Balancing documentation and direct patient care activities: A study of a mature electronic health record system

Momenipour, Amirmasoud; Pennathur, Priyadarshini R.

doi:10.1016/j.ergon.2019.06.012

Cited by 32 publications

(22 citation statements)

References 25 publications

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“…2 During an average 12-hour shift, nurses spend an estimated 19 to 40% documenting patient care and record data in over 600 flowsheet rows. 3 4 5 6 7 8 One quarter of nurses declared the EHR as cumbersome and almost half stated time spent documenting was problematic. 9 Further, 90% of nurses included in one study stated that the EHR had a negative effect on nurse–patient communication and 94% disagreed that the EHR promotes communication between the nurse and other members of the health care team.…”

Section: Background and Significancementioning

confidence: 99%

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Lindsay

Lytle

2022

Appl Clin Inform

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Background: Documentation burden associated with electronic health records (EHR) is well documented in the literature. Usability and functionality of the EHR are considered fragmented and disorganized making it difficult to synthesize clinical information. Few best practices are reported in the literature to support streamlining the configuration of documentation fields to align clinical workflow with EHR data entry elements. Objective: The primary objective was to improve performance, reduce duplication, and remove non-value-added tasks by redesigning the patient assessment template in the EHR using best practice approaches. Methods: A quality improvement approach and pre/post design was used to implement and evaluate best approaches to redesign standardized flowsheet documentation workflow. We implemented standards for usability modifications targeting efficiency, reducing redundancy and improving workflow navigation. The assessment type row was removed; a reassessment section was added to the first three flowsheet rows; and documentation practices were revised to document changes from the initial assessment by selecting the corresponding body system from the dropdown menu. Vendor-supplied timestamp data was used to evaluate documentation times. Video motion-time recording was used to capture click and scroll burden, defined as steps in documentation, and was analyzed using the Keystroke Level Model. Results: Results included an 18.5% decreased time in the EHR; decrease of 7-12% % total time in flowsheets; time savings of 1.5 to 6.5 minutes per reassessment per patient; and a decrease of 88-97% in number of steps to perform reassessment documentation. Conclusion: Workflow redesign to improve the usability and functionality decreased documentation time, redundancy, and click burden resulting in improved productivity. The time savings correlate to several hours per 12 hour shift which could be reallocated to value-added patient care activities. Revising documentation practices in alignment with redesign benefits staff by decreasing workload, improving quality, and satisfaction. Keywords: reassessment, documentation burden, electronic health records, workflow redesign

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Section: Background and Significancementioning

confidence: 99%

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Lindsay

Lytle

2022

Appl Clin Inform

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“…These include, for example, the management of data privacy [ 1 ] or digital competences to enhance appropriate patient communication via internet [ 6 ]. In addition, new tasks make demands such as increasing time spent with documentation [ 7 , 8 ] or with low usability electronic health records [ 9 ] and technical support among colleagues [ 10 ], which were previously beyond the scope of work of health professionals.…”

Section: Introductionmentioning

confidence: 99%

Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study

Golz¹,

Peter²,

Müller³

et al. 2021

JMIR Ment Health

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Background Psychiatric hospitals are becoming increasingly digitized because of the disruptive rise in technical possibilities. This digitization leads to new tasks and demands for health professionals, which can have an impact on technostress. It is unclear whether digital competence reduces technostress and how technostress affects health professionals’ mental and physical health. Objective This study aims to assess the association between digital competence and technostress, considering individual characteristics and the association between technostress and long-term consequences for health professionals. Methods Cross-sectional data from 3 Swiss psychiatric hospitals were analyzed using multiple linear regression. The dependent variables for the models were digital competence, technostress, and long-term consequences (intention to leave the organization or the profession, burnout symptoms, job satisfaction, general health status, quality of sleep, headaches, and work ability). One model was calculated for each long-term consequence. The mean scores for technostress and digital competence could range between 0 (fully disagree) and 4 (fully agree), where a high value for technostress indicated high technostress and a high value for digital competence indicated high digital competence. Results The sample comprised 493 health professionals in psychiatric hospitals. They rated their technostress as moderate (mean 1.30, SD 0.55) and their digital competence as high (mean 2.89, SD 0.73). Digital competence was found to be significantly associated with technostress (β=−.20; P<.001). Among the individual characteristics, age (β=.004; P=.03) and profession were significantly associated with both digital competence and technostress. Technostress is a relevant predictor of burnout symptoms (β=10.32; P<.001), job satisfaction (β=−6.08; P<.001), intention to leave the profession (β=4.53; P=.002), organization (β=7.68; P<.001), general health status (β=−4.47; P<.001), quality of sleep (β=−5.87; P<.001), headaches (β=6.58; P<.001), and work ability (β=−1.40; P<.001). Conclusions Physicians and nurses who have more interaction with digital technologies rate their technostress higher and their digital competence lower than those in other professions. Health professionals with low interaction with digital technologies appear to overestimate their digital competence. With increasing digitization in psychiatric hospitals, an increase in the relevance of this topic is expected. Educational organizations and psychiatric hospitals should proactively promote the digital competence of health professionals to manage expected disruptive changes.

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“…Without adequate documentation of services, it becomes difficult to track the progress of patients on treatment adherence. However, it remains critical to maintain a balance between documentation and patient care to ensure effective service delivery [17].…”

Section: Discussionmentioning

confidence: 99%

Nurses’ Perceptions Regarding the Antiretroviral Therapy Services at Selected Health Facilities in Lesotho

Nyangu¹,

Nkosi²

2022

AJNS

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In Lesotho, ART services are provided in primary health care (PHC) facilities which are mostly run by nurses. This study aimed to describe perceptions of nurses regarding the antiretroviral therapy services at PHC facilities across six selected districts in Lesotho. A cross sectional survey was conducted in which convenience sampling was used to select 214 nurses working at PHC facilities across six districts. They completed a structured self-report questionnaire that collected information on their perceptions using a Likert scale with six options (strongly agree, agree, neutral, disagree, strongly disagree, and no answer). The response rate was 92% (n=197) and data were analyzed using SPSS (23). Nurses' perceptions were positive and the same on whether ARVS and other medications were available; they were qualified and competent to provide ART services; they had adequate resources and equipment to provide ART services; they were satisfied with their jobs and the services they provided; and there was monitoring and evaluating system for the ART services. Nurses' perceptions significantly differed and were mostly negative on whether they were adequately staffed to provide ART services; their organizational structures allowed for the provision of adequate and efficient services; ART services were accessible; and there was adequate and accurate documentation of the ART services they provided. As nurses are the main health care providers in Lesotho, their perceptions are important in improving service delivery. It is important to standardize ART services across the districts to ensure equitable accessibility in line with service demand.

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Balancing documentation and direct patient care activities: A study of a mature electronic health record system

Cited by 32 publications

References 25 publications

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Implementing Best Practices to Redesign Workflow and Optimize Nursing Documentation in the Electronic Health Record

Technostress and Digital Competence Among Health Professionals in Swiss Psychiatric Hospitals: Cross-sectional Study

Nurses’ Perceptions Regarding the Antiretroviral Therapy Services at Selected Health Facilities in Lesotho

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