Improving practice one chart at a time: DNP student's perspective bringing technology and nursing together

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Fadi Islim, clinical nursing informatics analyst at Michigan Medicine and current doctorate in nursing practice (DNP) student at University of Michigan School of Nursing (UMSN), never intended to immigrate to the United States.

Originally from Jordan and trained as a nurse, in 2005 he had accepted a contract to work in Ireland and was getting ready to move there. With a month between accepting the contract and starting work, his brother, who was living in Dearborn, MI, suggested he come for a visit.

“I was 100% sure I would not get a visa. No one gets a visa [to come to the U.S. from Jordan].”

But he did, and when he came, he fell in love.

“I came in January and there was snow everywhere,” Islim remembered. “I told my brother, ‘I have to leave this country as soon as possible. I can’t tolerate that much snow.’ Then I saw my [future] wife. Their neighbor, she was playing outside with her little brother, and we got to talk, and I told my brother, I’m staying.”

“It was the best decision I ever made in my life.” 

Islim gave up everything back home and stayed in the U.S. with a week’s worth of clothes. He improved his English, his wife learned some Arabic, and they are now raising their two children (girls, aged 5 and 7) and expecting twins (one boy and one girl).

Working as a nurse

After making that bold leap, Islim began to sweat his chances of working as a nurse in the U.S.

“I had my bachelor’s in nursing, and I thought it would be a matter of doing some paperwork and taking a board exam, said Islim. “When I started applying to hospitals, it was much more difficult than I had expected.”

With a background as a surgical intensive care (SICU) nurse, he was finally able to join Michigan Medicine as a nurse’s aide in the SICU while he got certified, and then worked SICU until 2012, when he joined the electronic health records (EHR) team.

“Now, I am one year away from getting my doctorate in nursing practice degree from one of the biggest colleges in the U.S., treated with full respect and without any discrimination or feeling like an outsider,” Islim proudly said. “DNP Director Dr. Dana Tschannen was very supportive, and the faculty believed in me. The only way I could thank the institution that believed in me was to increase my education and use the knowledge to support our staff.”

From bedside to IT

Islim learned MiChart from the ground up by embedding with the software vendor for Michigan Medicine, Epic.

“Before I joined Epic in 2012, I never even owned a computer,” Islim said. “I had absolutely no knowledge about software or design. I worked probably 18 hours every single day between 2012 and when we went live in 2015.”

His clinical background helped him to understand the needs of bedside nurses.

“The electronic health record should allow the nurse to gain extra time to provide better care,” commented Islim. “Nurses should not care for the electronic health record more than the patient.”

This is where usability comes into play. In his role as human interface between bedside nurses and the information technology department at Michigan Medicine, Islim works to ensure smooth functioning of the electronic health record (EHR), called MiChart.

“Understanding what is being displayed to you helps you to make the right decision,” explained Islim. “Displaying the wrong data, or even accurate data that is displayed incorrectly could lead to decisions that harm the patient. Designing EHR with usability in mind helps ensure that clinicians are making decisions based off the best, most accurate information available.”

EHR to serve diverse needs

Islim sees the value of electronic health records not only in easing the bedside nurse’s workflow and creating more time for care and education, but also in improving care for different population groups. One group he is especially excited to see EHR work for is transgender patients.

“I would like to make sure our transgender patients are being treated fairly, not being asked the same questions that have been asked multiple times if that’s unnecessary. For a transgender patient, if the name is a male, looks like a male, but has a female organ, you want to make sure all the testing is done, or all the immunizations are done before that patient has an operation,” Islim said.

Similarly so for non-English speaking patients.

“The second your documentation determines your patient doesn’t understand English very well, or doesn’t speak it, we suggest you bring interpreter to the bedside. And when you want the patient to sign for a procedure, maybe a flag shows up: Did you have interpreter at the bedside to explain the procedure before signing? This should not show up if your documentation shows patient’s brother, or wife, is at the bedside and understands. If you already did that, that flag will not show up and bother you.”

“We’re in a campus that is full of diversity and we have all types of patients. My mom is a patient here. She doesn’t speak any English. She will always need someone to interpret,” Islim explained.  

Predictive analytics

With the advent of electronic health records, healthcare practitioners have been able to amass vast quantities of data. This moved quickly into data analytics: analyzing the data collected. Islim sees the next big step as predictive analytics: using the data to predict what is going to happen, and either prevent it from happening, or help it happen more quickly.

“Nurses now document the vitals, but we can use that data to tell the nurse which direction your patient is headed,” Islim explained.  

Islim listed the various ways in which EHR can predict necessary care, from warning of IV failure, to chance of falling and the possibility of patient depression. Small adjustments in care, the technical to the mundane, add up to ways in which the EHR system can help nurses provide the best care for their patients.

Another way in which predictive analytics can be helpful is to prevent readmission.

“Say your patient is in perfect condition right now. But you know when he is leaving, he has no support. He lives alone. Okay, what can we do to make sure he takes the medication on time, he does the exercises on time. Most of the patients who come back are that type of patient who goes home alone and they don’t have someone to remind them or support to do this or that. Should we have a phone call on a weekly basis? There are a lot of options,” he explained.

Promoting interdisciplinarity and preparing the next generation of nurses

Another advantage of EHR, according to Islim, is the potential it brings for collaboration and interdisciplinarity. Electronic health records are not just the nurse’s notes anymore – everyone on the care team is contributing to the patient’s record. This changes how the specialists interact with one another.

It takes some effort to shift the mentality towards interdisciplinarity.

“This is a practice change. I’m really glad I’m at the School of Nursing because the school understands how to train the new generation of nursing students to use EHR effectively.”