Essential Nurse Documentation: Studying EHR Burden during COVID-19 (ENDBurden)

项目摘要/摘要 这项混合方法的信息学研究使用了一系列数据科学方法来三角测量来自 访谈和电子病历文档，目的是从 新冠肺炎大流行，减轻电子病历负担。注册护士的电子健康记录负担已经在以下方面得到了证明 增加了记录时间、记录量、工作量、工作倦怠以及与贫困患者的联系 结果。减少电子病历负担是国家的优先事项，然而，没有明确的证据来区分 各种类型的文件对于支持病人护理至关重要。在认识到增加的工作负载需求方面 在新冠肺炎大流行期间，纽约发布命令，放宽了对 临床医生，包括护士。因此，纽约大流行期间的护士记录反映了 护士认为最重要的信息--为研究提供独特而难得的自然实验 文档负担。相反，密苏里州的COVID病例总体排名第18位， 也没有类似的州命令。为了促进科学的发展，我们将从一个 从数据科学和信息学的角度，发现哪些文档模式(即数据类型、数据量 输入和查看)被护士认为是必要的，并加班检查记录模式的变化 从大流行之前到现在。我们知道电子病历负担是存在的，但还不了解 哪些记录模式解释并影响患者护理活动与患者之间的关系 结果。我们将使用基于时间的EHR日志文件来衡量患者护理活动，其操作方式为 班次时间减去记录病人护理活动或查看数据所用的时间。我们的目标是呼吸系统 急危重症患者的护理管理，还包括危重病患者的精神错乱护理管理 护理患者-适用于住院的新冠肺炎患者和非新冠肺炎患者。具体的 目的是：目标1：检查护理数据输入和数据查看模式的时间趋势的变化 从2019年到现在的文件(如类型、数量)，包括新冠肺炎大流行 时间线。目标2： 调查护士如何定义和决定什么是病人护理所必需的记录 以及包罗万象的文档(即， 符合临床和法规要求的文档 需求) 论电子病历负担 。目标3：检查护理数据输入和数据查看模式的变化 记录和这些变化对患者护理活动和患者结局的影响，同时 控制与工作量、护士、患者、团队和组织相关的混杂因素 特点。

PROJECT SUMMARY/ABSTRACT This mixed-methods informatics study employs a series of data science methods triangulating data from Interviews and EHR documentation, with the goal to identify essential documentation from the COVID-19 pandemic and reduce EHR burden. EHR burden for registered nurses has been demonstrated by increased documentation time, documentation amount, workload, and burnout and linkages to poor patient outcomes. Decreasing EHR burden is a national priority, yet, there is no clear evidence to differentiate which types of documentation are essential to support patient care. In recognizing the increased workload demands during the COVID-19 pandemic, New York issued orders that relaxed documentation requirements for clinicians, including nurses. Therefore, nurses’ documentation during the pandemic in New York reflects the information deemed most essential by nurses – providing a unique and rare natural experiment to study documentation burden. On the contrary, Missouri ranked as the 18th highest state for COVID cases overall, and had no similar state orders. To advance the science, we will learn about nurses’ documentation from a data science and informatics perspective, discover which documentation patterns (i.e., types, amount of data entry and viewing) are deemed essential by nurses, and examine documentation pattern changes overtime from before the pandemic through present day. We know that EHR burden exists, yet it is not understood which documentation patterns explain and influence the relationship between patient care activities and patient outcomes. We will use an EHR log-file time-based measure of patient care activities, operationalized as “total shift time” minus “time spent documenting patient care activities or viewing data”. We will target respiratory care management for acute and critical care patients and also include delirium care management for critical care patients - applicable outcomes for both hospitalized COVID-19 and non-COVID-19 patients. The specific aims are to: Aim 1: Examine changes in the temporal trends of data entry and data viewing patterns of nursing documentation (e.g., types, amount) from 2019 through present day, inclusive of the COVID-19 pandemic timeline. Aim 2: Investigate how nurses define and decide what is essential to document for patient care and the impact of all-inclusive documentation (i.e., documentation that meets both clinical and regulatory demands) on EHR burden . Aim 3: Examine changes in data entry and data viewing patterns of nursing documentation and the impact of these changes on patient care activities and patient outcomes, while controlling for confounding factors related to workload, and nurse, patient, team, and organizational characteristics.