Nursing Documentation in a Mature EHR System

Nursing Documentation in a Mature EHR System

Kenric W. Hammond (VA Puget Sound Health Care System, USA), Charlene R. Weir (George W. Allen VA Medical Center, USA) and Efthimis N. Efthimiadis (University of Washington, USA)
Copyright: © 2009 |Pages: 21
DOI: 10.4018/978-1-60566-234-3.ch006
OnDemand PDF Download:


Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS is useful because problems of system adoption and startup do not interfere with observations. Factors interfering with optimal nursing use of CPD areparticularly challenging and of great concern, given today’s shortage of nursing manpower. We describe problems and advantages of CPD usage identified by nurses in a series of research interviews. The chief advantages of CPD for nurses found were better accessibility and reliability of patient care documentation. The main disadvantage was an awkward fit between current input technology and nursing workflow. A second disadvantage was difficulty in translating portrayal of the nursing process into readable documentation that is useful to all members of the clinical team. We interpret these findings to show that explicit consideration of nursing workflow constraints and communication processes is necessary for development of effective nursing documentation systems. Some findings point to a PCIS reconfiguration strategy that is feasible in the short term. Other findings suggest the value of considering mobile and team-oriented technologies in future versions of the PCIS.
Chapter Preview


Patient care information systems do not exist in a vacuum. Inevitably, these systems articulate with the cognitive, social and practical dynamics of teams of information workers in a health care environment. To the extent that workers’ tasks and the functionality of the information systems they use mesh well, these systems are accepted by their users and may demonstrate benefits measurable in terms of efficiency, safety and clinical effectiveness. Present computerized systems do not meet this challenge uniformly (Chaudhry et al., 2006) and are particularly poor at meeting the complex, multi-faceted information needs of nursing. Much of the nursing role in health care delivery is at the final delivery point of care. Nemeth, et al. (2005) call this aspect of health care delivery the “sharp end” of care. As these authors note “ . . . sharp end knowledge is dense, complex, changes rapidly, and is embedded in a complex social setting that resists scrutiny by those who are considered to be outsiders.’’(2005, p. 19)

One important aspect of a patient care information system (PCIS) is input and retrieval of electronic text, which we refer to as computerized patient care documentation or CPD. In this chapter, we will review CPD as practiced by direct providers of health care, focusing on nursing documentation. We will report on an ongoing investigation of CPD as it exists in a mature, complete and widely-deployed patient care information system, the United States Department of Veterans Affairs (VA) Computerized Patient Record System, known as CPRS. We will offer a preliminary analysis of these findings, taking a cognitive work analysis perspective, and illustrate our points with excerpts from individual and group interviews conducted in VA settings. Our findings will show important advantages of CPD for nursing in the VA and important problems, especially with the “task-technology fit” (Goodhue & Thompson, 1995) of CPD and nursing practice.

We will review applicable medical informatics literature and present hypotheses about the origins of the current state of affairs. We will discuss the scope and purpose of nursing documentation activity, and make some short and long term suggestions for improving the “fit” of CPD with nursing work, especially in inpatient care. Improving the “fit” of the CPD system with inpatient nursing care is important. Patient safety has been shown to be highly correlated with nurse (especially RN) staffing intensity, as reviewed by Hinshaw (2008). It is generally accepted that availability to patients is important to safety. In addition, numerous studies of medical errors suggest that effective inter-staff communication is also crucial (Bhasale, Miller, Reid, & Britt, 1998; Coiera, 2000; Wilson, Harrison, Gibberd, & Hamilton, 1999). In hospitals, ward nurses play a critical role in both areas. The more time nurses spend being pulled away from patient and staff contact to work with CPD the less time is available for safety-promoting activities of communication and patient monitoring. Nurses’ work with CPD should be as productive and relevant as possible. While our present scope is limited to examining nursing usage of the VA’s CPD system in a single facility, many of our most important observations address fundamental cognitive and workflow issues that would apply to nursing documentation in any health care setting using a PCIS.

Complete Chapter List

Search this Book:
Editorial Advisory Board
Table of Contents
Peter J. Murray
Bettina Staudinger
Chapter 1
Wanda Sneed
Nursing informaticists can be leaders in promoting prevention of illness and diseases in the 21st century. Developing an infrastructure for... Sample PDF
A Treatise on Rural Public Health Nursing
Chapter 2
Elfriede Fritz, Daniela Deufert, Johannes Hilbe
Experience in nursing practice shows that, in Austria, there are still problems with assessment in computer-based nursing documentation. Nursing... Sample PDF
Assessment in a Computer-Based Nursing Documentation
Chapter 3
Dawn Dowding, Rebecca Randell, Natasha Mitchell, Rebecca Foster, Valerie Lattimer, Carl Thompson
Increasingly, new and extended roles and responsibilities for nurses are being supported through the introduction of clinical decision support... Sample PDF
Clinical Decision Support Systems in Nursing
Chapter 4
Jerono P. Rotich
This chapter will give an overview of the healthcare-related challenges that most newcomer immigrants and refugees encounter as they acculturate... Sample PDF
Culturally Sensitive Healthcare for Newcomer Immigrants
Chapter 5
Pammla Petrucka, Sandra Bassendowski, Thomas F. James, Hazel Roberts, June Anonson
This chapter presents the imperatives of mobile technologies in healthcare as these impact (or potentially) impact on development. It presents the... Sample PDF
Mobile Technology in a Developing Context: Impacts and Directions for Nursing
Chapter 6
Kenric W. Hammond, Charlene R. Weir, Efthimis N. Efthimiadis
Computerized patient care documentation (CPD) is a vital part of a Patient Care Information System (PCIS). Studying CPD in a well-established PCIS... Sample PDF
Nursing Documentation in a Mature EHR System
Chapter 7
Sisira Edirippulige, Anthony C. Smith, Mark Bensink, Nigel R. Armfield, Richard Wootton
Nurses play a pivotal role in the provision of healthcare. Home telehealth, the use of information and communication technologies to deliver and... Sample PDF
Nurses and Telehealth: Current Practice and Future Trends
Chapter 8
Mary D. Oriol, Gail Tumulty
This chapter presents a theoretical framework and research base for the successful transition of an established Master of Science in Nursing program... Sample PDF
Successful Online Teaching and Learning Strategies
Chapter 9
Virginia Plummer
This chapter is about the major policy issue of nursing resource allocation for hospitals. Health service executives have different views about... Sample PDF
Shaping Funding Policy for Nursing Services
Chapter 10
Elizabeth M. Borycki, Andre W. Kushniruk, Shigeki Kuwata, Hiromi Watanabe
A range of new technologies/information systems are increasingly being used by nurses in healthcare organizations. These technologies/information... Sample PDF
Simulations to AssessMedication Administration Systems
Chapter 11
Peter Jones
This chapter explores the potential of a conceptual framework – Hodges’ model – both as a socio-technical structure and means to explore such... Sample PDF
Socio-Technical Structures, 4Ps and Hodges' Model
Chapter 12
Beth Perry Mahler, Margaret Edwards
Teaching nursing online requires teachers to purposefully use strategies that facilitate the development of virtual learning communities. The... Sample PDF
Strategies for Creating Virtual Learning Communities
Chapter 13
Roberta Cuel, Roberta Ferrario
In this chapter a case study is presented, in which the ethnomethodological approach is used to analyze the impact of the implementation of an... Sample PDF
The Impact of Technology in Organizational Communication
Chapter 14
Boris A. Kobrinsky, Nikolay V. Matveev
Telemedicine, or distant medical consultations using communication via electronic networks, is gradually becoming a standard of medical care... Sample PDF
The Roles of a Nurse in Telemedical Consultations
Chapter 15
Daniel Carbone
The purpose of this chapter is to broadly discuss the need for enhanced evidence-based medicine (EBM) by nurses in the context of rural Australia... Sample PDF
The Role of EBM and Nursing Informatics in Rural Australia
Chapter 16
Maureen Farrell
The use of mobile technologies in nursing education is rapidly increasing. Handheld computers are the most frequently used of these technologies as... Sample PDF
Use of Handheld Computers in Nursing Education
Chapter 17
Elizabeth Rogerson, Linda Martindale, Carolyn Waltz
This chapter addresses issues relating to nursing informatics as used and applied in nursing education. This includes the use of information... Sample PDF
Using Information Technology in Nursing Education
About the Contributors