Journal of Healthcare Management - March/April 2014 - (Page 131)

use of eHr d ocu Mentation By INTRODUCTION Documentation in the medical chart originally served to provide a record of a patient's care and to improve communication among healthcare providers. As medical records have evolved into true health records, documentation has come to serve many purposes, such as evidence for medical legal cases, required backup for reimbursement, and information for developing measures for quality and regulatory purposes. This expansion requires clinicians to spend increased time and effort documenting the care provided, with the unintended consequence that they potentially spend less time providing direct patient care. Study findings demonstrate that nurses have mixed perceptions about the electronic health record (EHR): It is extensive but time consuming (Saarinen & Aho, 2005; Scott, Rundall, Vogt, & Hsu, 2005); it helps and hinders nursing work (Kossman & Scheidenhelm, 2008; Hakes & Whittington, 2008; Dennis, Sweeney, Macdonald, & Morse, 1993); and it has both positive and negative effects on patient care (Koppel et al., 2005; Han et al., 2005; Fraenkel, Cowie, & Daley, 2003; Mekhjian et al., 2002). In one study, 73% of nurses reported spending at least 50% of their time using the EHR, which leaves less time for patient care (Kossman & Scheidenhelm, 2008). Some nurses reported that their critical thinking is reduced by using the EHR, but most nurses believed that its benefits outweigh its drawbacks (Moody, Slocumb, Berg, & Jackson, 2004; Fraenkel et al., 2003). Most research to date has looked specifically at the time and burden associated with documenting in an H ealtHcare w orkers in a H ospital s ysteM EHR. Few studies report clinician use of information from the EHR. Our aim was to determine what information from the EHR is viewed and how that information is used by different types of clinicians. BACKGROUND To guide discussion of the concepts, the structure-process-outcome (SPO) framework of Donabedian (1988) is used. According to Donabedian, structure refers to the settings in which care occurs, including equipment and facilities; process includes what is actually done in healthcare activities; and outcome is the impact of care on the health status of a population. This framework describes our approach to examining how a variety of healthcare clinicians use data and information documented in the EHR at a multihospital system. Figure 1 demonstrates the use of this model for the study, and each SPO step is explained further in the following paragraphs. Structure The EHR represents the structure for the documentation of healthcare in this study. This documentation provides the basis for patient care decisions. Clinical practitioners regularly contribute a great deal of information and data to the record to complete a multitude of tasks. For example, nurses record the patient's condition, care given, measurements taken, and medication administered through menu-driven checklists of nursing diagnoses, human body systems, and common patient problems. Although viewed as a time-saver by some nurses (Kossman & Scheidenhelm, 131

Table of Contents for the Digital Edition of Journal of Healthcare Management - March/April 2014

Journal of Healthcare Management - March/April 2014
Contents
Interview With Marna P. Borgstrom, FACHE, President and Chief Executive Officer, Yale New Haven Health System, and Chief Executive Officer, Yale-New Haven Hospital, Connecticut
Specialties: Missing in Our Healthcare Reform Strategies?
Costs and Benefits of Transforming Primary Care Practices: A Qualitative Study of North Carolina’s Improving Performance in Practice
Governing Board, C-suite, and Clinical Management Perceptions of Quality and Safety Structures, Processes, and Priorities in U.S. Hospitals
Use of Electronic Health Record Documentation by Healthcare Workers in an Acute Care Hospital System
Why Hospital Improvement Efforts Fail: A View From the Front Line

Journal of Healthcare Management - March/April 2014