More Data Does Not Equal Better Data

More data must be better, right?

This was most likely a sentiment at some point in the health IT evolution; however, today, with the ever-increasing demands on the time of clinical staff, the collection of more data has turned from a need for data, to a contributor of moral distress and burnout of our clinicians. At the 2019 HIMSS Conference, Susan G. McBride issued a call to action for industry leaders to optimize EHRs, both in streamlining the volume of data we ask our clinicians to document, as well as the need to focus on usability aspects of our technologies.

Since the implementation of the HITECH Act in 2009 and the expanding technology capabilities with data sharing, we have enabled the collection of large volumes of information, but now the question: is having more information better?

The answer is yes, and…

YES, technology has contributed significantly to improvements within healthcare. AND, at the same time, we need to fine-tune our focus on the reality clinicians are experiencing with documentation burden. We must improve the usability of all technology by being passionate ambassadors in protecting our most valuable resources – clinicians – from burnout.

As burnout is being felt and discussed in all realms of the healthcare industry, we know it will continue to impact healthcare in the future. By 2025, the healthcare shortage is projected to expand, with demand surpassing the supply of available physicians, nurses, technicians and aides. While data will always be important, having the right data, at the right time will change how we look at it; by presenting or collecting it in a better way, we can decrease the burden of documentation and contribute to a better work experience for our clinicians.

As the Chief Nursing Informatics Officer at Atrium Health, my role is to help the organization leverage technology for our clinicians to make processes easier, bring efficiencies to workflows, and to improve the patient’s experience.

In 2018, we discovered that over the years, we had continued to add questions and assessment information to our hospital admission documentation, resulting in more than 419 data elements being collected when a patient is admitted to the hospital. Like many healthcare organizations, we heard from our bedside nurses that this process had become a daunting task — both for clinicians and patients.

When we reviewed the information in detail, we discovered that the staff were documenting duplicative information, and entering details that were not essential for patient care (at least, not at the time of the encounter). Examples included having the nurse ask for contact information, even though it was previously documented by our registration personnel; or asking a patient about anesthesia experiences, even if they were not going to have surgery.

We wanted to make it better, and we knew there were efficiencies to be gained.

Melissa Scales, RN-BC, one of our Clinical Informatics Coordinators, worked with a team of clinicians and information and analytics services teammates to transition our custom documentation to Cerner’s evidence-based, Essential Clinical Dataset for Adult Admission. In this process, the team reviewed Cerner’s standardized content, compared our data elements, and were able to reduce redundancies, eliminate non value-added items, and decrease the overall time needed for nursing staff to document admission information. The project allowed for us to determine who is the best resource to gather information and make changes to improve workflow for everyone. Additionally, we were able to evaluate the usability design of the documentation and improve it by making it easier to input the data.

With the implementation of the Essential Clinical Dataset for Adult Admission, more than 280 documented data elements were eliminated. While we will continue to monitor the impact, it’s estimated that these changes will remove more than 6 million clicks a year for our nurses’ workflow and will give a minimum of 4,000 nursing hours back for patient care. It also means we will no longer be asking or assessing duplicative, non-essential information, which will contribute to a better patient experience.

The response from our staff has been overwhelmingly positive. One of our nurses shared with me how happy she was with the changes, saying it was a game changer and that her admission documentation time had been cut in half. When that happens, I’m reminded that more data is not the same as better data. It’s about having the right data, gathered by the right people, at the right time, and designed in the right way.

I’m happy we were able to make a difference to our clinicians and enable them to have more time to focus on what really matters: the patient. And we’re not done. Now is the time, as clinical informaticists and leaders, to remain ever vigilant, ever focused on getting the data and usability right. Only then can we deliver healthcare that is best for patients and best for our clinicians at the same time.

Originally posted on LinkedIn, this piece was written by Becky Fox, Chief Nursing Informatics Officer at Atrium Health.