Presentation
Designing for Better Clinical Documentation
DescriptionThe purpose of the project was to improve the frequency and quality of EMR-based clinical documentation for adult home-care nurses in the Greater Toronto Area.
VHA is a home healthcare organization which offers healthcare and support to patients and their informal caregivers of all ages and backgrounds. We worked closely with VHA to define the project objectives, key players, solvable challenges and what success looked like, to inform the focus of the project.
In order to deeply understand the challenges and drive the design of meaningful solutions, Healthcare Human Factors conducted ethnographic research in community-based clinics and in patient’s homes. Observations and in-context interviews were conducted to get to the core of the challenge, by understanding the drivers of the current documentation practices as well as the contexts surrounding them. Additionally, cognitive walkthroughs were conducted with home care nurses to get a better understanding of usability issues with the electronic documentation system hindering nurses’ ability to document accurately.
The overall aim was to understand:
• Clinicians’ goals when providing care
• Clinicians’ goals when documenting
• How they interact with the EMR, how it supports them, how it frustrates them
• How the environment around them implicates the ability to document
• How they make decisions about what to document
The research was then synthesized using empathy maps, affinity maps and root cause analysis. This process allowed us to identify the key themes that emerged, and also, to dig into the individual drivers and motivations for clinicians as they provided and documented care in the home.
A series of recommendations were created to improve the frequency and quality of clinical documentation. These recommendations focused not only on changes to the EMR, but also, to the processes, systems and environments that surrounded the interaction between clinicians and technology.
The findings and recommendations were presented back to the to a cross-sectional group of stakeholders within the homecare organization, including nurse supervisors, quality operations team members, IT, child and family rehabilitation department leaders, the vice president of quality, best practices, and education, and the VHA project lead and clinical informatics staff. HHF then facilitated small group discussions with these stakeholders to glean feedback on our proposed solutions and to prioritize them using an impact-effort matrix. During each discussion, participants were asked to select three recommendations which they felt would make the greatest impact in improving clinical documentation. These recommendations were then plotted on a matrix based on anticipated impact on clinical documentation and effort to implement. The outputs of this discussion shaped our final recommendations.
Recommendations were provided for both product design, as well as around enabling factors that surrounded the EMR. This was to create a holistic set of conditions that would make it easier for clinical teams to efficiently capture and share key information about patients and the care they receive. These findings were presented to the VHA project team, who would then independently review and determine which recommendations to implement.
Key Takeaways
• The success of the project depended on continuous collaboration and communication between all the stakeholders from the homecare organization and HHF.
• Conducting observations in the environments the documentation system was being used in was key to understanding factors outside of the documentation system preventing quality and timely documentation.
• Directly communicating and emphasizing the purpose of trying to improve the ease of documentation was important to get homecare nurses to be open to having a human factors specialist observe their work.
• Transforming the research insights into personas, key user needs, and grouping the key findings into themes was an impactful method to help all stakeholders understand the varying and expansive challenges the nurses face in the community. Moreover, this lent itself to an easier method for the organization to prioritize the issues to address.
• Additional insights can be gleaned by conducting interviews with other clinician groups who have been able to complete their documentation in a more timely and accurate manner.
The target audience for this presentation is healthcare providers, policy makers, EMR developers, and additional stakeholders seeking to develop or improve their clinical documentation practices. This project highlights the importance of capturing system-level data and observations which may assist or pose barriers to effective workflow and implementation. This presentation aims to discuss design insights, findings, and recommendations for improving the clinical documentation process for VHA and seeks to begin discussion on how these findings can be applied to additional healthcare environments.
This work was conducted in conjunction with Kartini Mistry, Sandra Li-James, and Alistair Forsyth at the VHA Home HealthCare in Toronto, Ontario.
VHA is a home healthcare organization which offers healthcare and support to patients and their informal caregivers of all ages and backgrounds. We worked closely with VHA to define the project objectives, key players, solvable challenges and what success looked like, to inform the focus of the project.
In order to deeply understand the challenges and drive the design of meaningful solutions, Healthcare Human Factors conducted ethnographic research in community-based clinics and in patient’s homes. Observations and in-context interviews were conducted to get to the core of the challenge, by understanding the drivers of the current documentation practices as well as the contexts surrounding them. Additionally, cognitive walkthroughs were conducted with home care nurses to get a better understanding of usability issues with the electronic documentation system hindering nurses’ ability to document accurately.
The overall aim was to understand:
• Clinicians’ goals when providing care
• Clinicians’ goals when documenting
• How they interact with the EMR, how it supports them, how it frustrates them
• How the environment around them implicates the ability to document
• How they make decisions about what to document
The research was then synthesized using empathy maps, affinity maps and root cause analysis. This process allowed us to identify the key themes that emerged, and also, to dig into the individual drivers and motivations for clinicians as they provided and documented care in the home.
A series of recommendations were created to improve the frequency and quality of clinical documentation. These recommendations focused not only on changes to the EMR, but also, to the processes, systems and environments that surrounded the interaction between clinicians and technology.
The findings and recommendations were presented back to the to a cross-sectional group of stakeholders within the homecare organization, including nurse supervisors, quality operations team members, IT, child and family rehabilitation department leaders, the vice president of quality, best practices, and education, and the VHA project lead and clinical informatics staff. HHF then facilitated small group discussions with these stakeholders to glean feedback on our proposed solutions and to prioritize them using an impact-effort matrix. During each discussion, participants were asked to select three recommendations which they felt would make the greatest impact in improving clinical documentation. These recommendations were then plotted on a matrix based on anticipated impact on clinical documentation and effort to implement. The outputs of this discussion shaped our final recommendations.
Recommendations were provided for both product design, as well as around enabling factors that surrounded the EMR. This was to create a holistic set of conditions that would make it easier for clinical teams to efficiently capture and share key information about patients and the care they receive. These findings were presented to the VHA project team, who would then independently review and determine which recommendations to implement.
Key Takeaways
• The success of the project depended on continuous collaboration and communication between all the stakeholders from the homecare organization and HHF.
• Conducting observations in the environments the documentation system was being used in was key to understanding factors outside of the documentation system preventing quality and timely documentation.
• Directly communicating and emphasizing the purpose of trying to improve the ease of documentation was important to get homecare nurses to be open to having a human factors specialist observe their work.
• Transforming the research insights into personas, key user needs, and grouping the key findings into themes was an impactful method to help all stakeholders understand the varying and expansive challenges the nurses face in the community. Moreover, this lent itself to an easier method for the organization to prioritize the issues to address.
• Additional insights can be gleaned by conducting interviews with other clinician groups who have been able to complete their documentation in a more timely and accurate manner.
The target audience for this presentation is healthcare providers, policy makers, EMR developers, and additional stakeholders seeking to develop or improve their clinical documentation practices. This project highlights the importance of capturing system-level data and observations which may assist or pose barriers to effective workflow and implementation. This presentation aims to discuss design insights, findings, and recommendations for improving the clinical documentation process for VHA and seeks to begin discussion on how these findings can be applied to additional healthcare environments.
This work was conducted in conjunction with Kartini Mistry, Sandra Li-James, and Alistair Forsyth at the VHA Home HealthCare in Toronto, Ontario.
Event Type
Oral Presentations
TimeWednesday, March 279:15am - 9:37am CDT
LocationSalon A-2
Digital Health