Journal of Healthcare Management - March/April 2014 - (Page 143)

use of eHr d ocu Mentation By Future Research Implications for future research may include studies to further understand patterns of information use from the EHR and the effects of using selected components on patient care decisions and patient outcomes. A study using direct observation of clinicians' use of EHR information may yield further understanding of how and why they use it. Studies using methodologies to capture actual access to and timing of EHR components may serve as better measures of EHR use. Finally, further study into the effects of streamlining EHR components with clinician use would add insight into strategies to improve end users' experience with the system. CONCLUSION Critically evaluating an organization's EHR processes and redesigning its structure to streamline documentation are important steps toward saving time and maximizing efficient use of the system. Findings from this study demonstrate that clinical care workers from a variety of disciplines spend a significant amount of time reviewing information from the EHR; however, only a few areas are frequently reviewed. Many areas of the EHR are rarely accessed for review by numerous study participants. It is possible that clinicians operate through real-time use of information, where historical documentation may seem irrelevant. The sections in the EHR frequently viewed may indicate the data deemed important by clinicians for patient care. Final Note on the Study Subsequent to this study's completion, the organization's informatics department used these findings in part to H ealtHcare w orkers in a H ospital s ysteM drive changes through forming a redesign team to streamline the EHR and address complexities and redundancies in documentation. Changes in nursing documentation reduced the number of flow sheets required and included a new "condition narrative" field to allow a more complete telling of the patient's story. In addition, clinical summaries were created to contain meaningful data. The redesign team also met with the regulatory personnel to ascertain the necessity of discrete elements of documentation to meet government and accreditation requirements. Those components without clear rationale for use were eliminated. Recently, these changes were implemented and have resulted in positive outcomes, consolidated flow sheets, and approximately half the number of computer clicks needed compared to before the redesign, with positive feedback about the improved ease of use of the EHR. The heightened level of awareness about what clinicians are asked to document and increased scrutiny of additions to documentation have proved beneficial, and areas within the EHR identified to have low usage are now assessed for usefulness and considered for elimination. REFERENCES Banner, L., & Olney, C. (2009). Automated clinical documentation. Computers, Informatics, Nursing, 27(2), 75-81. Ben-Assuli, O., Leshno, M., & Stabtai, I. (2012). Using electronic medical record systems for admission decisions in emergency departments: Examining the crowdedness effect. Journal of Medical Systems, 36(6), 3795- 3803. doi 10.1007/s10916-012-9852-0 Bosman, R., Rood, E., Oudemans-van Straaten, H., Van der Spoel, J., Wester, J., & Zandstra, D. (2003). Intensive care information 143

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