Journal of Healthcare Management - March/April 2014 - (Page 142)
J o u r n al
of
H ealt H care M anage Ment 59:2 M arcH /a pril 2014
Implications for Managers in
Healthcare
As regulatory requirements continually
evolve, hospitals are under pressure to
collect more data that are not pertinent
to direct patient care, such as presenton-admission indicators and Core
Measures data sets. Clinicians may not
be aware of why they are asked to document this additional information, but
they do recognize the burden of time
required to do so. Facilities should be
cognizant of this perception and avoid
redundancy in documentation requirements. Other implications for optimized
use of the EHR include streamlining
documentation for concise entry of
information and facilitating efficient
health information exchange during
care transitions.
Clinicians at all levels rely on vital
information to make clinical decisions.
Automatically populating information into numerous forms may reduce
workload, but it requires information
to reside in multiple places in the EHR.
Thus, important information may go
unread when it resides on flow sheets or
forms unfamiliar to the users. Although
clinicians go through a mandatory
orientation upon hire, they may rely
significantly on coworkers to help them
use the EHR once they start working. If
the more experienced coworkers are not
familiar with forms or have developed
work-arounds, new hires may follow in
those footsteps.
We recommend that leaders and
EHR designers be mindful of adding
fields for documentation and to include
end users in discussions about changes
that will involve them. Opportunities
for shared documentation between
disciplines may further reduce redundant documentation. Providing frontline caregivers with information about
availability of clinical summary views
and soliciting input on information for
inclusion may expedite widespread use.
Finally, some areas of the EHR are made
up of multiple checkboxes and lists,
which may not tell the story of significant events. Incorporating options for
narrative descriptions in a format conducive to reading may augment clinician
communication and understanding for
patient care.
Study Limitations
The study had several limitations. It was
conducted in a single hospital system
and had a low response rate and small
sample size; thus, our results are not
generalizable across all practice settings.
Additionally, we only included team
members from the IP and ED settings,
and our findings may not be applicable to other patient care areas. While
we did assess a variety of settings and
included subjects from many clinical
disciplines, there may have been variation in documentation review practices
beyond the study findings. The sample
size of provider types was too small
to conduct an analysis of difference
between particular specialty practices to
answer the research questions. Selection
bias in the study was possible toward
subjects who are comfortable completing online surveys, as they may have
been more willing to participate and
experience more comfort using an EHR
than nonparticipants. Another limitation was recall bias and using measures
of self-report rather than actual measures of access.
142
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
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