'Much bigger than just a global pandemic': How hospitals can plan crisis EHR documentation

EHR documentation burden is not a new concern, but the problem came to a head during the COVID-19 pandemic as nurses and other clinicians were under growing pressure to provide care to more and more patients during virus surges. 

“This is something that, ever since EHRs have been about, there have always been usability issues. Do we really need to be documenting that? How do we document things that really do need to be put into the electronic health record?” Stephanie Hoelscher, DNP, associate professor and informatics nurse specialist at the Texas Tech University Health Sciences Center, told MobiHealthNews.

Hoelscher and Serena Bumpus, DNP, regional senior director of clinical surveillance at Ascension, wanted to take a deep dive into what hospitals were doing in Texas during surges, and figure out how they could better handle crises in the future.

But the goal of the Texas pilot study goes beyond infectious diseases like COVID-19. They took an “all-hazards approach,” so hospitals could more quickly switch to crisis documentation standards in the event of other disasters or health threats.

“Disasters can happen at any time outside of a pandemic,” Bumpus said. “When you think about hurricanes, tornadoes, any other type of disaster … We need to look at this as something in a bigger picture, because this is much bigger than just a global pandemic. And so that really was what launched our study and the work we’re doing right now.”

Some documentation standards can’t be cut, like those that are regulatory requirements or are needed for patient safety, like medication adherence. But many hospitals implemented changes to initial screenings, admission assessments and discharge processes.

Their upcoming national study will continue the research and work to define what a surge is, which can vary based on state and coverage area. The goal is to figure out what’s working for the majority of providers, thus allowing hospitals to replicate their ideas and change them as necessary. 

It also highlights the importance of including nurses and other clinicians who are heavily using the EHR when considering changes.

“To me, making sure that you have brought nurses into the conversation is paramount,” Hoelscher said. “If you have two non-clinician informaticists looking at each other and saying, ‘What should we do? What do you want to do?’ That should be your cue to stop. If you two don’t know, then you need to get somebody involved that does know.”

At the same time, EHR documentation changes can sometimes cause friction, even when those updates are backed by evidence. Making changes during a high-stress time like a COVID-19 surge can also be difficult, because the EHR may suddenly look a lot less familiar.

“As nurses, the electronic health record is so deeply embedded into the work that we do. We create this cadence on how we document,” Bumpus said. “I’ve always looked at the EHR kind of like a grocery store. So you know where the bread is, you know where the milk is. And you can go right there, and you can get in, and you can get out. But if you go to a brand new grocery store, you’ve got to go looking for all of that stuff.”

The HIMSS22 session “Reducing Nursing Documentation Burden in a Time of Crisis” will take place on Tuesday, March 15, between 3:00 p.m. and 4:00 p.m. in Orange County Convention Center W330A.

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