Journal of Healthcare Management - March/April 2014 - (Page 141)

use of eHr d ocu Mentation By specifically designed by and for clinical workers to simplify review of clinically relevant indicators. One possible explanation is that many clinicians were not familiar with these documents. Hripcsak et al. (2011) found that progress notes of residents and medical students are read by clinicians. Previous history and physical records are also found to be helpful when patients are readmitted. This research study found that, for inpatient EHRs, Diagnostic Results was the most frequently accessed (89%) area by all providers. Physician Orders was also frequently used, in addition to the History and Physical and Progress Notes areas. According to Green and Thomas (2008), physicians look to nursing documentation for details about changes in patients' status. Nurses also use information in summary reports to synthesize patient data between shifts (Staggers, Clark, Blaz, & Kapsandoy, 2011). One of the limitations in electronic documentation is the lack of narrative description about significant events, thus hindering a complete understanding of the patient's "story." In this research, practitioners such as prescribers and nurses most commonly used the EHR information to make clinical decisions for the patient and to gain an understanding of the overall condition of the patient. These practitioners most often look to Vital Signs, Weight/Height/BMI, and Diagnostic Tests for this information. The SPO "loop" is closed through the use of the clinical information contained in the EHR to guide patient care decision making and communication. An important finding from this study was knowledge about which H ealtHcare w orkers in a H ospital s ysteM elements in the EHR are viewed by various clinicians in acute care and how that information is used to guide clinical care. To meet the needs of clinical caregivers, it is key to determine which EHR components are important to those clinicians and ensure ease of access in user-friendly formats. Our finding on how little prescribers reviewed nursing and ancillary documentation supports results from previous studies. Many hours are spent documenting information that no one uses, potentially reducing time for patient care. The finding that few clinical practitioners review the plan of care may partially explain the common problems of communication and fragmentation in acute healthcare. Another important finding in the study was the limited awareness and use of EHR components available for clinicians. The lack of clinical summaries use may be explained by a lack of awareness or limited usefulness of the tools to guide clinical care. It is essential to engage clinical practitioners with the designers of these documents to meet clinicians' needs as consumers. Creating views of data that are concise, relevant, and meaningful for clinicians may augment their ability to make clinical decisions. Findings from the sample of practitioners in the ED indicate that they use information needed in real time to manage single episodes of care. Much information in the ED is passed on in verbal conversations and reviews of previous care. Having access to clinical résumés helps caregivers develop a story about patients who enter the hospital and may explain the frequent use of these résumés in the ED setting. 141

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