Nursing and the Value PropositionHow information can help transform the healthcare system

John Welton, PhD, RNDean & ProfessorSchool of Nursing and Health SciencesFlorida Southern College, Lakeland FL

Nursing Knowledge: Big Data Research for Transforming Healthcare

From the Original NMDS Conference:“ Reliable, timely and comparative data are needed to

describe the health status of various populations in reference to nursing care needs; to assess, diagnose, plan, intervene, or manage, and evaluate nursing care; and to investigate the quality and outcome of nursing care, the availability and costs of nursing resources, and the use and costs of nursing services.”

Werley, H. H. (1988). Introduction to the nursing minimum data set and its development. In H.H.Werley & N. M. Lang (Eds.), Identification of the Nursing Minimum Data Set (pp. 1-15). New York: Springer.)

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Reformulating the Vision: 21st CenturyReliable, timely and comparative data are needed to:

1.Develop efficient, effective, productive, data-driven and value-driven nursing care systems

2.compare and benchmark nursing care across many different settings and identify and emulate best performance

3.Achieve exceptional outcomes and results of nursing care

4.Provide the best nursing care at the least costs and best price

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Building a Better Health Care System

What is the added value of nursing care?

• Nurses collect data, LOTS of data

• Holy Grail: these data are now in EHRs

Barriers and gaps . . . .

How do we use these data to achieve the stated vision?

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Nursing is a Practice

One nurse – One patient, family, community at a time

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Quality Perspective

• What is good nursing care?

• What/who is a good nurse?

• How to measure:

• Quality vs. performance?

• Quality vs. costs?

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Big Nursing Data

Ubiquitous Data:• Nursing assessment, problem lists, treatments, nursing

diagnosis, interventions, outcomes, intensity• Patient clinical data, vital signs, medication

administration, assessments, labs, etc.• ADT (admission/discharge/transfer) or

clinical appointment, home visit, nursing home, etc.• Charge/billing, cost data• Discharge summary

Key Point: use existing data to achieve the vision to build a better nursing system and build a better healthcare system

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Key Recommendations

1. Link nurses directly to patients in the EHR • Use nurse:patient assignment data to evaluate nursing care and

nurses• All nurses have a National Provider Identifier (NPI)

2. Develop nursing business intelligence and analytic methods and tool• Focus: nursing/nurse productivity, efficiency, performance,

effectiveness, costs/finance, quality, and outcomes (results)• Compare within/across settings• Vendor buy-in: collect these data, cross platform utility• Payer buy-in: optimum payment for optimum nursing care• Consumer buy-in: demand the best nursing care

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Optimizing Nursing CareProductivity • Maximize nursing time/$ dedicated to

patients/patient care

Efficiency • Minimize waste of nursing time/$

Patient Acuity • Identify need for nursing care

Nursing Performance • Optimize the process of nursing care

Effectiveness • Optimize the practice of nurses and nursing care to meet patient needs

Quality/Safety • Minimize “defects” of nursing care

Assignment and Staffing • Assign right nurse for the patient• Provide the necessary nursing resources

to meet changing patient needs

Nursing Finance • Assure best nursing care at the best price• Identify nursing added value that

decrease patient costs of care

Outcomes • Promote superior results of nursing care 9

The Business of Caring

• Benchmarking performance• Comparing nursing within/across settings• Productivity vs. Efficiency vs. Performance• Nursing costs/quality tradeoffs

• Analytic Framework:• Cost/intensity variability• Pattern recognition• Trending and forecasting• Thresholds and parameters

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Take Away Points

1. Massive EHR nursing data = Holy Grail

2. Link nurses to patients – who, what, where, when, why?

3. Develop new methods/metrics, real time information, lead to better decision making

4. Nursing value – how to define within theframework of our data?

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Challenge to the Group

1. What is the bold vision for the future?2. How to build a better healthcare and nursing care system

using existing or new derived data?3. Who are the best nurses and where are the best nursing

systems? How can we benchmark and compare nursing across difference settings?

4. How do we achieve better nursing productivity, efficiency, performance, effectiveness? What data will inform nurses and other leaders? What are the types of analyses we can produce with emerging data in the EHR?

5. Who are the key stakeholders and who will own the solutions and action items? 12