The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

3 Introduction . 6 Project Purpose . 7 Project Importance . 7 Theoretical Framework . 8 Relationship to Advanced Nursing Practice . 10 Contribution and Anticipated Benefits . 11 Literature Review . 12 Electronic Health Record . 12 Patient-Centered Care . 13 Barriers to Effective Communication and Utilization of the EHR . 14 Facilitators to Effective Communication and Utilization of the EHR. 15 Training and Education . 16 Methods . 20 Development of Project Material and Implementation . 20 Evaluation and Discussion . 24 Discussion . 27 Implications for Practice, Education, and Research . 29 Limitations . 32 Conclusion . 32 References . 34 Appendix A . 37 Appendix B . 40 THE ELECTRONIC HEALTH RECORD SCORECARD 5 List of Tables and Figures Table 1 . 25 Figure 1 . 27 THE ELECTRONIC HEALTH RECORD SCORECARD 6 The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills Introduction The use of an electronic health record (EHR) has become ubiquitous in almost every health care setting from hospitals and ambulatory care clinics to primary care and specialty practices. According to the Centers for Medicaid and Medicare Services, potential benefits of EHRs include streamlining clinical workflow, supporting evidence-based decisions, improving quality management, and facilitating outcome reporting (Zhang, Chen, Ashfaq, Bell, Calvitti, Farber, . Agha, 2016). Additionally, EHRs can play an important role in the delivery of patientcentered care. EHRs have the potential to enhance patient trust, increase patient autonomy, and facilitate patient-centered communication (Zhang et al., 2016). While studies have shown the positive impact of EHR use within the clinical practice setting, the research also suggests that ineffective use of the EHR can have a negative impact on provider-patient relationships (Asan & Montague, 2012). These outcomes are largely influenced by the provider’s skill in using the computer, the physical layout of the exam room, the level of distraction that providers experience when using the computer, and the configuration of the EHR itself (Street, Liu, Farber, Chen, Calvitti, Zuest, . Agha, 2014). Despite the increasing deployment of computers in healthcare facilities, it has become apparent that both patients and providers still have reservations about the role of the computer in the clinical encounter (Kumarapeli & de Lusignan, 2013). This project attempted to establish a better understanding of effective EHR communication and utilization skills to assist in the development and integration of EHR systems in the clinical practice setting. THE ELECTRONIC HEALTH RECORD SCORECARD 7 Project Purpose The purpose of this project was to provide insight on “best” practice patterns for effective communication and use of the EHR in the clinical practice setting. Through the application of an educational needs assessment, this project aimed to assess current status of EHR use and communication skills among health care providers in the clinical practice. Serving as a benchmark, this assessment has the potential to help guide future information technology (IT) development, training, and education for all health care providers. The needs assessment consisted of a comprehensive scorecard that focused on provider’s EHR usage styles including chart review and documentation, workspace characteristics, how providers manage their interactions with EHRs and their patients during the visit, the availability of training and support, and any issues they experience arising from technology. The goal of this scorecard was to help providers and practices as a whole identify strengths and/or limitations in their current EHR communication and utilization patterns. The utility of this scorecard could be far-reaching as more practices convert to EHRs and must attend to the provider-patient relationship in the process. The scorecard is not specific to any one software program, media device, or practice setting. The information gathered from this scorecard may assist practices in optimizing their use of the EHR by identifying areas of success and areas in need of improvement with regards to EHR use. Furthermore, this information could help direct future teaching and training opportunities and may aid in the development of a standard educational protocol for effective EHR communication and use across all practice settings. Project Importance Provider-patient communication is paramount to the provider-patient relationship and a key element in health care delivery (Asan & Montague, 2012). This communication affects THE ELECTRONIC HEALTH RECORD SCORECARD 8 patient satisfaction, adherence to prescribed or recommended therapies, provider-patient conflict resolution, and clinical outcomes (Rose, Ritcher, & Kapustin, 2014). With the introduction of the EHR, the paradigm has shifted from a two-way interaction, between provider and patient, to now a three-way exchange involving the EHR system. It is a delicate dance that requires skill, strategy, and training. If EHRs are to be used effectively, facilitators and barriers to EHR communication and use must first be identified and understood (Saleem, Flanagan, Russ, McMullen, Elli, Russell, . Frankel, 2014). The intent of this needs assessment is to identify the factors within a practice that are beneficial or disadvantageous to EHR communication and use. With the application of a comprehensive scorecard, a measure of baseline EHR communication and utilization skills can be roughly determined. No instrument for a comprehensive assessment of EHR communication or utilization skills has been identified in the literature to date. Furthermore, there is an increasing need for provider training focusing on EHR usability/functionality, the development of patient-centered interview skills, and patient engagement. The information gathered from this project may aid in the development of standardized training and educational offerings in effective communication and use of EHR. Theoretical Framework The theoretical framework guiding this project is Rozzano Locsin’s (2005) middle-range theory, Technological Competency as Caring in Nursing. This theory is best described as a “conceptual model that defines the relatedness among technology, caring, and nursing” (Casterline, 2006, p. 273). Human caring is the foundation of the nursing profession. As technology develops, the priority must remain with the patient. While technology has the potential of bringing the patient closer to the provider, it can also increase the gap between them. Locsin emphasizes the importance of being authentic and intentionally present within the THE ELECTRONIC HEALTH RECORD SCORECARD 9 encounter (Locsin, 2016). He warns that fixation with technology may result in robotic mannerisms (“robo-nurse”) which takes away from the appreciation of caring for persons moment to moment (Locsin, 2005). It is imperative that health care providers realize technology and computer skill competence is merely a tool to optimize patient care. While maintaining focus on the patient, the provider can strategically incorporate technology to provide safe, high-quality care to meet their patients’ individual needs. Locsin’s theory promotes “the navigation of innovative responses within contemporary realities, in which technology is u