Nurse scientist gives more time with patients

People don’t become nurses because they love data entry. Bonnie Adrian went back to school to become a nurse because she wanted to make a greater impact on people’s lives.

The UCHealth nurse research scientist leads Project Joy, a team that improves the electronic-health record (EHR), allowing  colleagues to spend more time taking care of patients and less time in front of a computer.

Project Joy’s outcomes have attracted national attention to UCHealth leadership in addressing EHR burden. Project Joy saves  nurses 18 minutes per 12-hour shift on charting, a decrease of more than 350 million clicks per year.

“EHR burden negatively affects clinicians in two ways,” says Adrian. “Documentation burden wastes clinician time entering data that lacks value for patient care. Cognitive burden consumes mental bandwidth, which increases risks for clinical errors. Project Joy decreases clutter, to put visual focus on what is meaningful, what matters.”

When she enrolled in nursing school, Adrian already had a doctorate in socio-cultural anthropology. She was a professor at the University of Denver teaching students who weren’t as engaged as she’d hoped.

“I said, ‘Why am I using my talents in this way? I want to make a difference in this world,’” she said. “I was longing for an opportunity to have a greater impact.”

Adrian enrolled in nursing school and graduated during the Great Recession. Unable to find clinical work, she was introduced through campus connections to then-Chief Nursing Officer Carolyn Sanders with University of Colorado Hospital, who hired her for an opportunity to use her skills for both research and health care.

“In archaeology, you go to a site and you try to figure out where there might be artifacts. You pull things out of the ground to understand past civilizations. Ancient people didn’t put those things there for you to learn about,” Adrian said. “I started looking at electronic health records as archaeology – so many things in the EHR can be used for purposes beyond the original reason why the data was captured, to understand health care delivery processes.”

For example, barcode medication scanning exists to improve medication administration safety and record accuracy, but that information can also be used to learn about nursing practice and improve care.

UCHealth Director of Clinical Informatics Alice Pekarek said Adrian’s position is unique in the information technology world. Few health systems in the United States support a research nurse scientist on a clinical informatics team within IT.

“This is a tribute to UCHealth leadership understanding that rapidly-changing technologies present opportunities to challenge the status quo and to do things differently,” Pekarek said. “Bonnie has the perfect skill set and personality to take on a project like Project Joy.”

Adrian’s use of EHR data for research led to the development of Project Joy. Sometimes, the data that nurses are required to manually enter into EHR is unnecessarily tedious and “non-meaningful,” she said.

“Looking at the data on the back end for research studies, we can see that nursing staff too often enter data that is inaccurate, contradictory or missing. We cannot advance the field of nursing without complete and accurate data to fuel research. The EHR presents nursing staff with too many meaningless data fields, to the point where nurses don’t know where to focus documentation time and care.”

“If the EHR doesn’t respect the nurse, is the nurse going to respect the EHR?” she said. “How do we create systems of documentation that are less burdensome and generate more accurate information?”

Project Joy includes a committee of 55 participants with clinical nurses from all inpatient practice areas and regions along with representatives from areas such as legal, risk, quality and regulatory. The committee’s breadth is designed to ensure optimizations align with the many uses of health records.

The team presented its work at multiple national conferences including the American Nurses Credentialing Center’s 2019 Magnet Conference in Orlando, Florida. In January, Project Joy presented at 25 By 5: Symposium to Reduce Documentation Burden on U.S. Clinicians by 75% by 2025. The symposium was hosted by Columbia University’s Department of Biomedical Informatics.

Project Joy was featured in Florence Health, a New York City-based publication for frontline health professionals, under the title “Meet the Team of Nurses Who Revolutionized Their Hospital’s EHR System.”