Analysis Report Three - Information Systems and Healthcare Provider Interactions

Executive Summary

This report examines how electronic health record (EHR) systems have changed the way healthcare providers document, communicate, and coordinate patient care. Although EHRs have improved access to patient information and increased data availability, the readings show that implementation often creates new challenges for caregivers, including increased documentation demands, workflow disruptions, and resistance to organizational change. Successfully implementing an EHR requires more than installing new technology. Healthcare organizations must also support physicians, nurses, and other caregivers as they adapt to new workflows and responsibilities.

Using data from the MIMIC-III database, this report analyzes caregiver activity through two visualizations based on the CAREGIVERS table. These analyses demonstrate how EHR data can provide valuable insight into caregiver workload and documentation patterns that may help healthcare organizations improve staffing decisions, workflow efficiency, and patient care. Based on the literature and supporting research, this report recommends ongoing employee training, stronger leadership during implementation, and continued use of clinical judgment alongside technology to ensure EHR systems support rather than replace caregivers’ expertise.

Introduction

Electronic health records (EHRs) have become a central part of modern healthcare because they allow providers to store, access, and share patient information more efficiently than traditional paper records. The federal government’s Meaningful Use initiative encouraged healthcare organizations to adopt EHR systems with the goal of improving care coordination, patient safety, and overall quality of care. While EHR implementation has increased access to real-time patient information, research has shown that successfully adopting these systems requires much more than simply installing new technology. Healthcare organizations must also address the impact these systems have on physicians, nurses, and other caregivers as they adjust to new workflows and documentation requirements (Rathert et al. 2019).

The assigned readings highlight both the advantages and challenges of EHR implementation. Providers reported benefits such as easier access to patient information, improved communication between departments, and better support for clinical decision-making. At the same time, many caregivers experienced increased documentation demands, workflow interruptions, limited interoperability between systems, and frustration with technology that sometimes interfered with patient interactions. The readings also introduce the idea that implementing an EHR is not only a technological change but also an organizational change that requires effective leadership and ongoing support for employees. Viewing implementation through the stages of grief framework helps explain why some caregivers initially resist new technology and emphasizes the importance of thoughtful change management throughout the adoption process (Rathert et al. 2019; McAlearney et al. 2015).

The Healthcare Context

Healthcare organizations across the United States continue to expand their use of electronic health records, clinical decision support systems, and artificial intelligence to improve patient care and operational efficiency. While these technologies have created significant benefits, they have also introduced new challenges for healthcare workers who must balance technology with their own professional judgment. As healthcare systems become increasingly dependent on electronic documentation and automated decision support, caregivers are expected to manage larger amounts of information while maintaining high-quality patient care.

One example of these challenges is described in a recent Wall Street Journal article discussing how nurses have experienced conflicts between artificial intelligence recommendations and their own clinical judgment. In one case, an oncology nurse recognized that a patient was not septic despite an AI-generated sepsis alert. Although she believed the alert was incorrect based on years of clinical experience, hospital protocols required additional testing because the algorithm identified the patient as high risk. Situations like this demonstrate that technology should support clinical decision-making rather than replace the expertise developed by experienced healthcare professionals (Bannon 2023).

The research on EHR implementation reaches a similar conclusion. While electronic records improve access to patient information and support communication across healthcare teams, organizations often struggle with issues such as increased documentation requirements, poor interoperability between different EHR systems, insufficient user training, and reduced face-to-face interaction between providers and patients. These challenges can contribute to frustration, burnout, and resistance to new technology if healthcare organizations do not adequately prepare employees for implementation (Rathert et al. 2019).

Successful healthcare organizations recognize that EHR implementation is both a technological and organizational change. The Journey Through Grief study compares the transition to an EHR system with the stages of grief, explaining that caregivers often experience denial, frustration, bargaining, and uncertainty before ultimately accepting new workflows. The authors argue that managers play an essential role in reducing these barriers by communicating a clear vision, providing continuous training, involving clinicians throughout implementation, and offering ongoing support after the system goes live. These strategies help reduce resistance while allowing caregivers to maintain confidence in their ability to deliver high-quality patient care (McAlearney et al. 2015).

Data Visualizations

Visualization One

SELECT 
  caregivers.description,
  COUNT(*) AS chart_count
FROM caregivers
INNER JOIN chartevents
ON caregivers.cgid = chartevents.cgid
WHERE caregivers.description IS NOT NULL
GROUP BY caregivers.description
HAVING chart_count > 100
ORDER BY chart_count DESC
LIMIT 10

ggplot(data = myquery1,
       aes(x = reorder(description, chart_count), y = chart_count)) +
  geom_col() +
  coord_flip() +
  labs(title = "Top Caregiver Groups by Charted Events",
       x = "Caregiver Group",
       y = "Number of Charted Events")

This visualization examines which caregiver groups recorded the greatest number of charted events in the MIMIC-III database. I chose this analysis because one of the primary purposes of an electronic health record is to capture and organize patient documentation. By looking at the number of charted events entered by each caregiver group, we can better understand which healthcare professionals rely most heavily on the EHR as part of their daily responsibilities.

To create this visualization, the CAREGIVERS table was joined with the CHARTEVENTS table using the caregiver ID (cgid) so each charted event could be linked to the caregiver who documented it. The query then used the COUNT() function and GROUP BY clause to calculate the total number of charted events for each caregiver group. Since the data was already summarized within the SQL query, a geom_col() graph was used to display the results.

The results show that registered nurses (RNs) recorded the greatest number of charted events, followed by respiratory therapists and several other caregiver groups. This is expected because nurses document vital signs, patient assessments, medication administration, and many other routine aspects of patient care throughout an ICU stay. Having this information available through an EHR allows healthcare organizations to better understand documentation workload, identify where caregivers may be spending the most time documenting patient information, and make more informed staffing and workflow decisions.

Visualization Two

SELECT
  caregivers.description,
  SUM(value) AS total_output
FROM outputevents
INNER JOIN caregivers
ON outputevents.cgid = caregivers.cgid
WHERE caregivers.description IS NOT NULL
GROUP BY caregivers.description
HAVING total_output > 0
ORDER BY total_output DESC
LIMIT 10

ggplot(data = myquery2,
       aes(x = reorder(description, total_output), y = total_output)) +
  geom_col() +
  coord_flip() +
  labs(title = "Top Caregiver Groups by Total Recorded Patient Output",
       x = "Caregiver Group",
       y = "Total Recorded Output")

This visualization shows the total recorded patient output documented by each caregiver group in the MIMIC-III database. I chose this analysis because electronic health records do more than store patient documentation—they also record important clinical measurements that help caregivers monitor a patient’s condition over time. Examining the total recorded patient output by caregiver group provides insight into which healthcare professionals are responsible for documenting these observations and how EHR data can be used to better understand caregiver responsibilities.

To create this visualization, the CAREGIVERS table was joined with the OUTPUTEVENTS table using the caregiver ID (cgid) so each output event could be linked to the caregiver who recorded it. The query then used the SUM() function and GROUP BY clause to calculate the total recorded patient output for each caregiver group. Since the data was summarized within the SQL query, a geom_col() graph was used to display the results.

The results show that registered nurses (RNs) recorded the greatest total patient output, followed by several other caregiver groups. This finding is expected because nurses routinely document patient intake and output measurements that help monitor hydration status, kidney function, and overall patient condition. Unlike the first visualization, which focused on documentation workload, this analysis highlights the amount of clinical information being captured within the electronic health record. By centralizing these measurements, EHR systems make it easier for healthcare providers to monitor patient progress, communicate across the care team, and make more informed clinical decisions.

Recommendations for Industry

Healthcare organizations should recognize that implementing an electronic health record system is both a technological and organizational change. While EHRs provide valuable access to patient information and improve communication across healthcare teams, successful implementation depends on how well caregivers are supported throughout the transition. Hospitals should provide comprehensive training before and after implementation, involve caregivers in the planning and testing process, and offer ongoing technical support to reduce frustration and increase confidence with the new system. These strategies can help reduce resistance to change while improving employee satisfaction and patient care.

The findings from this report also demonstrate how EHR data can be used beyond direct patient care to improve hospital operations. The first visualization showed that registered nurses record the greatest number of charted events, while the second visualization showed that they also document the largest amount of patient output. Together, these findings highlight the significant documentation responsibilities placed on nurses and emphasize the importance of using EHR data to better understand caregiver workload. Healthcare administrators can use these insights to evaluate staffing levels, identify opportunities to reduce unnecessary documentation, and improve workflow efficiency. Most importantly, organizations should continue to view technology as a tool that supports clinical decision-making rather than replacing the experience and judgment of healthcare professionals.

References

Bannon, Lisa. 2023. “When AI Overrules the Nurses Caring for You.” The Wall Street Journal.

McAlearney, Ann S., Jennifer L. Hefner, Cynthia J. Sieck, and Timothy R. Huerta. 2015. “The Journey Through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation.” Health Services Research 50 (2): 462–88. https://doi.org/10.1111/1475-6773.12227.

Rathert, Cheryl, Tracy H. Porter, Jessica N. Mittler, and Michelle Fleig-Palmer. 2019. “Seven Years After Meaningful Use: Physicians’ and Nurses’ Experiences with Electronic Health Records.” Health Care Management Review 44 (1): 30–40. https://doi.org/10.1097/HMR.0000000000000168.