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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