banner
HCPro

Nursing roles elevated under value-based care: Are IT tools keeping up?


CLICK to Email E-mail
CLICK for Print Version Print
Archives

By Julie Mills, RN, MBA, senior manager, clinical solutions executive, PerfectServe

As the healthcare industry transitions toward a value-based payment model, new delivery methods are needed to expand primary care access, leverage population health management, improve patient engagement, and expand interdisciplinary care team collaboration. Throughout this evolution, nurses have a prominent role in leading the charge to help patients stay out of the hospital by managing their health proactively.

Research out of Cedars-Sinai, as reported by the U.S. Health Resources and Services Administration (Burnes Bolton, 2018), demonstrates four specific examples of new nursing roles that have already begun coalescing to meet the demands of value-based care:

  1. Reduce avoidable admissions and readmissions: To reduce avoidable admissions and readmissions, nurse practitioners are deployed to skilled nursing facilities, where they see patients within 24 hours of admission and 2-3 times per week thereafter. This results in a 35% drop in avoidable admissions, a 40% drop in readmissions, and a 30% drop in length of stay.
  2. Bolster population health management: Within population health management programs, nurses practice proactive health maintenance by going where people live, work, or attend school to lead self-help programs and address social determinants of health. For example, the Family Connects Durham program provides free home visits by RNs to parents of children who are 2-12 weeks old, and every dollar spent saves $3 in avoided hospital emergency costs (Duke Sanford Center for Child and Family Policy, n.d.).
  3. Expand the care team: Given that healthcare is a team sport, nurses now work with pharmacists to provide education where medication literacy is lacking. They ensure safe medication use within the home and work with social workers to ease transitions across the healthcare system.
  4. Increase technical acumen: The role of the nurse technologist is also increasing as nurses work with engineers, informaticists, and scientists to remotely monitor patient conditions and deploy technology that provides early warnings during the care of patients with chronic conditions. This results in improved self-care management, early detection of health changes, and interventions that prevent hospitalization.


Another example comes from primary care settings. Some progressive providers increase patient access by conducting nurse-only patient visits during which RNs document patient histories, order lab or other diagnostic tests, and determine patient acuity. As a result of these expanding roles and increased responsibilities, on average, nurses now spend as little as 25% of their time at the bedside (Healthleaders, 2009).

Heavier burdens necessitate technological change
If nurses are to meet the new demands of value-based care, better technology is absolutely essential. The electronic health record (EHR) alone is not enough to answer the call.

On top of day-to-day clinical workloads, nurses will only be successful if tools for easier communication and care coordination keep pace. Inefficient workflows associated with legacy communication devices and numerous overlapping systems add incremental complexity as the care team evolves to include nurses, physicians, therapists, and home care workers across multiple hospital and acute and primary settings.

Technology adds value to nurses in value-based care
Clinical communication and collaboration technology is one sector making rapid advancements to meet the evolving needs of nurses. New platforms automatically communicate with the correctly assigned physician, coordinate care among expanded care teams, and give nurses tools to educate and empower patients.

For example, advanced communication technology helps nurses communicate efficiently with other members of the care team, including those offsite, such as home health nurses and healthcare professionals at specialized hospitals, skilled nursing facilities, and wound care clinics. Automated secure text messages replace manual, time-consuming communication tasks currently used to prepare or follow up with patients.

Six relief points to consider
As new technology applications continue to reduce the burden of non-clinical and administrative tasks, nurses can assume a more significant role under value-based care and focus their time on patients who need additional care. Here are six specific points to consider when evaluating new technology solutions to better support expanded nursing roles:

  1. Care team coordination: Collaborate with providers inside and outside the walls of the facility. Connect with on-call care team members as a group, or by name or role such as “on-call cardiologist,” ensuring a nurse can reach the right physician at the right time to improve outcomes without the inefficiencies of referencing call schedules or playing phone-to-pager tag with physicians.
  2. Pre-appointment patient communication: Automate the communication of day-of-procedure information, appointment reminders, and wayfinding details to prepare patients for upcoming appointments or procedures.
  3. Post–appointment patient communication: Automate post-discharge communications to reiterate the care plan, send timely reminders (such as prescription pickup or follow-up scheduling prompts), and assess patient health status and satisfaction with text-first survey questionnaires. Nurses can then prioritize follow-up with patients in need of clinical intervention.
  4. Time-critical updates: Rather than force nurses to log in to the EHR to check for results or orders, critical updates (orders and critical lab results) are pushed to the nurse and other care team members to speed up care delivery.
  5. Real-time charting: A mobile, easy-to-use interface to access patient information and take notes, with text shortcuts, voice-to-text, and intelligent field mapping reduces duplicate data entry.
  6. Nurse call, alarms, alerts: Nurses receive alerts on their mobile devices and web apps, where they can accept, escalate for assistance, or call back to speak with the patient.


Under value-based care, nurses lead the effort to sustain patients and help them to proactively manage their health in a way that keeps them out of the hospital. Nurses provide more patient-centered, efficient, and cost-effective care, from pre-appointment to intake to discharge and follow-up.
 
Enabling nurses to take on these elevated roles requires the use of better technology, which enables better workflows and practices that alleviate fatigue and burnout while also achieving optimal efficiency and better outcomes at lower costs.

References
Burnes Bolton, L. (2018). Nurses Role in Advancing Value Based Healthcare. Retrieved from https://www.hrsa.gov/sites/default/files/hrsa/advisory-committees/nursing/meetings/2018/nacnep-sept2018-nurses-role-in-advancing-value-based-healthcare.pdf

Duke Sanford Center for Child and Family Policy. (n.d.). Durham Connects nurse home visits help infants, save dollars. Retrieved from https://childandfamilypolicy.duke.edu/news/nurse-home-visiting-benefits-infants-saves-dollars/

HealthLeaders. (2009). Outsourcing Discharge Follow-up Calls Keep Nurses at the Bedside. Retrieved from https://www.healthleadersmedia.com/nursing/outsourcing-discharge-follow-calls-keep-nurses-bedside


About the Author:
Julie Mills has an MBA in Healthcare Administration from Indiana Wesleyan University, a Bachelor of Science in Nursing from Bellarmine University, and is currently in pursuit of a Doctor of Nursing Practice degree at the University of Tennessee, Chattanooga. Julie served in the United States Air Force Nurse Corps after graduation from college, and most recently, Julie has turned her clinical expertise and nursing experience toward improving clinical workflow and communication in today’s healthcare systems as senior manager, clinical solutions executive at PerfectServe. She can be reached at: jmills@perfectserve.net.