The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

Mehta, Raj; Radhakrishnan, Nila; Warring, Carrie D.; Jain, Ankur; Fuentes, Jorge; Dolganiuc, Angela; Lourdes, Laura S.; Busigin, John; Leverence, Robert

doi:10.4338/aci-2015-11-ra-0164

Cited by 31 publications

(12 citation statements)

References 36 publications

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“…The finding that PHN documentation changed after eB-fHV guideline implementation in ways that reflected the eB-fHV guideline for a group of clients receiving interventions before and after guideline implementation confirms the notion that the guideline embedded within the eHr for documentation influences intervention documentation patterns [10,[22][23][24]. This is seen in the increased documentation of interventions for the terms found within the eB-fHV such as the Health care supervision, Mental health, and interpersonal relationship problems, and the large reduction of "unspecified" targets.…”

Section: Discussionmentioning

confidence: 61%

“…Demographic, outcome, and intervention data were exported from the eHr in excel format. Standard inferential and descriptive analyses were conducted using SPSS v. 22 and Microsoft excel 2010. frequencies and percentages of documented interventions before and after guideline implementation by Omaha System problems, categories, and targets were compared to fHV data using chi-square, with significance tested using z scores [30], and patterns visualized using heat maps created in excel. Baseline and final Knowledge, Behavior, and Status outcome ratings were compared using a paired samples t-test.…”

Section: Analytic Strategymentioning

confidence: 99%

“…The use of evidence-based and problem-oriented templates in eHrs is associated with improved note quality without significant change in total documentation time. Such templates may provide clinical decision support during documentation [22,23]. consistent with the goals of the learning Health System [24], data generated by PHNs in eHrs has potential for use in evaluation and research, including benchmarking PHN outcomes across agencies [13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

Monsen¹,

Swenson²,

Klotzbach³

et al. 2017

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The objective of this quality evaluation was to evaluate the changes in public health nursing (PHN) interventions after the implementation of an evidence-based family home visiting (eB-fHV) guideline encoded using the Omaha System. Design and sample: This quality improvement evaluation was conducted using a secondary dataset of 27,910 PHN family home visiting interventions from visits to 129 adult clients enrolled in eB-fHV programs in a Midwestern PHN agency. The interventions were documented 12 months before and 14 months after eB-fHV Guideline implementation. The eB-fHV consisted of 94 PHN interventions for 10 Omaha System problems, with electronic health record (eHr) data generated by PHNs during routine clinical documentation. Standard descriptive and inferential statistics were employed in the analysis. Measures: The Omaha System was used to compare PHN practice before and after the guideline implementation. Results: Documentation patterns revealed that PHNs tailored interventions while also shifting toward the use of the eB-fHV guideline interventions. Ten eB-fHV problems accounted for 96.3% of interventions documented before and 98.5% of interventions documented after implementation. The proportion of interventions before and after eB-fHV by problem differed significantly for all problems except Substance use. fewer interventions were provided after eB-fHV for the primary problems of Pregnancy and Postpartum, with a shift to more interventions for caretaking/parenting. Conclusion: The PHN documentation demonstrated an adherence to the eB-fHV guideline, while tailoring the evidence-based interventions differentially by problem. further research is needed to extend this quality improvement approach to other guidelines and populations.

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Section: Discussionmentioning

confidence: 61%

Section: Analytic Strategymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

Monsen¹,

Swenson²,

Klotzbach³

et al. 2017

Kontakt

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“…Given the ubiquity and ease of developing templated notes to facilitate documentation within the EHR among practicing clinicians, residents, and students in many countries, creation of a templated note guiding students through the H&P 360 domains could be one approach to promote uptake. EHR-based template studies to date have focused on inpatient resident and faculty subjects with primary endpoints including note quality, quality of care, and time to note completion [12][13][14]. However, few studies have evaluated the use of templates to intentionally improve documentation related to patient perspectives and social and behavioral determinants of health [15,16]; most such initiatives have centered on interprofessional team members rather than on promoting psychosocial documentation within a physician's scope of work [17,18].…”

Section: Introductionmentioning

confidence: 99%

Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study

Rieger¹,

Anderson²,

Press³

et al. 2023

JMIR Med Educ

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Background Patients’ perspectives and social contexts are critical for prevention of hospital readmissions; however, neither is routinely assessed using the traditional history and physical (H&P) examination nor commonly documented in the electronic health record (EHR). The H&P 360 is a revised H&P template that integrates routine assessment of patient perspectives and goals, mental health, and an expanded social history (behavioral health, social support, living environment and resources, function). Although the H&P 360 has shown promise in increasing psychosocial documentation in focused teaching contexts, its uptake and impact in routine clinical settings are unknown. Objective The aim of this study was to assess the feasibility, acceptability, and impact on care planning of implementing an inpatient H&P 360 template in the EHR for use by fourth-year medical students. Methods A mixed methods study design was used. Fourth-year medical students on internal medicine subinternship (subI) services were given a brief training on the H&P 360 and access to EHR-based H&P 360 templates. Students not working in the intensive care unit (ICU) were asked to use the templates at least once per call cycle, whereas use by ICU students was elective. An EHR query was used to identify all H&P 360 and traditional H&P admission notes authored by non-ICU students at University of Chicago (UC) Medicine. Of these notes, all H&P 360 notes and a sample of traditional H&P notes were reviewed by two researchers for the presence of H&P 360 domains and impact on patient care. A postcourse survey was administered to query all students for their perspectives on the H&P 360. Results Of the 13 non-ICU subIs at UC Medicine, 6 (46%) used the H&P 360 templates at least once, which accounted for 14%-92% of their authored admission notes (median 56%). Content analysis was performed with 45 H&P 360 notes and 54 traditional H&P notes. Psychosocial documentation across all H&P 360 domains (patient perspectives and goals, mental health, expanded social history elements) was more common in H&P 360 compared with traditional notes. Related to impact on patient care, H&P 360 notes more commonly identified needs (20% H&P 360; 9% H&P) and described interdisciplinary coordination (78% H&P 360; 41% H&P). Of the 11 subIs completing surveys, the vast majority (n=10, 91%) felt the H&P 360 helped them understand patient goals and improved the patient-provider relationship. Most students (n=8, 73%) felt the H&P 360 took an appropriate amount of time. Conclusions Students who applied the H&P 360 using templated notes in the EHR found it feasible and helpful. These students wrote notes reflecting enhanced assessment of goals and perspectives for patient-engaged care and contextual factors important to preventing rehospitalization. Reasons some students did not use the templated H&P 360 should be examined in future studies. Uptake may be enhanced through earlier and repeated exposure and greater engagement by residents and attendings. Larger-scale implementation studies can help further elucidate the complexities of implementing nonbiomedical information within EHRs.

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“…1 Hospitalist groups work collaboratively because of the shiftwork required for 24/7 patient coverage, and first-rate clinical documentation is essential for quality care. 2 Thoughtful clinical documentation not only transmits one provider's clinical reasoning to other providers but is a professional responsibility. 3 Hospitalists spend two-thirds of their time in indirect patient-care activities and approximately one quarter of their time on documentation in electronic health records (EHRs).…”

mentioning

confidence: 99%

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric

Kotwal

Klimpl

Tackett

et al. 2019

Journal of Hospital Medicine

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OBJECTIVE: To establish a metric for evaluating hospitalists’ documentation of clinical reasoning in admission notes. STUDY DESIGN: Retrospective study. SETTING: Admissions from 2014 to 2017 at three hospitals in Maryland. PARTICIPANTS: Hospitalist physicians. MEASUREMENTS: A subset of patients admitted with fever, syncope/dizziness, or abdominal pain were randomly selected. The nine-item Clinical Reasoning in Admission Note Assessment & Plan (CRANAPL) tool was developed to assess the comprehensiveness of clinical reasoning documented in the assessment and plans (A&Ps) of admission notes. Two authors scored all A&Ps by using this tool. A&Ps with global clinical reasoning and global readability/clarity measures were also scored. All data were deidentified prior to scoring. RESULTS: The 285 admission notes that were evaluated were authored by 120 hospitalists. The mean total CRANAPL score given by both raters was 6.4 (SD 2.2). The intraclass correlation measuring interrater reliability for the total CRANAPL score was 0.83 (95% CI, 0.76-0.87). Associations between the CRANAPL total score and global clinical reasoning score and global readability/clarity measures were statistically significant (P < .001). Notes from academic hospitals had higher CRANAPL scores (7.4 [SD 2.0] and 6.6 [SD 2.1]) than those from the community hospital (5.2 [SD 1.9]), P < .001. CONCLUSIONS: This study represents the first step to characterizing clinical reasoning documentation in hospital medicine. With some validity evidence established for the CRANAPL tool, it may be possible to assess the documentation of clinical reasoning by hospitalists.

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The Use of Evidence-Based, Problem-Oriented Templates as a Clinical Decision Support in an Inpatient Electronic Health Record System

Cited by 31 publications

References 36 publications

Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

Empirical evaluation of the changes in public health nursing interventions after the implementation of an evidence-based family home visiting guideline

Implementation of a Biopsychosocial History and Physical Exam Template in the Electronic Health Record: Mixed Methods Study

Documentation of Clinical Reasoning in Admission Notes of Hospitalists: Validation of the CRANAPL Assessment Rubric

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