This activity has been developed for the intermediate EHR student user. The student will review five patient charts from the EHR. Using “Plan, Do, Study/Check, Act” (PDSA/PDCA) students will analyze the documentation of consents in the chart for accuracy and quality. Quality management, performance improvement and initiatives within a healthcare system are discussed.
Prerequisites
1. Completion of Scavenger Hunts Levels I-III
2. Completion of Neehr Perfect Activity: Retrieval of Data
Student instructions
1. If you have questions about this activity, please contact your instructor for assistance.
2. Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.
3. Screen displays are provided as a guide and some data (e.g. dates and times) may vary.
Objectives
Demonstrate the ability to retrieve and interpret data from the patient chart.
Utilize word processing software to create a table and answer questions.
Analyze the implementation of the EHR in the quality improvement process.
Produce quality assessment including quality management, data quality, and identification of best practices for health information systems.
Glossary
Quality Improvement (QI): Systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. (www.hrsa.gov)
Continuous Quality Improvement (CQI): Is a quality management process that encourages all health care team members to continuously ask the questions, “How are we doing?” and “Can we do it better?” (Edwards, 2008). To address these questions, a practice needs structured clinical and administrative data. (www.healthit.gov)
Rapid-Cycle Quality Improvement: A QI methodology that was developed out of the need to see improvement quicker. It reduces wasted activity and efforts for a quick turnaround on QI projects.
PDSA/PDCA: Plan, Do, Study/Check, Act. A commonly used QI strategy that is a four step rapid-cycle quality improvement strategy.
Plan: Identify an opportunity to improve and plan a change
Do: Carry out the plan on a sample number of patients.
Study/Check: Examine the results. Were your goals achieved?
Act: Use your results to make a definitive decision. Incorporate the changes into your workflow.
The activity
Use the following five patients to complete this activity:
a. Karen Knealy
b. Roy Gallant
c. Kara Williams
d. Larry Lumbar
e. Sheila Masters
You are completing an internship in the Quality Department at General Hospital. As part of your internship, the director of the department has asked you to complete a small quality improvement project utilizing their EHR. The director would like you to determine if the five charts chosen have a consent form in them, if the form is filled out completely and if everyone who needs to has ‘signed’ the consent. She has given you the following worksheet as a guideline to follow:
1. Recreate the worksheet above and fill in the blanks. Create your own table for step #3. Ensure you list the names of the patients you have used for your mini QI study. Some of your answers will be hypothetical in nature (i.e.: what would you expect to happen if you implemented your quality improvement strategy?).
Select one component of patient care to improve (make sure it can be improved via rapid-cycle PDCA/PDSA):
I would like to improve the documentation of the patient’s records clinical.
Randomly select five charts to review. Determine a specific question (who, what, when, how) that will be asked when looking at charts (this should relate to the component of patient care you are trying to improve)
Five patients were used to complete the chart under the review. Their health documents were analyzed and their consent on this documentation was valued which the values were keyed in electrically using a computer.
Patient’s Chart
Yes
No
Karen Knealy
Consent was properly signed and documented
Roy Gallant
Consent was properly signed and documented
Kara Williams
No consent
Larry Lumbar
Consent was properly signed and documented
Sheila Masters
Consent
What is your goal for improvement?
The quality improvement goal is introducing a modern way of recording the patient’s health information electronically using a word processing software with their consent. This will reduce the time that is required by a physician or any other employee to analyze the patient and therefore, serve as many patients as possible. The introduction of modern EHR will also increase the patient’s effective diagnosis reducing the medical errors. This will also secure the patient’s private data and some of the information can be electronically transferred to other medical facilities if a change in hospital may arise.
Analyze the process and come up with your QI process (keep it simple)
a. Plan: The plan will be to introduce the new methods of EHR in the documentation area. There will be an investigation of potential interventions that can be used where these strategies can be implemented altogether.
b. Do: I will use five patients who I will start by interviewing them on how their health records are implemented. This will help in adapting the changes to in regards to the health facility and how they can be improved. At this stage, we will identify some of the barriers that may be considered and how to deal with them.
c. Check/study: A study was made and analyzed to see if the changes were successful. The changes were then implemented and progress against the documentation was observed where the results showed that the EHR worked.
d. Act: According to the results from the selected patients, the system could actually work and it will be of much benefit in the health facility. This concluded that EHR should be incorporated and be used in larger scale in the facility.
In the same document, include the following Critical Thinking Questions and your answers.
Critical thinking questions
2. Most physicians feel as if EHRs do not save them time. What is your response to this?
EHRs were introduced to save time in the health department and the physicians who think it might be wasting their time might be wrong. This system will create an easier and faster access to the clinical data. this will increase the effective care and coordination of clinical workflows. Moreover, EHR will enhance the completion of documents before they are saved for easier access the next time the information is to be used. By so doing, the idle time will be reduced greatly.
3. When implementing organization wide QI initiatives, many employees and physicians take the attitude of “that won’t work here.” How should the organization respond?.
There should be a choice of intervention that is compatible with the organizations new improvement strategies and the local culture of the prior employees. The employees that were working there had their own values that they may not need to change. When creating a QI, this may need to be observed to avoid the negativity of these employees.
First you should establish an improvement of goals. By so doing, you will have a better chance to clarify the objectives to all those that you need to start working on. This will also involve the support of these employees to help you implement them. These goals should not be biased and they should reflect on the specific items you intend to improve.
You should identify possible strategies that you are going to undertake in order to implement these new strategies. This may include preparing a written action plan that will keep most of these employees at per with you.
4. Do you feel quality improvement is an easier process now that many healthcare organizations are utilizing an EHR? Why?
Yes, quality improvement is now an easier process in the healthcare organizations due to the introduction of EHR. This is because there is an accurate, complete patient information that is up to date and effective care at the health centers. This method is much safer and reliable since it gives a complete documentation which is accurate.
Submit your work
Document your answers directly on this document as you complete the activity. When you are finished, save this document and upload it to your Learning Management System (LMS). If you have any questions about submitting your work to your LMS, please contact your instructor.
