Informatics: What is Nursing ‘Clinical Content’?

I wrote the content of this post some time ago because I realised that I was having many conversations about what I understood as ‘clinical content’ but many people didn’t know what I was referring to, except if they worked in informatics.  It took me ages to ‘get it’ but increasingly I realise this is a very important part of the future if we are going to develop electronic patient records.Record keeping nurse

So, imagine the scenario, you are a newly qualified nurse and you have had a couple of days on the ward and at last you are sent to assess a newly admitted patient.  You pick up all the documentation and forms and off you go.  I am confident that those pieces of paper would affect the information you collect.  They are clinical content.

Clinical content refers to the components of nursing records that:

1     Structure care processes and;

2     Provides information at the point of care that supports clinical decision making.

Examples include:

1     Templates (for data collection – supporting nursing to make high quality assessments),

2     Risk assessment frameworks (to bring evidence to care processes for example PU risk assessment)

3     Care pathways (to support clinicians in making optimal decisions about care plans with patients).

They may also include alerts and warnings, where professionals’ attention is brought to a particular aspect of a patient’s condition for example an allergy.

Why is clinical content important?

  •  Safety

If we collect consistent evidence based information and use this to deliver care we can improve safety, for example, well structured and common handover documents as patients move across the systems can help to maintain continuity of care and avoid safety incidents.

  • Sharing

If we are to enable sharing of records with patients, attention to clinical content will make sure we document in open and transparent ways that enable people to understand the record.

  • Expertise of workforce

We know that the experience in the nursing workforce is set to fall as the older more experienced nurses leave the workforce. Good quality and evidence based clinical content can be used to guide staff through care processes and build their nursing knowledge and expertise.

  • Efficiency

Implementing electronic systems does not always make work more efficient on its own and only by judicious professional review can we make sure that the paper systems converted to electronic are robust and not wasteful.

  • Improving quality

Providing staff with the best information at the point of care helps to make sure that patients receive high quality evidence based care. It also allows us to robustly review our performance in a structured way; for example, we need to be able to measure pressure ulcer incidence. In order to understand how we might be able to improve and to investigate if we are outliers from a performance perspective we need to be able to compare ourselves with others, so we need data collection that is common. This leads us to conclude that common data collection templates should be important.

  • Information overload

In the new information age there is almost too much information available for staff to integrate into their practice. Well governed and managed clinical content can help staff to be as up to date as possible.

Is Clinical Content just about electronic records?
Clinical content is commonly referred to as a component of electronic records but actually all record keeping systems have a component of clinical content. If you visit any ward or department you are likely to find assessment frameworks and templates for collecting information, as well as possibly local standardised care plans. Sometimes these have strict governance applied but paper records have a tendency to proliferate, for example, in one city they found that they had around 600 pieces of paper to be used in nursing records.
Why should we be concerned about this? Doesn’t the system work we have now work?
As the world we work in becomes more and more electronic so nursing is likely to evolve to catch up with the world around us. We can of course just turn our pieces of paper into electronic versions of the same, but this would represent a huge missed opportunity. Experience of implementing electronic records in the US shows that just making paper electronic, while a low complexity approach, adds the lowest value in terms of quality, efficiency and safety. We have a huge opportunity to improve things but we need to grasp this now, and we need professional leadership to make it happen.

Isn’t this about IT and, therefore, not a professional issue?
This is definitely not about IT. When any clinician starts using a new system it will come as an empty vessel, a bit like a show home. In order to make it useful, and contribute its potential, it needs clinicians to make it work for them through adding high quality well governed content. Also professionals need to work out how it will work for them, to continue with the show home analogy they need to make sure the sofa fits into the room and that the colours match.

Why don’t systems come with content already in place?
Some systems will come with some content from the system supplier or a third party. If anyone takes this content they are likely to find that it perhaps is not fit for their organisation (most content is from the US) and requires a lot of review to make it fit for purpose.

Should we be developing our own content now?
It is a good idea to start to develop nursing content and to streamline existing records now even if you are not planning an electronic record. If this is done carefully it can ease the way forward for implementing electronic records. The downside of this is that it is expensive and time consuming and if every organisation has to do this alone it may represent large sums of NHS funds. Nursing is already behind the curve professionally; the medical profession is already making strides forward to enable standards such as discharge summaries to be used across the service. Nursing has a tremendous track record of innovation and with good leadership clinical content development could contribute to other priorities such as QIPP and the productive initiative.

What needs to happen to make this a reality?
The first step is senior clinical leadership and ownership by the profession. In order for this to happen we need to be clearer about why this is important and what any activity can offer.
Governance, ownership and risk will be key issues to be explored.

So next time you fill in an assessment form, complete a nursing record or perform an admission assessment or discharge – you are using clinical content.  It’s too important to ignore!

medical records


5 thoughts on “Informatics: What is Nursing ‘Clinical Content’?

  1. Thank you for writing this Anne. I had a conversation recently where I was told I wasn’t in the real world because I think as you do! Still a long way to go. …..

  2. We had an internal clinical content development group to progress with this when we were procuring an EPR and did a lot of work. Unfortunately due to organisational changes the emphasis on securing a single system has moved and we are now developing systems based on a best of breed approach. This helps with clinical engage and local ownership although this also leads to more work to develop the clinical content in lots of separate systems. I agree with Mandy we have a long way to go……

  3. So well explained Anne, thank you. This will help me get the message accross to those that find the concepts hard to understand, as we all did at one point.

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