Enable front-line clinicians to actively participate in redesign and refresh of electronic health record (EHR) user interfaces, rapid cycle approvals, successful implementation of changes, and more efficient operations.

Prior to this novel structure, a bottleneck in organizational structure caused a backlog of enhancement requests and maintenance tickets for the electronic health record (EHR). Limited input from end users resulted in implementation catastrophes and retracted work. Front-line clinicians were dissatisfied with the EHR and lost trust in the shared governance model. Nursing administration, clinical informatics analysts, and the shared leadership council (SLC) sought to protect time for collaborative EHR design development by direct patient care providers and implement meaningful EHR changes quickly and effectively.

The documentation task force, comprised of multidisciplinary bedside clinicians and various levels of clinical experts, was formed to review EHR enhancement requests and upgrades. This forum provided dedicated work time to fully vet and investigate recommendations and ensure sound decision making on high impact, complex EHR changes. Direct patient care providers contributed design specifications and considered end user impact. Resulting recommendations were presented by front-line clinicians to SLC for final review and approval. The task force dissolved once a recommendation was approved through SLC.

Leveraging a Magnet nursing culture, the task force has driven impactful, desired, and complex redesigns of EHR documentation in areas such as activities of daily living, pain, intake and output, and infection prevention. In the first year, 79% more EHR tickets have been completed and median days to completion has decreased by 88% for enhancement requests. Realized benefits also include early involvement of end users in process improvement, leadership development, promotion of high reliability organizational culture, structural empowerment, and improved adoption of change.
Implementation of an improved intake form, along with the use of a prioritization matrix, enhances understanding of current state workflow and clinical needs. Requiring more detailed specifications and evidence-based references from requestors enables faster approval and prioritization of EHR requests based on organizational goals and regulatory requirements. Active participation and accountability with requestors also increased form completion and satisfaction among clinicians. Impact of this change will be provided at conference time.

The task force model is flexible, inclusionary, meaningful, empowering, and practical. The model has applications in various subjects and areas beyond EHR enhancement and can be used to promote collaborative initiatives between content experts and direct patient care providers.

Cheryl Cordova MSN, RN, OCN

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