Optimizing the Use of Electronic Health Records

EHR Assessment and Evaluation to Support Healthcare Outcome Objectives The outcome-related goals that the tertiary care hospital seeks to achieve include the following: 1) Strengthen adult admissions screening at intake for pain, depression, and adverse health behaviors such as smoking, excess alcohol intake, and body mass index (BMI) greater than 30; 2) implement comprehensive geriatric assessment for all adults 65 years of age and over who are hospitalized for more than seven days or readmitted within less than three days following discharge; and 3) promote care team performance.

The electronic health record (EHR) is the default system for adult admissions, and it includes documentation standards and structures such as SOAP and checklists. Hospital staff are provided periodic guidelines through educational venues or through referral to the electronic policy and procedure manual.

Given this information, the data elements that should be included in the EHR assessment and evaluation screens are as follows: If the EHR system uses the National Institute of Standards and Technology's (NIST) EHR usability protocol, NISTIR 7804, these review areas should be included (Lowry, et al., 2012): Clinical Decision Clinical Information Reconciliation Drug-drug, drug-allergy interactions Electronic Medical Administration ePrescribing Med -- Allergies Medications list Order Entry User defined The information system defaults and alerts could be used to achieve the outcome-related goals by utilizing user tools that basically sit on top of the HER system and record the movements of the users.

In addition to tracking, add-in systems such as TURF can be used for many different functions (Lowry, et al., 2012). In user sessions, a tracking system can be used capture screen shots, keystrokes, mouse clicks and verbal comments recorded in an audio file (Lowry, et al., 2012). For administration, the tracking tool can capture information on consent forms, non-disclosures, and the demographics of groups and individuals (Lowry, et al., 2012).

The tracking system can also be set to alert for specific problems, such as how users are conducting e-prescribe or the creation of care documents (Lowry, et al., 2012). Advanced manager-users can establish optimum selection paths or define the steps users should take when conducting a particular task, and them compare the steps with other user actions (Lowry, et al., 2012). If sophisticated reports are needed, systems like TURF can be used to employ counting and tools for statistical analysis, such as one-way ANOVA (Lowry, et al., 2012).

Screening improvements are a strong foundation for achieving the outcome-related goals of the hospital, but the EHR system must be supported by vigilant care staff who tune into the goals as they go about their work. The EHR system is only as good as the users, which means that guidelines for integrating the system functions with the hospital goals may need to be established and become part of the EHR training program provided to staff. The EHR system can be designed to.