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Point-of-Care Computing for Interdisciplinary Teams: New and Emerging Trends By Michelle Troseth, RN, MSN

Point-of-care technologies are transforming how nurses practice and deliver care, according to “Equipped for Efficiency: Improving Nursing Care Through Technology,” a 2008 report from the California HealthCare Foundation. Nursing and other disciplines are beginning to reap the rewards of preloaded systems and look forward to a future that features interdisciplinary integration at the point of care and smart integration of patient information.

Emergence and Transcendence of Point of Care
A growing number of vendors have begun to adapt system functionality to support professional practice, evidence-based content, and interdisciplinary integration at the point of care. National initiatives such as Technology Informatics Guiding Educational Reform (TIGER) are also in the game, calling for practices in information/knowledge management and technology tools for nurses. Meanwhile, TIGER working groups, such as Usability and Clinical Application Design, give transparency and voice to the role, function, and scope of technology in the daily workflows of nurses. Similar projects exist within the American Academy of Nursing, the American Medical Informatics Association, HIMSS, and the American Nursing Informatics Association.

The Emergence of the Preloaded System
Clinical decision support (CDS) companies now offer hospital system solutions similar to those offered by Apple–iPods preloaded with music. Hospitals can tap into systems preloaded with an evidence-based professional practice framework and content, useable within any vendor application. Such evidence-based information supports the professional process of care, from diagnosis and care planning to the documentation of interventions and evaluation of the care process. The results are twofold: “leapfrogging” of care standardization and greater cost control in the highly repetitive “design and build” process.

A large Midwestern healthcare system had created its own clinical content and flow sheets but eventually chose a preloaded option featuring interdisciplinary content. Because the CDS software was designed to support professional practice and workflow, it required minimal tweaking by IT professionals, who calculated a time savings of close to 75% over design and build. The healthcare system benefited from more rapid standardization of care and a successful Joint Commission survey just five weeks after CDS activation.

In the years ahead, some experts believe all clinicians will increasingly depend on CDS systems for guidance on potential complications, clinical lab results, diagnostic tests, patient evaluation, and interdisciplinary consultations. Such interventions and support may improve the quality of care and control costs by reducing the repetition and duplication that plague healthcare.

Emergence of Interdisciplinary Integrated Care and Competencies
Instead of consulting dusty textbooks for advice, nurses will receive timely how-to skills training at the point of care. Nurses whose patients have specific problems will consult point-of-care systems for advice on how to perform procedures such as chest tube insertion assistance and maintenance. Such technologies are already available to nurses through online multimedia resources that offer direct access to skills required for patient procedures at the point of care.

CDS systems must use both design and content to enhance interdisciplinary integration and collaboration. Consider nurses and respiratory therapists who work side by side and require a single approach to system use and documentation. When treating a patient with asthma, the nurse and the therapist use the system as a team, carefully documenting the patient’s story and tapping into the same body of evidence-based content. With this approach, clinicians within varied disciplines could emerge as mutual mentors and coaches. Patients, in turn, reap the benefits of care free from excessive fragmentation, duplication, and stress.

CDS systems offer content developed, written, and implemented from an interdisciplinary point of view. No longer does one discipline reign over, dominate, or cancel out another. Instead, system design and information supports the work of the entire healthcare team while honoring each team member’s contribution. Barriers between and among disciplines may fade as all parties embrace a common set of decision-support tools that help their individual and integrated scopes of practice.
Although nurses and respiratory therapists may overlap in scope of practice, they will still maintain distinctive sets of knowledge, skill, and expertise. And before building evidence-based content to generate better health outcomes, hospitals will focus on each discipline’s unique scope of practice, as well as areas of overlap.

Integration is also on the horizon for physicians and nurses, not only in daily clinical documentation but also in the integration of clinical practice guidelines with evidence-based order sets to create a complete integrated electronic health record that reflects practice at the point of care. 

Hospitals have already witnessed positive outcomes using evidence-based content and interdisciplinary CDS to significantly reduce falls and pressure ulcers. For example, one healthcare system in the South reported a decrease in pressure ulcers of 69% and an 85% reduction in falls.

Emergence of “Smart” Integration of Patient Information
As technology advances, so will the ability of clinicians to leverage the technology. Clinicians will spend less time entering data and more time synthesizing it. While today’s hospitals depend on clinicians to manually enter data, tomorrow’s clinicians will benefit from technology companies’ current investments in “smart” devices, vests, blankets, and rooms. 

These devices will input critical patient data that nurses and other disciplines can view and use for improved clinical reasoning and decision making. Charges for professional services are likely to be based on the duration of each discipline’s presence in the patient room, as well as the value and clarity of the discipline’s contribution of care, as documented within the electronic health record.

However, complete point-of-care transformation will evolve only when nurses join forces with other clinical professionals and vendors to improve outcomes in health and the business of health. Working together, varied disciplines will draw from a common repository of evidence-based content to anticipate a patient’s risk, determine needed surveillance, and tailor a plan of care.

— Michelle Troseth, RN, MSN, is the executive vice president and chief professional practice officer for the Clinical Practice Model Resource Center, a business unit of Elsevier, Inc.