Dataset Information

Therapists' experiences with implementing new documentation practices for low back pain in electronic health care records: an interview study.

ABSTRACT:

Objective

Clinical practice is constantly changing with new guidelines being published, changes in patients' preferences but also by new qualitative requirements for therapists and institutional surveys on delivered care. Electronic health records (EHR) are used for all these purposes. We involved physiotherapists and occupational therapists in an intervention to change documentation practice in their electronic health record for low back pain (LBP) and later evaluated the feasibility of the new health records. The aim of the present study was to explore therapists' experiences working with the new EHR.

Results

Three themes were identified thru interviews: (I) Facilitators and motivators towards implementation, (II) Changing routines as a group and (III) Obstacles against successful implementation. This study identifies a need for involving therapists and management for successful change of electronic health care records usage in municipalities. However, difficulties were encountered in meeting documentation of practice requirements and obtaining sufficient data quality in the EHR for data to be used for daily use, quality assessment and research. In this small descriptive study, developing an EHR that simultaneously serves treatment plans, quality assessment, and research purposes was not expressed being feasible. Further research in this area is needed.

SUBMITTER: Toftdahl AKS

PROVIDER: S-EPMC10605498 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Therapists' experiences with implementing new documentation practices for low back pain in electronic health care records: an interview study.

Toftdahl Anne Katrine Skjølstrup AKS Ibsen Stine S Pape-Haugaard Louise Bilenberg LB Riis Allan A

BMC research notes 20231026 1

<h4>Objective</h4>Clinical practice is constantly changing with new guidelines being published, changes in patients' preferences but also by new qualitative requirements for therapists and institutional surveys on delivered care. Electronic health records (EHR) are used for all these purposes. We involved physiotherapists and occupational therapists in an intervention to change documentation practice in their electronic health record for low back pain (LBP) and later evaluated the feasibility of ...[more]

PMID: 37885004

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Project description:BackgroundDocumentation burden associated with electronic health records (EHR) is well documented in the literature. Usability and functionality of the EHR are considered fragmented and disorganized making it difficult to synthesize clinical information. Few best practices are reported in the literature to support streamlining the configuration of documentation fields to align clinical workflow with EHR data entry elements.ObjectiveThe primary objective was to improve performance, reduce duplication, and remove nonvalue-added tasks by redesigning the patient assessment template in the EHR using best practice approaches.MethodsA quality improvement approach and pre-/postdesign was used to implement and evaluate best approaches to redesign standardized flowsheet documentation workflow. We implemented standards for usability modifications targeting efficiency, reducing redundancy, and improving workflow navigation. The assessment type row was removed; a reassessment section was added to the first three flowsheet rows and documentation practices were revised to document changes from the initial assessment by selecting the corresponding body system from the dropdown menu. Vendor-supplied timestamp data were used to evaluate documentation times. Video motion-time recording was used to capture click and scroll burden, defined as steps in documentation, and was analyzed using the Keystrok Level Model.ResultsThis study's results included an 18.5% decreased time in the EHR; decrease of 7 to 12% of total time in flowsheets; time savings of 1.5 to 6.5 minutes per reassessment per patient; and a decrease of 88 to 97% in number of steps to perform reassessment documentation.ConclusionWorkflow redesign to improve the usability and functionality decreased documentation time, redundancy, and click burden resulting in improved productivity. The time savings correlate to several hours per 12-hour shift which could be reallocated to value-added patient care activities. Revising documentation practices in alignment with redesign benefits staff by decreasing workload, improving quality, and satisfaction.

Project description:BackgroundPolicies promoting widespread adoption of electronic medical records (EMRs) are premised on the hope that they can improve the coordination of care. Yet little is known about whether and how physician practices use current EMRs to facilitate coordination.ObjectivesWe examine whether and how practices use commercial EMRs to support coordination tasks and identify work-around practices have created to address new coordination challenges.Design, settingSemi-structured telephone interviews in 12 randomly selected communities.ParticipantsSixty respondents, including 52 physicians or staff from 26 practices with commercial ambulatory care EMRs in place for at least 2 years, chief medical officers at four EMR vendors, and four national thought leaders.ResultsSix major themes emerged: (1) EMRs facilitate within-office care coordination, chiefly by providing access to data during patient encounters and through electronic messaging; (2) EMRs are less able to support coordination between clinicians and settings, in part due to their design and a lack of standardization of key data elements required for information exchange; (3) managing information overflow from EMRs is a challenge for clinicians; (4) clinicians believe current EMRs cannot adequately capture the medical decision-making process and future care plans to support coordination; (5) realizing EMRs' potential for facilitating coordination requires evolution of practice operational processes; (6) current fee-for-service reimbursement encourages EMR use for documentation of billable events (office visits, procedures) and not of care coordination (which is not a billable activity).ConclusionsThere is a gap between policy-makers' expectation of, and clinical practitioners' experience with, current electronic medical records' ability to support coordination of care. Policymakers could expand current health information technology policies to support assessment of how well the technology facilitates tasks necessary for coordination. By reforming payment policy to include care coordination, policymakers could encourage the evolution of EMR technology to include capabilities that support coordination, for example, allowing for inter-practice data exchange and multi-provider clinical decision support.

Project description:BackgroundIn the past decade, the use of digital or electronic records in social care has risen worldwide, capturing key information for service delivery. The COVID-19 pandemic accelerated digitization in health and social care. For example, the UK government created a fund specifically for adult social care provider organizations to adopt digital social care records. These developments offer valuable learning opportunities for implementing digital care records in adult social care settings.ObjectiveThis rapid scoping review aimed to understand what is known about the implementation of digital care records in adult social care and how implementation varies across use cases, settings, and broader contexts.MethodsA scoping review methodology was used, with amendments made to enable a rapid review. Comprehensive searches based on the concepts of digital care records, social care, and interoperability were conducted across the MEDLINE, EmCare, Web of Science Core Collection, HMIC Health Management Information Consortium, Social Policy and Practice, and Social Services Abstracts databases. Studies published between 2018 and 2023 in English were included. One reviewer screened titles and abstracts, while 2 reviewers extracted data. Thematic analysis mapped findings against the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework.ResultsOur search identified 2499 references. After screening titles and abstracts, 71 records were selected for full-text review, resulting in 31 references from 29 studies. Studies originated from 11 countries, including 1 multicountry study, with the United Kingdom being the most represented (10/29, 34%). Studies were most often conducted in nursing homes or facilities (7/29, 24%) with older people as the target population (6/29, 21%). Health records were the most investigated record type (12/29, 41%). We identified 45 facilitators and 102 barriers to digital care record implementation across 28 studies, spanning 6 of the 7 NASSS framework domains and aligning with 5 overarching themes that require greater active management regarding implementation. Intended or actual implementation outcomes were reported in 17 (59%) of the 29 studies.ConclusionsThe findings suggest that implementation is complex due to a lack of consensus on what digital care records and expected outcomes and impacts should look like. The literature often lacks clear definitions and robust study designs. To be successful, implementation should consider complexity, while studies should use robust frameworks and mixed methods or quantitative designs where appropriate. Future research should define the target population, gather data on carer or service user experiences, and focus on digital care records specifically used in social care.

Dataset Information

Therapists' experiences with implementing new documentation practices for low back pain in electronic health care records: an interview study.

Objective

Results

Publications

Therapists' experiences with implementing new documentation practices for low back pain in electronic health care records: an interview study.

Similar Datasets

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