What in the World is ARRA? And what does it mean for Bedside Nurses?

ARRA is the American Recovery and Reinvestment Act. It was signed into law by President Barack Obama on February 17, 2009.

According to the U.S. Government’s recovery.gov website, “The purpose of the $787 billion Recovery package is to jump-start the economy to create and save jobs.”

Title XIII of this 407-page document is “Health Information Technology”.

HIGHLIGHTS:

    • In Section 13301 (page 113): it shows that ARRA has provided for, among other things, “Immediate funding to strengthen the health information technology infrastructure.”
    • In Section 3001 (page 116), it says that the purpose of the Office of the National Coordinator for Health Information Technology (ONCHIT) is to “perform the duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure that allows for the electronic use and exchange of information”.
  • And furthermore, one of it’s objectives is “The utilization of an electronic health record for each person in the United States by 2014.”(page 117)

SO, WHAT DOES IT MEAN FOR NURSES AT THE BEDSIDE?

1. If your facility is still using paper charting, it could mean that you will probably be hearing that there is a “push” for your organization to start transitioning to electronic charting or electronic health record (EHR) in the near future.

2. If you are planning to start or move to a job at one of the larger hospitals or a major teaching hospital in the country, chances are they are already using an EHR or getting to roll one out, so you need to be ready to learn a new skill – using an EHR while continuing to provide safe, quality care to your patients.

3. If you are a nurse working in a facility with an EHR in place, you already have a very valuable skill – one that is already useful and might prove transferable in the future.

A study released on March 25, 2009 showed that out of 2,952 hospitals in the U.S., only 1.5% had a “comprehensive” EHR in place, and an additional 7.6% had a “basic” EHR in place by 2008.

(According to the survey, “comprehensive” EHR was defined by an expert panel as having 24 functionalities – for example, physician notes, lab reports, medications-present in all major clinical units of a hospital. The criteria for “basic” EHR was having ten functionalities in at least one major clinical unit.”)

This means that a bedside nurse with some experience using an EHR can be a valuable resource if he/she goes to work in a facility that is just starting to adopt one. This is especially true if the EHR being used is the same or similar to the one he/she is familiar with. And even if the EHRs are different, just the experience of being able to use one can, in my opinion, certainly give nurses a degree of comfort in using a new or different EHR.

4. With the national push to use an EHR for each person in the United States by 2014, we will most probably be seeing more admission endorsements/documentation (that usually comes with the patient when they are admitted/transferred from a clinic or another facility) in the form of portable storage devices (such as flash drives) instead of paper. We can then expect a change in our routines, procedures, and even bedside software/hardware to include the ability to access these devices.

5. With more comprehensive EHRs put in place, we have even more information on our fingertips to be able to help provide better and safer care for our patients.

I am not by any means saying that the road to “an EHR for each person in the U.S. by 2014” will be a smooth one. After experiencing 2 different EHR implementations (and using 2 other electronic documentation systems that were already in place when I arrived), I can tell you stories of woe, tears, tantrums and overall stress in using them, especially when transitioning to a new one. Eventually, however, most nurses adapt to the new technology and new way of doing things, and some go on to become expert users.

What I’m trying to share in this note, which I hope will be heard clearly, is that using an EHR is already a reality for many people and many facilities. It is no longer something out of a futuristic book or movie. It is here, now, and will be even more commonplace in the next few years.

There are many opportunities here for bedside nurses, foremost of which is our ever-increasing ability to tap into more comprehensive information about our patients – giving us new and more powerful tools to help provide them with the best possible care.

Other opportunities abound: bedside nurses who want to transition to new careers can become teachers (clinical instructors or facility-based trainers) and user support / implementation facilitators for this new technology. Even now, many nurses are finding new careers in nursing informatics and other areas of health information technology, including telemedicine.

And of course, bedside nurses familiar with EHR who choose to provide direct patient care throughout their careers will be invaluable resources to future generations of nurses and physicians.

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RESOURCES:

ARRA FAQs

The Recovery Act Blog is the official White House page for updates about the Recovery Act

Study Finds U.S. Hospitals Extremely Slow to Adopt Electronic Health Records, Citing Cost

The original study as it appears in the New England Journal of Medicine

A summary of the major healthcare provisions of the ARRA

 

(REPUBLISHED AND UPDATED from my article in Facebook originally written in May 2010)