Implementation to Optimization: A Tailored, Data-Driven Approach to Improve Provider Efficiency and Confidence in Use of the Electronic Medical Record

Kadish, Sarah; Mayer, Erica L.; Jackman, David M.; Pomerantz, Mark; Brady, Lauren; Dimitriadis, Audra; Cleveland, Jessica; Wagner, Andrew J.

doi:10.1200/jop.18.00093

Cited by 22 publications

(37 citation statements)

References 10 publications

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“…Studies were conducted in the United States (n = 31), 13 , 14 , 22 , 27 , 28 , 43 , 52–76 Europe (n = 1), 29 and Asia (n = 3). 77–79 Studies included a mix of ambulatory (n = 22) 14 , 22 , 27–29 , 52–54 , 56 , 61–66 , 69 , 71–75 and hospital (ie, inpatient and emergency) settings (n = 11) 13 , 55 , 57 , 59 , 60 , 67 , 68 , 70 , 76 , 78 , 79 with 2 involving both. 58 , 77 A majority of those studies involved single sites (77.1%) and were affiliated with an academic institution/teaching hospital (80.0%).…”

Section: Resultsmentioning

confidence: 99%

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

129

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Background Objective Electronic health records (EHRs) are linked with documentation burden resulting in clinician burnout. While clear classifications and validated measures of burnout exist, documentation burden remains ill-defined and inconsistently measured. We aim to conduct a scoping review focused on identifying approaches to documentation burden measurement and their characteristics. Materials and Methods Based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Extension for Scoping Reviews (ScR) guidelines, we conducted a scoping review assessing MEDLINE, Embase, Web of Science, and CINAHL from inception to April 2020 for studies investigating documentation burden among physicians and nurses in ambulatory or inpatient settings. Two reviewers evaluated each potentially relevant study for inclusion/exclusion criteria. Results Of the 3482 articles retrieved, 35 studies met inclusion criteria. We identified 15 measurement characteristics, including 7 effort constructs: EHR usage and workload, clinical documentation/review, EHR work after hours and remotely, administrative tasks, cognitively cumbersome work, fragmentation of workflow, and patient interaction. We uncovered 4 time constructs: average time, proportion of time, timeliness of completion, activity rate, and 11 units of analysis. Only 45.0% of studies assessed the impact of EHRs on clinicians and/or patients and 40.0% mentioned clinician burnout . Discussion Standard and validated measures of documentation burden are lacking. While time and effort were the core concepts measured, there appears to be no consensus on the best approach nor degree of rigor to study documentation burden. Conclusion Further research is needed to reliably operationalize the concept of documentation burden, explore best practices for measurement, and standardize its use.

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Section: Resultsmentioning

confidence: 99%

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Moy

Schwartz

Chen

et al. 2021

Journal of the American Medical Informatics Association

129

View full text Add to dashboard Cite

show abstract

“… 23–25 In addition to current usability concerns, we identified clinicians’ uncertainty about the impact of using EMR functionality. Although these findings may suggest a need for ongoing training, 53 research into root cause analysis (a Safety I perspective) has identified training is a “poor solution” to address serious systems safety issues. 54 Our findings do, however, show that clinicians use of HIT depends on their understanding of the HIT system as a whole.…”

Section: Discussionmentioning

confidence: 99%

Variation in electronic test results management and its implications for patient safety: A multisite investigation

Thomas

Dahm

et al. 2020

Journal of the American Medical Informatics Association

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Objective The management and follow-up of diagnostic test results is a major patient safety concern. The aim of this qualitative study was to explore how clinicians manage test results on an everyday basis (work-as-done) in a health information technology–enabled emergency department setting. The objectives were to identify (1) variations in work-as-done in test results management and (2) the strategies clinicians use to ensure optimal management of diagnostic test results. Materials and Methods Qualitative interviews (n = 26) and field observations were conducted across 3 Australian emergency departments. Interview data coded for results management (ie, tracking, acknowledgment, and follow-up), and artifacts, were reviewed to identify variations in descriptions of work-as-done. Thematic analysis was performed to identify common themes. Results Despite using the same test result management application, there were variations in how the system was used. We identified 5 themes relating to electronic test results management: (1) tracking test results, (2) use and understanding of system functionality, (3) visibility of result actions and acknowledgment, (4) results inbox use, and (5) challenges associated with the absence of an inbox for results notifications for advanced practice nurses. Discussion Our findings highlight that variations in work-as-done can function to overcome perceived impediments to managing test results in a HIT-enabled environment and thus identify potential risks in the process. By illuminating work-as-done, we identified strategies clinicians use to enhance test result management including paper-based manual processes, cognitive reminders, and adaptive use of electronic medical record functionality. Conclusions Test results tracking and follow-up is a priority area in need of health information technology development and training to improve team-based collaboration/communication of results follow-up and diagnostic safety.

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“…12,[17][18][19][20][21][22][23][24][25][26][27] Optimization, variably defined as "maintained attention to the sustained use of the EHR" 17 or "the process that maximizes the benefits and utility of the EHR system," 18 relies heavily on training and education. Many of these optimization training efforts have been described [28][29][30][31] ; however, evaluations of more comprehensive, bidirectional optimization programs are sparse. 12 Software configuration and "intensive process reengineering" 20 require iteration and considerable organizational support.…”

Section: Background and Significancementioning

confidence: 99%

Multidisciplinary Sprint Program Achieved Specialty-Specific EHR Optimization in 20 Clinics

et al. 2021

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Objective The objective of the study was to highlight and analyze the outcomes of software configuration requests received from Sprint, a comprehensive, clinic-centered electronic health record (EHR) optimization program. Methods A retrospective review of 1,254 Sprint workbook requests identified (1) the responsible EHR team, (2) the clinical efficiency gained from the request, and (3) the EHR intervention conducted. Results Requests were received from 407 clinicians and 538 staff over 31 weeks of Sprint. Sixty-nine percent of the requests were completed during the Sprint. Of all requests, 25% required net new build, 73% required technical investigation and/or solutions, and 2% of the requests were escalated to the vendor. The clinical specialty groups requested a higher percentage of items that earned them clinical review (16 vs. 10%) and documentation (29 vs. 23%) efficiencies compared with their primary care colleagues who requested slightly more order modifications (22 vs. 20%). Clinical efficiencies most commonly associated with workbook requests included documentation (28%), ordering (20%), in basket (17%), and clinical review (15%). Sprint user requests evaluated by ambulatory, hardware, security, and training teams comprised 80% of reported items. Discussion Sprint requests were categorized as clean-up, break-fix, workflow investigation, or new build. On-site collaboration with clinical care teams permitted consensus-building, drove vetting, and iteration of EHR build, and led to goal-driven, usable workflows and EHR products. Conclusion This program evaluation demonstrates the process by which optimization can occur and the products that result when we adhere to optimization principles in health care organizations.

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Implementation to Optimization: A Tailored, Data-Driven Approach to Improve Provider Efficiency and Confidence in Use of the Electronic Medical Record

Cited by 22 publications

References 10 publications

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Measurement of clinical documentation burden among physicians and nurses using electronic health records: a scoping review

Variation in electronic test results management and its implications for patient safety: A multisite investigation

Multidisciplinary Sprint Program Achieved Specialty-Specific EHR Optimization in 20 Clinics

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