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EXECUTIVE SUMMARY
* This case study explores costs of electronic health record (EHR) implementation with the nursing super-user role in a metropolitan, not-for-profit health care system.
* Tapping the local pool of unemployed newly graduated nurses as half the required super-user workforce leveraged the technology skills of novice registered nurses (RNs) as trainers of experienced nurses in five hospitals.
* The novel workforce migrated from hospital to hospital, thereby reducing the number of experienced nurses reassigned to super-user duties in each hospital.
* This strategy reduced the amount of contract labor required to backfill nurse super-users' clinical shifts.
* Employment of the recently graduated nurses as RN residents upon completion of the EHR implementation enabled the organization to augment its clinical workforce with expert users of its EHR.
* The proposed innovative model increases super-users, minimizes disruption of core staffing, and dramatically reduces expense.
THE AMERICAN RECOVERY and Reinvestment Act of 2009 is the foundation of a complex body of regulations, intended to promote development of a national health care infrastructure. A key subset of those regulations, the Health Information Technology for Economic and Clinical Health Act (HITECH Act), was signed into law on February 17, 2009 (U.S. Department of Health & Human Services, 2009). In addition to strengthening enforcement of privacy and security provisions of the Health Insurance Portability and Accountability Act of 1996, the HITECH Act established incentives to providers and hospitals for the adoption of electronic health record (EHR) technology.
Eligibility for incentives requires the organization verify the EHR is utilized in a meaningful manner. Meaningful use is demonstrated by "the use of certified EHR technology in a meaningful manner...that provides for the electronic exchange of health information...to improve the quality of care" (Centers for Disease Control and Prevention, 2012, para. 1). Selection and implementation of an EHR are not a guarantee of success. Full adoption evidenced by meaningful use of the technology by end-users "is crucial to achieving the intended effects of the systems" (Granlien & Hertzum, 2012, p. 216).
Problem Statement
The project setting was an integrated health care delivery system in California comprising six hospitals, multiple ambulatory clinics, a skilled nursing facility, and an array of subacute, transitional care, rehabilitation, and home health and hospice programs. In response...