I just saw an advertisement for a company offering predictive analytics so that within minutes after the clinician inputs data, predictions are made. It even tells you how many visits will result in a good outcome and what kind of visits those are. There’s another tech company that guides you to better allocate your resources (you are the resource, by the way).
Although I love computers, I wonder if we are trying too hard to substitute computer data for critical thinking. Using computer predictions to determine how much care should be delivered has too many opportunities to fail, and failure in nursing harms patients.
The algorithms in this and other programs are based on thousands of patient episodes. In theory this is good. Validation is achieved by the repetition of results across many occurences. TUG tests and PHQ depression assessments are validated but those results are not influenced to any great degree by data that we are unable to measure.
So, agency owners who are interested in these data crunching, predictive programs might want to ask what information goes into making these predictions and what variables can influence the data. OASIS and basic assessment data is readily available but OASIS does not ask about income or education level; both of which influence a patient’s response to care provided. Typical assessment data does not provide insight into family dynamics or how far it is to the nearest grocery store, hospital or their MD office.
If nurses surrender their own critical thinking to these programs, they are primed to violate the most fundamental of nursing standards by not individualizing care for the patient. Only the assessing clinician can do that. If non-clinical managers use these programs to determine the value of a nurse, he or she may end up on the radar simply for providing the patient what is needed.
I have never seen a computer program brought before the board of nursing or any of the therapy boards. If the computer advised the nurse to insert a knife into the eye of the patient, the computer would not be held accountable for the resulting loss of vision. The nurse is and always will be ultimately responsible for the nursing care rendered to the patient.
The legal implications are enough to make me glad I am not a lawyer and cannot give legal advice. That’s not to say you won’t wish you had called a lawyer before you allowed a computer to make clinical decisions for you.
I am an information junkie. If I had access to one of these programs, I would play with it the way Sheldon and Leonard played Halo on Wednesday nights. But I don’t think that is how this predictive technology will be used. My fear is that clinicians will be judged on how many visits they provide and whether the number falls within the computer generated parameters. I am afraid that careplans will be altered to accommodate an algorithm, and the patient will receive care they do not need or not receive care they do need.
There are no recipes for patient care – add five visits and a teaching guide for diabetes; stir well and season to taste with footcare. The best software helps clinicians care for patients. A good system frees up time by handling non-clinical tasks and minimizes the work of complete and accurate documentation . (No routine visit nursing note should require 20+ pages when printed.) Documentation in the home during a visit is ideal but not if it puts the computer between the patient and the clinician. Making information available when needed is much different than a Where’s Waldo game to locate vital signs in a sea of useless information.
Most State Boards of Nursing have a statement similar to the below taken from the Louisiana State Practice Act:
The standards are based on the premise that the registered nurse is responsible for and accountable to the individual for the quality of nursing care he or she receives. Documentation must reflect the quality of care.
If you are unable to find a similar statement in your state’s practice act, look for one that says:
Computer directed nursing is acceptable should the nurse not feel up to thinking critically.
You probably won’t find anything like that. Registered Nurses are able to delegate tasks but never responsibility.
If you have a different opinion, we’d like to hear it. Please email or leave a comment. And remember, we are information junkies and do not want to go into flagrant withdrawals but we also think you can do a better job of caring for patients than any software, anywhere, anytime.
And we can help. We have coding and OASIS certified nurses ready to review your admissions and give you the information you need to craft a care plan.
OASIS and Coding Review 
Your article reminds me of the computer documentation I have reviewed in home health computerized records. Nurses would pull the computer prepared information on a disease or medication and just place it in the patient record. Trouble was when you reviewed the information it wasn’t individualized for the patient. Typically it contained words that the patient wouldn’t understand. I was always taught to teach in a method that the patient would understand and be able to comply with. These computer prepared documents are usually large. It makes you think that the nurse taught on all the information listed in it. But upon examination you find that there is nothing documented about the patient’s understanding of any part of what was charted. If every visit has to stand alone, the visit probably would not be paid. Because of the way the computer system works, every entry is entered in a separate section. I have found clinicians pulling information from other visits into a current visit. When reading the information, you realize that the information is wrong but the clinician didn’t catch it. Usually you find this in the summary section. Charting has become a major challenge in home health at the expense of good patient care . If we have to rely on analytics and other programs to say what the patient will have, then we truly lost control of patient care. Patients are not robots. No one is a clone of anyone else so therefore you can’t treat them the same. Nurses will have to really step up their skills to document the special needs of the patient who does not match what the analytics show is the norm or computer programs.
I think many computer programs try to protect the agencies from their nurses by trying to cover every contingency. It doesn’t work and it is insulting to nurses and gives false confidence to management.