Visualizing and Trending Nursing Use of the Electronic Health Record

Nurses are the largest users of electronic health record (EHR) systems in health care. Front-line nurses at our healthcare system expressed the need to remove unnecessary documentation and improve efficiency in Epic. Documentation burden in the EHR is defined as non-meaningful documentation elements and will increase over time if not identified and removed.

With the support of our chief nursing officer (CNO), the information technology (IT) healthcare system’s nursing documentation improvement (NDI) team comprised of analysts and informatics nurse specialists collaborated with bedside nurses on a quality improvement project to redesign flowsheet templates and streamline documentation. We were also given the task of creating meaningful KPIs for our various nursing documentation burden initiatives for our academic health system (AHS) leadership.

The electronic health record (EHR) vendor time data was used pre-/post-implementation to measure time in system and per activity. The NDI team manually analyzed the monthly workbooks to drilldown by campus, specialty, department, and nurse. Findings were presented at our monthly steering council meetings with the CNO and IT meetings to measure project success and to determine department(s)/nurse(s) for outreach. The EHR vendor time data provides meaningful information but may be challenging to quickly trend data and perform comparative analysis across several workbooks. The EHR executive summary report gave our CNO a high-level overview of how we compared to our peers, but it is not an interactive tool to further analyze and pivot metrics. The EHR vendor time data and executive summary also did not provide metrics on nursing tenure at our organization to measure nursing mastery overtime. Our steering council desired a shareable dashboard to quickly explore metrics and trends, and to easily compare hospital locations and departments that they oversee.

The NDI and IT reporting team partnered to develop an interactive dashboard that consolidates monthly time in system data for ease of access and use. The NDI and reporting team met weekly to strategize on dashboard layout and design. The NDI team created a metrics specification content tracker to discuss dashboard scope, key metrics and filters, and build timeline with the reporting team and IT leadership. Metrics identified are related to in-flight nurse well-being projects such as flowsheet efficiency and standard medication administration timing.

The dashboard provides aggregated enterprise data as well as hospital/department/nurse drilldown for each metric. Dashboard filters include direct patient care, day shift, shift duration, hospital, location, department, nurse, and nursing experience. We created a medication administration filter to use as a proxy to identify nurses who provide direct patient care. We leveraged human resources (HR) nursing experience metrics to explore nurse role and tenure over time and how that impacts time spent in the EHR. Time-stamp interventions or project go-lives can be marked on the linear trend graphs to track interventions. Metrics benchmarks also help us to initiate process improvements. Making data accessible and meaningful can help create better informed decisions on which projects to undertake as resources are finite.