Maintaining a Consistent Big Picture: Meaningful Use of a Web-based POC EHR System

Abstract

OBJECTIVE: To test the hypothesis that Hands-on Automated Nursing Data System (HANDS) “big picture summary” can be implemented uniformly across diverse settings, and result in positive registered nurse (RN) and plan of care (POC) data outcomes across time.

DESIGN: In a longitudinal, multisite, full test study, a representative convenience sample of eight medical-surgical units from four hospitals (one university, two large community, and one small community) in one Midwestern state implemented the HANDS intervention for 24 (four units) or 12 (four units) months.

MEASUREMENTS: (a) RN outcomes—percentage completing training, satisfaction with standardized terminologies, perception of HANDS usefulness, POC submission compliance rate. (b) POC data outcomes—validity (rate of optional changes/episode); reliability of terms and ratings; and volume of standardized data generated.

RESULTS: One hundred percent of the RNs who worked on the eight study units successfully completed the required standardized training; all units selected participated for the entire 12- or 24-month designated period; compliance rates for POC entry at every patient hand-off were 78–92%; reliability coefficients for use of the standardized terms and ratings were moderately strong; the pattern of optional POC changes per episode declined but remained reasonable across time; and the nurses generated a database of 40,747 episodes of care.

LIMITATIONS: Only RNs and medical-surgical units participated.

CONCLUSION: It is possible to effectively standardize the capture and visualization of useful “big picture” healthcare information across diverse settings. Findings offer a viable alternative to the current practice of introducing new health information layers that ultimately increase the complexity and inconsistency of information for frontline users.

Keywords

Continuity of care electronic health record interdisciplinary nursing plan of care standardization terminologies

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References

Allen

(1998). Record-keeping and routine nursing practice: The view from the wards. Journal of Advanced Nursing, 27(6), 1223–1230.

Bjorvell

Wredling

Thorell-Ekstrand

(2002). Long-term increase in quality of nursing documentation: Effects of a comprehensive intervention. Scandinavian Journal of Caring Sciences, 16(1), 34–42.

Blumenthal

Tavenner

(2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363(6), 501–504. doi:10.1056/NEJMp1006114

Currell

Urquhart

Grant

M. J.

Hardiker

N. R.

(2009). Nursing record systems: Effects on nursing practice and healthcare outcomes. Cochrane Database of Systematic Reviews, (1). doi:10.1002/14651858.CD002099.pub2

Darmer

M. R.

Ankersen

Nielsen

B. G.

Landberger

Lippert

Egerod

(2006). Nursing documentation audit—The effects of a VIPS implementation programme in Denmark. Journal of Clinical Nursing, 15(5), 525–534.

Department of Health and Human Services . (2010). Health information technology: Revisions to initial set of standards, implementation specifications, and certification criteria for electronic health record technology. Interim final rule with request for comments. Federal Register, 75, 44589–44654.

Ehrenberg

Ehnfors

(2001). The accuracy of patient records in Swedish nursing homes: Congruence of record content and nurses' and patients' descriptions. Scandinavian Journal of Caring Sciences, 15(4), 303–310.

Ehrmann

S. C.

Zuniga

R. E.

(1997). The flashlight evaluation handbook. Washington, DC: The TLT Group.

Griffiths

Hutchings

(1999). The wider implications of an audit of care plan documentation. Journal of Clinical Nursing, 8(1), 57–65.

10.

Guerra

(2010). Five members dominate HIE market. Information Week . Retrieved from http://www.informationweek.com/news/healthcare/clinical-systems/225702631

11.

Hardey

Payne

Coleman

(2000). “Scraps”: Hidden nursing information and its influence on the delivery of care. Journal of Advanced Nursing, 32(1), 208–214.

12.

Healthcare Information Technology Standard Panel . (2009). Comparison of CCR/CCD and CDA documents and HITSP products . Retrieved July 7, 2011 from http://publicaa.ansi.org/sites/apdl/hitspadmin/Matrices/HITSP_09_N_451.pdf

13.

Hutchins

(1995). Cognition in the wild. Cambridge, MA: MIT Press.

14.

Institute of Medicine . (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

15.

Joint Commission . (2010). 2010 Hospital accreditation standards. Oakbrook Terrace, IL: Author.

16.

Kärkkäinen

Bondas

Eriksson

(2005). Documentation of individualized patient care: A qualitative metasynthesis. Nursing Ethics, 12(2), 123–132.

17.

Karkkainen

Eriksson

(2004). Structuring the documentation of nursing care on the basis of a theoretical process model. Scandinavian Journal of Caring Sciences, 18(2), 229–236. doi:10.1111/j.1471-6712.2004.00274.x SCS274 [pii]

18.

Karkkainen

Eriksson

(2005). Recording the content of the caring process. Journal of Nursing Management, 13(3), 202–208. doi:JNM540 [pii] 10.1111/j.1365-2834.2005.00540.x

19.

Keenan

G. M.

Stocker

J. R.

Geo-Thomas

A. T.

Soparkar

N. R.

Barkauskas

V. H.

Lee

J. L.

(2002). The HANDS project: Studying and refining the automated collection of a cross-setting clinical data set. Computers, Informatics, Nursing, 20(3), 89–100.

20.

Keenan

G. M.

Yakel

(2005). Promoting safe nursing care by bringing visibility to the disciplinary aspects of interdisciplinary care. American Medical Informatics Association Annual Symposium Proceedings, 2005, 385–389. doi:57367 [pii]

21.

Keenan

G. M.

Yakel

Dunn Lopez

Tschannen

Ford

Y. B.

Sorokin

(submitted). Challenges to nurses' efforts of retrieving, documenting and communicating patient care. Journal of the American Medical Informatics Association.

22.

Keenan

G. M.

Yakel

Tschannen

Mandeville

(2008). Documentation and the nurse care planning process. In Hughes

R. G.

(Ed.), Patient safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality (US). doi:NBK2674 [bookaccession]

23.

Larrabee

J. H.

Boldreghini

Elder-Sorella

Turner

Z. M.

Wender

R. G.

Hart

J. M.

(2001). Evaluation of documentation before and after implementation of a nursing information system in an acute care hospital. Computers in Nursing, 17(2), 56–65.

24.

Lee

T. T.

(2005). Nursing diagnoses: Factors affecting their use in charting standardized care plans. Journal of Clinical Nursing, 14(5), 640–647.

25.

Lee

T. T.

Chang

P. C.

(2004). Standardized care plans: Experiences of nurses in Taiwan. Journal of Clinical Nursing, 13(1), 33–40.

26.

Liu

J. L.

Wyatt

J. C.

(2010). The case for randomized controlled trials to assess the impact of clinical information systems. Journal of the American Medical Informatics Association, 18, 173–180. doi:10.1136/jamia.2010.010306

27.

Mason

(1999). Guide to practice or “load of rubbish”? The influence of care plans on nursing practice in five clinical areas in Northern Ireland. Journal of Advanced Nursing, 29(2), 380–387.

28.

McCloskey Dochterman

J. C.

Bulechek

G. M.

(2004). Nursing interventions classification (et al.). St. Louis, MO: Mosby.

29.

Mishra

A. K.

(1992). Organizational responses to crisis: The role of mutual trust and top management teams. Ann Arbor, MI: University of Michigan.

30.

Moorhead

Johnson

Maas

; Iowa Outcomes Project . (2004). Nursing outcomes classification (NOC). St. Louis, MO: Mosby.

31.

NANDA-I . (2003). NANDA-Nursing diagnoses: Definition and classification 2003–2004. Philadelphia: Author.

32.

Scherb

(2002). Outcomes research: Making a difference. Outcomes Management, 6(1), 22–26.

33.

Stead

W. W.

Lin

H. S.

(2009). Computational technology for effective health care: Immediate steps and strategic directions. Washington, DC: USA National Academies Press.

34.

Stokke

T. A.

Kalfoss

M. H.

(1999). Structure and content in Norwegian nursing care documentation. Scandinavian Journal of Caring Sciences, 13(1), 18–25.

35.

Vest

J. R.

Zhao

Jasperson

Gamm

L. D.

Ohsfeldt

R. L.

(2011). Factors motivating and affecting health information exchange usage. Journal of the American Medical Informatics Association, 18(2), 143–149. doi:jamia.2010.004812 [pii] 10.1136/jamia.2010.004812

36.

Vogus

Welbourne

T. M.

(2003). Structuring for high reliability: HR practices and mindful processes in reliability-seeking organizations. Journal of Organizational Behavior, 24, 877–903.

37.

Weick

K. E.

(1987). Organizational culture as a source of high reliability. California Management Review, 29(2), 112–127.

38.

Weick

K. E.

Roberts

K. H.

(1993). Collective mind in organizations: Heedful interrelating on flight decks. Administrative Science Quarterly, 38(3), 357–382.

39.

Weick

K. E.

Sutcliffe

K. M.

(2001). Managing the unexpected: Assuring high performance in an age of complexity. San Francisco: Jossey-Bass.

40.

Weick

K. E.

Sutcliffe

K. M.

(2006). Mindfulness and the quality of organization attention. Organization Science, 17(4), 514–524.

41.

Westra

Dey

Steinbach

Kumar

Oancea

Savik

, . . . Dierich

(2011). Interpretable predictive models for knowledge discovery from home-care electronic health records. Journal of Healthcare Engineering, 2(1), 55–71.

42.

Westra

Savik

Oancea

Chormanski

Holmes

J. H.

Bliss

(2011). Predicting improvements in urinary and bowel incontinence for home health patients using electronic health record data. Journal of Wound Ostomy and Continence Nursing, 38(1), 77–87.