Adventist HealthCare

Adventist HealthCare nurses improve chart documentation, review time with clinical documentation performance improvement project

Nurses at Adventist HealthCare, based in Gaithersburg, Maryland, are more satisfied with the electronic health record (EHR) after a clinical documentation performance improvement (CDPI) project helped streamline nursing workflows and decrease time spent in the EHR.

From launch of the CDPI project in November 2015 to March 2017:

• Nurses’ documentation time decreased by two minutes, five seconds.
• Chart review time decreased by four minutes, two seconds per patient per shift.
• Overall active time spent per patient within the EHR decreased by more than 18 minutes — from 29 minutes, 50 seconds, to 11 minutes, three seconds.

The Adventist team collaborated with Cerner to develop the governance structure and tools necessary to streamline the use of their EHR.

As part of the new governance process, Adventist created a system-wide steering committee comprised of nursing and clinical leaders to find ways to improve the EHR and internal communications. Nurses and clinicians collaborated, providing specific examples of how to improve the EHR for their departments, which opened the meetings for further discussion.

“As a health system, our operational premise is that ‘we are the same until we are different,’” said Susan Glover, RN, senior vice president and chief quality officer. “We established a standardized quarterly release cycle with strict guiding principles to ensure a disciplined approach to EHR management.”

Adventist leveraged near real-time nursing efficiency data available in Cerner Advance to measure nurses’ overall EHR improvements from the original baseline data.

Adventist’s leadership team supported the nurses’ EHR experience by setting aside time for training prior to releasing quarterly updates.

Adventist used Cerner’s Model Experience standards for EHR enhancements as a guide for the steering committee to follow. If a nurse or clinician did not agree with a portion of the model standard, they had to present an objective evidence/fact-based rationale to justify requested localizations. This allowed Adventist to better align to the model standard, which improved the daily tasks and workflows with minimal localization.

In October 2015, a Cerner nurse executive visited Adventist’s Maryland campuses to solicit feedback on the cause of nurses’ dissatisfaction with the EHR. The nurse executive’s report determined the issues they encountered:

• Complex workflows
• Poor internal communications
• Lengthy amount of time spent documenting and completing tasks within the chart — interfered with the time needed to provide more direct, personal patient care

“We worked with Cerner to learn what our system actually was and how to clean it up and make it work in a way that is best for both our nurses and clinicians,” said Jason Neel, director, operational excellence and quality services. “With these improvements, the nursing staff streamlined the amount of time spent in the system, which allows them to spend more time with the patient at the bedside.”

According to a Q1 2017 release survey:

• More than 50 percent of 106 responses from Adventist’s nursing team agreed that the improvements from the quarterly release made the EHR easier to use, made them more efficient in their roles and enhanced the quality of clinical service they delivered.
• The weighted average of responses from the survey was 3.71 on a 4.0 scale — surpassing the CDPI project’s targeted goal of 3.5.
• These results meant more responders said they agreed the releases made improvements compared to a baseline score of 3.17 in Q1 2016.