for heart failure patients in the intensive care unit (ICU) using electronic
health records (EHRs). The goal was to improve interprofessional collaboration, communication,
and shared decision-making and ultimately lower medical errors, mortalities, and length of
hospital stays.

Population/Stakeholders

i. Population

3
In line with Essential 5 (Informatics and Healthcare Technology) requirement for Masters
of Nursing graduates, we developed and implemented an electronic medical record (EMR) or
electronic health record (EHR) for intensive care unit (ICU) patients with heart failure. ICU
patients with heart failure often face adverse health outcomes – high mortality rates, extended
hospital stays, and increased costs – due to defective workflows and processes (Zobel et al.,
2012). These adverse outcomes and inefficient workflows and processes stem from
miscommunication and lack of collaboration, leading to wrong decisions. ICU patients with heart
failure often have little time to survive, meaning that the clinical decisions made within seconds
or minutes can determine life and death. We developed and implemented an electronic health
record (HER) to improve interprofessional communication and collaboration to support shared
decision-making.
ii. Stakeholders
a. Heart failure ICU Patients. The first and most critical stakeholders were ICU
patients admitted with heart failure, which occurs when the heart fails to pump blood properly
around the body. Patients in cardiac ICU receive round-the-clock monitoring of the cardiac
rhythm using the ECG (electrocardiogram).
b. Project Manager or EHR Implementation Lead. The project manager is
another integral member of the EHR implementation team. The project manager was responsible
for the program’s overall implementation activities, including developing actionable objectives
and goals, developing project requirements and milestones, and meeting deadlines. He was
responsible for linking the different phases of the project – planning, design, development,
implementation, and testing – ensuring that they were seamless and communicated together
(Office of the National Coordinator for Health Information Technology, 2019).

4
c. EHR Team Lead. The EHR team lead worked closely with the project manager
and other leads, and he was crucial in making final decisions regarding the overall project
implementation plan.
d. EHR App developer. The app developer was the individual (company) tasked
with designing, developing, installing, and testing the electronic health record software or
system. The EHR developer custom-built an EHR application for our cardiac ICU department,
linking it with other departments like the pharmacy, laboratory, and many others.
e. Other stakeholders. The other critical stakeholders involved in the
implementation process were the physician champion, nurse lead, scheduler lead, medical
assistant lead, information technology lead, workflow redesign lead, meaningful use lead, and
the training/super-user lead.

Setting

The setting for the program implementation was the local community hospital’s cardiac
or cardiovascular intensive care unit (CICU), which admits patients with heart failure and other
heart-related problems, such as cardiac arrest, acute myocardial infarction, shock, and
arrhythmias. The hospital’s cardiac ICU has a 10-bed capacity. Services offered include cardiac
arrest diagnosis, emergency response activation, early cardiopulmonary resuscitation, rapid
defibrillation, advanced and basic emergency clinical services, and advanced post-cardiac arrest
care and life support, including mechanical ventilation, blood purification, and temperature
management.
The high mortality rates among heart failure patients in CICU prompted the facility to
form a team to oversee an EHR implementation to improve interprofessional (physicians, nurses,
pharmacists) communication and collaboration and streamline internal workflows and processes.

5
At the implementation time, the average mortality rate stood at 9.5%, while the average length of
stay at the CICU was 3-6 days, and the medical errors stood at 5%. The decision to implement an
electronic health record was informed by previous research that has placed better health
outcomes in cardiovascular ICUs to EHRs and other technologies (Kunitomo et al., 2021).
According to evidence, EHR systems can potentially improve communication and sharing of
accurate patient data at the point of care.

Desired Outcomes

The first desired outcome was to reduce mortality rates from cardiac arrests and other
heart-related problems among patients admitted to the hospital’s cardiovascular intensive care
unit. We also wanted to reduce medical errors, and the length of hospital stays for CICU patients.
At the implementation time, the average mortality rate stood at 9.5%, while the average length of
stay at the CICU was 3-6 days, and the medical errors stood at 5%. Twelve months after
implementing the EHR system, we discovered that length of stay dropped to 1-4 days, while
mortality rates and medical errors reduced by 8% and 11%, respectively.

Conclusion

The primary objective of implementing the EHR system was to conform to the Essential
V (Informatics and Healthcare Technology), which requires that master’s-prepared graduates
design and use innovative technologies to deliver and promote care and apply communication
apps and technologies to coordinate and integrate care. In particular, we designed and
implemented a certified electronic health record in the cardiac/cardiovascular ICU to improve
interprofessional communication, collaboration, and shared decision-making. Specifically, the
technology streamlined CICU workflows and processes, improved sharing of accurate health

6
information (including patient data) at the point of care, reduced misdiagnosis and other medical
errors, and lowered the length of stay at the CICU and mortality rates.

7

References

American Association of Colleges of Nursing. (2011). The Essentials of Master’s Education in
Nursing. https://www.aacnnursing.org/portals/42/publications/mastersessentials11.pdf
Kunitomo, Y., et al. (2021). Electronic health record risk score provides earlier prognostication
of clinical outcomes in patients admitted to the cardiac intensive care unit. American
Heart Journal, 238, 85-88. doi: 10.1016/j.ahj.2021.04.004
Office of the National Coordinator for Health Information Technology. (2019). Who are the key
stakeholders during electronic health record (EHR) implementation? HealthIT.gov.
https://www.healthit.gov/faq/who-are-key-stakeholders-during-electronic-health-record-
ehr-implementation
Zobel, C., et al. (2012). Mortality in a cardiac intensive care unit. Clinical Research in
Cardiology, 101(7), 521-524. doi: 10.1007/s00392-012-0421-9