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Bloom Blog

Nursing background ups Tina's technology game

By Louise Kinross

Tina Smiley has a unique role at Holland Bloorview, bringing her knowledge as a nurse to the design of technology that houses data critical to patient care. Tina is responsible for the pharmacy, laboratory and quality and risk management applications of Meditech Expanse, our electronic health information system. This is where clinicians order patient medications; order and review lab tests and results; and report safety incidents. Tina joined Holland Bloorview in 2005 as an inpatient registered nurse, working most recently with children in rehab following painful bone surgeries and life-changing spinal-cord injuries. She moved to her information management and technology role in 2012. 

BLOOM: How did you get into this field?

Tina Smiley: I have a passion for nursing and information technology. In my early years as a registered nurse, technology was becoming the next big thing in health care, and it blended beautifully with my passion for nursing.

BLOOM: How did you get into nursing in the first place?

Tina Smiley: I was a patient myself. When I was about 10 years old I was very sick and hospitalized at Centenary Hospital. This was my first major encounter with being ill. The nurses were very compassionate and wore their hearts on their sleeves. I wanted to be able to do what they did, and that's how I ended up becoming a pediatric nurse.

In my teen years I knew what I wanted to do when I grew up. I took all the high school courses I needed to be in the right stream for a health profession. I then received a bachelor of Science in nursing at Toronto Metropolitan University, where I did my undergrad. A few years later, I completed a master of Science in nursing from the University of Phoenix while working as a full-time nurse here. 

BLOOM: What is a typical day like now?

Tina Smiley: In a nutshell, the goal is to support staff and manage the systems we have in place. I'm part of the clinical half of the Meditech team. I'm in charge of managing and maintaining the pharmacy, laboratory and quality and risk management applications and their dictionaries. I also work on new builds, revise existing builds, and provide help-desk support to the organization. 

BLOOM: What are dictionaries?

Tina Smiley: Meditech is kind of like the overall software program and the dictionaries are where we house data related to our pharmacy, lab and quality and risk management applications. Each application has its own set of dictionaries. It's where we input the data to build the screens the staff see when they access the charts and do their documentation.

During the workday, I may be troubleshooting issues. I may be working on a new build, or revising an existing one. Some of these changes can be time consuming, depending on how complex they are. For example, a lot of testing may be involved. It may require talking to staff to get their feedback or to clarify their work flows. There are nuances to someone's work flow, so I pull in frontline staff to get feedback in real time. I also work on our help desk and do on-call support during business and after hours.

BLOOM: What's the greatest challenge of your job?

Tina Smiley: There's a lot of balancing of competing priorities in the day, so time management is very important. But I wouldn't say that it is challenging. I don't see things as a challenge, I see them as opportunities to find solutions, to learn something new, and to grow as a professional. Yes, there is stress involved in any role, but that's normal in life and you learn to work with that and get through it.

BLOOM: What's the greatest joy?

Tina Smiley: Being able to help others. It's the same overall feeling that I had when working directly with patients and families as a registered nurse. What I do now with technology also touches on their lives.

BLOOM: Can you give us an example of how your work impacts patient care?

Tina Smiley: Throughout the years many projects have trickled down to the frontline where they impact clinical practice, the care provided and patient safety. 

For example, when we went live with Meditech Expanse we didn't have a lab interface in two directions between Holland Bloorview and Sunnybrook. So we were functioning on a hybrid model where orders went into Meditech electronically, but the results came back from Sunnybrook on paper. That affected multiple departments in terms of added workload, and we weren't able to trend data. 

Since then we've implemented a working, two-way interface and eliminated the paper processes. Results come back into Meditech and file electronically in the patient's records. Staff can now trend the data and multiple people can access it at the same time. That made a positive impact on quality of care, enhanced patience safety, and mitigated the risks of paper processes.

In another example, I recently completed the first phase of a point-of-care project. Our new glucometers check your blood sugar automatically and file the results electronically in the chart. So nurses no longer have to to manually type the results. Whenever you have to type information, there is the opportunity for error. We've removed that safety risk.  

The second phase of the project is to implement a second diagnostic device in collaboration with Sunnybrook. Instead of sending lab specimens to Sunnybrook for a patient's electrolytes and blood gases, we can use a handheld device to test at the bedside, almost instantly, which saves time. Staff can then make an informed clinical decision based on the results in the palm of their hands.

Our goal is to give staff the tools to make their jobs safer and more efficient. We try our best to automate as much as we can, while keeping patient safety as the main priority.

BLOOM: What qualities do you need to be good at your job?

Tina Smiley: You definitely need to have excellent customer service skills. Yes, I'm working with technology and behind my computer mostly, but I'm still supporting people through consultations, projects and with the help desk.

You're also like a project manager. So you need excellent communication, organizational and change management skills.

BLOOM: It sounds like your experience as a nurse is essential.

Tina Smiley: Yes it is. What I bring is a lived experience as a frontline nurse user of our technology systems. In my role as a clinical application specialist, I'm able to be a true subject matter expert because of my foundation in nursing.  I can understand what the user is going through, even when their explanation isn't the clearest. I have an appreciation of how the systems work and how things are connected. I'm able to troubleshoot with ease because I have experience using the systems on both ends.

BLOOM: Can you give another example of how your work improves patient care?

Tina Smiley: Quality improvements come from the data we collect in our incident reporting system. In the past we recognized that safety issues were underreported because it was too complicated to navigate the screens.

When I redesigned the incident management screen, I didn't sit in a room with a few people and say 'We want to do it this way.' A collaborative approach was taken. We sought feedback from frontline staff on how to make the screens more simple and user friendly.

We never want the technology to get in the way of people reporting things. We value ideas and suggestions from end-users. Including frontline staff in the design process allows us to detect trends. Together we can learn where we can make a change in processes and procedures.

BLOOM: If you could change one thing about children's rehab from a technology perspective, what would it be?

Tina Smiley: From the outpatient side, I know a pet peeve is when families arrive for an appointment and the check-in process involves several steps to alert staff. On my wish list is the possibility of an app we could give to families, or maybe a self check-in kiosk, so the family can notify the right parties of their arrival. That would remove a lot of the manual steps we currently take.

BLOOM: So it would be done electronically versus the parent telling a staff person they're here, and then that person paging someone, and sometimes there's a breakdown in communication.

Tina Smiley: Yes, that would be a huge win for our appointments staff and clinicians. 

BLOOM: How does Holland Bloorview stack up in terms of its use of technology?

Tina Smiley: We are leaders in the use of technology to enhance care. Our clinical data follows the patient whether they're an inpatient, day patient, or outpatient. At Holland Bloorview, continuity of care is seamless, no matter which department or service you're seen in.

Conversely, I've worked in places where the chart does not follow the patient. For example, in an Emergency department a chart is created. But when you're admitted, the unit has to make a new chart, manually copying data from the Emergency department. This introduces a risk of transcription errors because the two charts don't talk to each other. They're not integrated.

BLOOM: Is there anything we haven't spoken about that would be helpful for our readers to know?

Tina Smiley: I want people to know that although I work with technology I'm still very much a nurse. I keep current in terms of anything practice related, and I keep my credentials up to date.

The pandemic proved to the world that there is value in having nurses on any team, working in all industries. The perception of a nurse is no longer restricted to providing direct care at a bedside.

Ten years ago I took a step outside my comfort zone professionally. As a result, I'm able to see things and question things with a unique perspective. I can look ahead and think about potential problems or risks as a decision is being made. My successes today are a result of my lived experiences gaining knowledge and clinical expertise as a nurse. Nursing practice should lead and inform technology, not the other way around.

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