The Impact of an Electronic Health Record to Advancing Nurse Navigation Using Standardized Metrics in a Healthcare System

November 2021 Vol 12, No 11
Jeanne Silva, MSN, RN-BC, CMSRN, CN-BN
RWJBarnabas Health System and Rutgers Cancer Institute of New Jersey, Somerset, NJ
Avni Patel, BSN, RN
RWJBarnabas Health System and Rutgers Cancer Institute of New Jersey, Somerset, NJ

Background: As the healthcare landscape is evolving from independent hospitals to large healthcare systems, the challenge of standardizing programs such as navigation becomes paramount to ensuring best practices and service consistency. Oncology navigation has made advances to define metrics and quality measures; however, challenges still exist when navigation programs span across diverse healthcare systems without the advantage of a systemwide healthcare record or the ability to track key performance indicators. The team of 35 navigators serves diverse populations anchored by a National Cancer Institute–Designated Cancer Center and includes local community hospitals. Equally diverse is the method of data collection, ranging from 2 facilities using ink and paper, 7 relying on Excel spreadsheets, and 1 urban site using a siloed navigation-specific electronic health record (EHR). Metrics set the tone to evaluate a program’s effectiveness, measure clinical outcomes, and assess patient obstacles to treatment. Aggregating data was time-consuming and difficult to validate. Obtaining critical accreditation data, such as patient barriers to care, was limited.

Objectives: To implement standardized navigation metrics with an enterprise-wide EHR. The EHR will capture navigation-specific data to benchmark against the industry and internal standards across a multiple- site healthcare system.

Methods: We convened a working group of facility leaders, nurse navigators as subject matter experts, informatics, and vendor experts. The stakeholders conducted an in-depth review of industry standard metrics, establishing a consensus of tracking 8 key measures. The high-level assessment identified the need to improve efficiency and productivity, quality of care, patient safety, meet accreditation standards, identify barriers, and interventions. The EHR provides the ability to aggregate and integrate data to improve care coordination and reporting.

Results: The EHR was deployed to all 35 oncology nurse navigators, plus screening navigators and a limited number of social workers and dietitians. Phases of implementation were tracked in audit logs to validate adoption, with ongoing justifications and template adjustments. Navigation return on investment (ROI) is critical to the advancement of a navigation program. Reports justify the navigator’s volume counting new patients (average 25 per month), encounters with patients (average 4 per patient), and time on back-end tasks. Tracking volume metrics gave insight into COVID shifts as new patients decreased and encounters increased 50% as nurses navigated complex situations.

An essential function of navigation is assessing barriers to care. With the EHR, barriers were consistently tracked, providing insight into common obstacles. Standard measures in the electronic program highlight that 93% of patients experience at minimum 1 barrier to care. Among the top barriers, financial and transportation barriers are crucial problems. The information helps develop programs to alleviate the obstacles.

Conclusions: The EHR provides the navigator visibility of the patient’s journey, exposing critical information to the nurses while transitioning patients through various facilities. Standardizing evidence-based benchmarks provides ROI data measuring navigation’s effectiveness, emerging barriers, and volumes against internal and external metrics.

In addition to standardizing navigation, the EHR removed the institutional silos, creating a unified collaboration of the navigators, and improved patient outcomes.

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Last modified: November 15, 2022

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