With the expansion of technology into every aspect of healthcare, the Academy of Oncology Nurse & Patient Navigators (AONN+) Technology & Innovation (T&I) Committee focuses on using technology to support and facilitate patient navigation in 3 ways:
- Capture data/metrics for evaluation (eg, integration into electronic medical records [EMRs])
- Quality improvement in navigation (eg, identifying patients, case review)
- Patient education and navigator resources (eg, use of smartphones and mobile devices, access to digital health tools)
Our committee members are from all disciplines, including patient and nurse navigators, administrators, and technologists/information systems professionals who are interested in how to leverage technology to support the implementation and evaluation of navigation.
The T&I Committee is looking forward to sharing insights and experiences from our committee and AONN+ members highlighting the role of technology and innovation to improve the care of cancer patients. This article focuses on the role of technology in ensuring the navigation metrics can be measured and used to provide and improve cancer care.
The AONN+ DOMAINS for certification are: Professional Roles and Responsibilities, Patient Advocacy/Patient Empowerment, Psychosocial Support Services/Assessment, Coordination of Care/Care Transitions, Community Outreach/Prevention, Operations Management/Organizational Development/Health Economics, Survivorship/End of Life, and Research/Quality/Performance Improvement. Each of these domains contains a comprehensive list of all areas in which nurse and patient navigators (navigator) practice that influence financial stability of their organizations and improve quality patient care and outcomes.
To help with measuring the effectiveness and sustainability of navigation programs, the AONN+ Standardized Navigation Metrics Task Force, under the umbrella of the AONN+ Evidence into Practice Committee, developed 35 standardized metrics across 3 focus areas: Patient Experience (PE), Clinical Outcomes (CO), and Return on Investment (ROI). The areas of focus were chosen because of their ability to provide institutional leadership with the data necessary to prove the impact on quality patient care and rationale for continued support and potential growth/improvement initiatives of navigation programs. The AONN+ Metrics Source Document outlines the 35 metrics in detail (www.aonnonline.org/metrics-source-document).
Consistent with the mission of the AONN+ T&I Committee, we accepted the challenge of identifying technical solutions and supporting the overall technical skill development of AONN+ members. By working with AONN+ members to improve the data collection process and enhance the efficiency, accuracy, and simplicity of data collection in the 3 focus areas mentioned above, we strive to improve the overall quality of data collected.
In addition, the T&I Committee aims to work with AONN+ members to inspire and support the role of the navigator in the identification, selection, and utility of technology in all other areas of certification of navigators.
There are many barriers that need to be removed for technology to meet its full potential in data analytics and the management of metrics used to assess hospital business and patient care quality. One of the most significant issues is that of data quality. To this end, the AONN+ T&I Committee has chosen to work with AONN+ members and other committees to address obstacles the nurse navigator community face in standardizing, collecting, and managing the data for the following metrics: PE, CO, and ROI. The T&I Committee will bring value to:
- Identification of opportunities for problem-solving technical solutions
- The process of selecting and assessing the value of technology solutions
- Identification, exploration, and implementation of new technologies that may improve best practices in the navigation role overall
- Enable the AONN+ members to share ideas for high-quality data collection and management of data among members
Healthcare providers, such as navigators, have patient care as their priority. Focusing so much time on patient care creates strain for many providers to have the time necessary to engage in developing technical skills to become subject matter experts of a given technology, analyze process improvements that may benefit from data collection technology, and assess new technologies and the quality improvement impact they may bring. And, even if time was not an issue, leading decision-making discussions on use of technology and presenting possible solutions or opportunities to executive hospital leadership can be intimidating. The primary skill of many healthcare providers is not likely to be business-related.
Once a problem or opportunity has been identified, the challenge is to determine the right technology solution among what is usually a varied mix of external alternatives and internal solutions that have developed through the course of time. Each alternative will try to tackle problems and provide solutions in differentiated ways. As an example, while an application user interface may be similar to that of another option, the specific types of data collected, or the way the system may interface with current hospital information systems, such as EMRs, may be totally different. Some alternatives will be better than others based on the needs of the institution. Knowing what questions to ask and what answers to listen for is essential to good technical decision-making. In general, assessing the right technical solution can be very complex and involve many stakeholders.
Finally, establishing the true value of making a particular IT solution decision can be difficult. While intuitive reasoning can sometimes lead to a seemingly obvious conclusion about how much time or money can be saved, or easily present the impact to quality of care that can be provided by a particular IT solution, many times lack of hard financial facts and objective evidence can stall or stop the decision-making processes. In addition, if a solution is chosen without hard financial, time and money, and quality improvement insights, change management, user acceptance, and overall sustainability can be negatively impacted.
The goal of the AONN+ T&I Committee will be to offer a wide variety of ways to guide the navigation community in research and assessment of alternatives to ultimately take advantage of technology solutions.
Our approach to bringing forward support will follow adult learning principles and be driven through a variety of different media. This will ensure that we structure the way navigators share ideas, concepts, and learnings to meet the needs of working professionals and the variety of learning styles that exist in the AONN+ membership.
Through the remainder of 2018 and early part of 2019, the AONN+ T&I Committee will be delivering at least 3 webinars that will bring ideas and new skill development opportunities to help the AONN+ membership with identifying and assessing technical challenges and solutions. The goal will be to empower the AONN+ membership with information and skills to ensure a sustainable approach to gathering and managing data to drive actionable outcomes in all areas of navigation, but in particular in the areas that are part of the PE, CO, and ROI analytic reviews.
The goal of these webinars will be to help navigators:
- Build skills and knowledge necessary to aid in the technical decision-making process related to how technology can be used for the collection and management of PE, CO, and ROI data
- Provide cancer programs with access to the best information possible on what technical tools may be helpful to gathering and managing PE, CO, and ROI metrics
- Enable cancer care programs to share the success of their oncology navigation metric collection process on a national level and foster the collaboration of best practices among cancer programs for data collection
Beyond Q1 2019, the AONN+ T&I Committee will be using data collected from AONN+ membership to identify other possible means of engaging and supporting our collective membership improvement in the use of technology in ways that bring value to the role of navigation, cost-effective care, and overall patient care quality.
We will strive to support the skill development and information exchange with the goal of enhancing overall capabilities in each of the AONN+ DOMAINS—Professional Roles and Responsibilities, Patient Advocacy/Patient Empowerment, Psychosocial Support Services/Assessment, Coordination of Care/Care Transitions, Community Outreach/Prevention, Operations Management/Organizational Development/Health Economics, Survivorship/End of Life, and Research/Quality/Performance Improvement.
The AONN+ Standardized Navigation Metrics Task Force has defined and outlined the criteria and rationale for the 35 standards to which nurse navigation program performance can be measured across PE, CO, and ROI. As good as these standards are, and the importance they play in improving patient healthcare and efficiency in delivery of healthcare, we have all heard the old saying as it relates to the use of data in decision-making: “Garbage in, garbage out.”
When it comes to cost and quality of data, the manner in which those data are collected, managed, stored, and brought forward to stakeholders for decision-making is often not as good as it needs to be. Many cancer care teams are faced with the challenge of collecting and gathering data from a number of disparate sources of data, and this adds to the complexity. Since performance metric systems are forms of clinical decision support, it is important to consider that clinical decision support systems use data from a variety of sources to provide guidance to physicians at the point of care. However, several studies have shown that data from these registries often cannot be trusted to be accurate or complete. For instance, one study shows that accuracy and completeness in medical registries may be as low as 67% and 30.7%, respectively.1
Because the quality of data plays such a significant role in decision-making not only in patient care but in investments to be made in performance or quality improvements, decisions in change management, etc, it is important that the AONN+ T&I Committee is leaned on to:
- Create awareness of the resources that exist to support navigators in their day-to-day work
- Partner with other organizations to identify innovative ideas that help navigators advance patient care
- Conduct a survey to determine the technology and training priorities of AONN+ members
- Grow committee membership
Data quality is imperative for any program that is using data to build metrics, manage performance, and make quality patient health and business decisions. Technology can play a significant role in helping to improve the quality of data and the efficiency with which data are collected and used. The role of cancer care nurse navigators is significant, and they can benefit from technology in many ways. In addition, they can play an influential role in deciding what technology is needed to enhance the patient care process, drive quality healthcare in general, and help to control administration costs. The AONN+ T&I Committee will provide tools, support, and resources to help improve the AONN+ membership proficiency in technology assessment, utility, and evangelism to technology.
Call to Action
AONN+ strongly encourages each navigation program to build a strong sustainable business case and demonstrate that all areas of navigation be measured and reported. Through discussion, the AONN+ T&I Committee would like your support in identifying technical solutions that may be required, collaborating with other navigators to build skills in identifying internal technical solutions and bringing the solutions forward to senior leadership, and producing best practices that will help change management actions that may be necessary considerations for other institutions to implement.
Finally, please note that AONN+ will develop a metrics repository for programs to report outcomes, share lessons learned, and share what performance improvement initiatives have been implemented to enhance and improve navigation processes. This provides a vehicle to share data nationally and develop standardized reporting. The AONN+ T&I Committee would like your support and insight to help build this standardized reporting tool.
The author gratefully acknowledges the Standardized Navigation Metrics Task Force team: Sharon Gentry, RN, MSN, ONN-CG, AOCN, CBCN; Elizabeth Brown, MSN, MHA, RN, NE-BC, OCN; Nicole Messier, BSN, RN, OCN; Barbara Rizzo McHale, BS, RN, ONN-CG, OCN, CBCN; Cheryl Bellomo, MSN, RN, ONN-CG, OCN; Linda Bily, MA, CSA, OPN-CG; Vanessa Rodriguez, MSW, OPN-CG; Tricia Strusowski, RN, MS; Elaine Sein, RN, BSN, CBCN; and Danelle Johnston, MSN, RN, ONN-CG, OCN. The author also wishes to thank AONN+ for the continued support and resources toward this initiative.
- Hasan S, Padman R. Analyzing the effect of data quality on the accuracy of clinical decision support systems: a computer simulation approach. AMIA Annu Symp Proc. 2006:324-328.