Leveraging Technology for EMR Account Request Process

The American Nurses Association’s Nursing Informatics Scope and Standards of Practice identifies compliance and integrity management as a core functional area of nursing informatics. The informatics nurse specialists advocates for protecting health information, ensuring the ethical use of patient data, maintaining the data’s integrity and security, and protecting the confidentiality of patient health information. Moving beyond EHR implementation, INS also play a key role in leveraging technology to optimize workflows in the healthcare setting.

The security informatics nurse specialists in the department of clinical research clinical informatics at the Clinical Center, National Institutes of Health (NIH), function in a unique position as advocates in protecting patient health information. The security INS is responsible for the oversight and management of end-user accounts for the clinical research information system (CRIS) electronic health record. This includes creating, modifying, and inactivating user accounts, as well as performing ongoing maintenance tasks surrounding access to the EHR application. The team supports EHR user accounts for all interdisciplinary staff (clinical and research) for the entire NIH community, which comprises of the clinical center and 27 institutes and centers. The security team INS is responsible for determining the security rights to assign to end users based on their roles and job functions, as well as the level of EHR training completed.

The user accounts process was initiated by the submission of the CRIS account request PDF form to the CRIS security team. This was followed by a series of steps to grant the user access to the EMR. However, the workflow was cumbersome for the requestor and the security INS. Deficiencies included misplaced/lost paper forms, inaccurate form completion, web browser limitations, and signature authentication issues. These led to end user delayed access to the EMR, user dissatisfaction, and ultimately disruption in the continuum of care. Moreover, there were administrative challenges with the storing and archiving PDF forms, as well as the retrieval and auditing of user access data. Remote work related to the COVID-19 pandemic added another layer of technical complexity in the process.

The team implemented a quality improvement project to streamline the user account process by developing a one-stop electronic process utilizing automated workflow technology. This involved forming an alliance and collaborating with a multidisciplinary team of stakeholders to revise user account policies and processes. The systems development life cycle framework was used to bring the project from inception to completion. End user acceptance was vital to the success of this project. The project results were decreased administrative workload, improved communication, user interface, simplified workflow, and increased user satisfaction.