--Put your SQL code in this block
SELECT
cg.description AS caregiver_role,
COUNT(ce.row_id) AS total_chart_events
FROM caregivers cg
INNER JOIN chartevents ce
ON cg.cgid = ce.cgid
GROUP BY caregiver_role
HAVING total_chart_events > 500
ORDER BY total_chart_events DESC;Analysis Report Three - Information Systems and Healthcare Provider Interactions
Executive Summary
Electronic Health Record, also known as EHR, systems have become important tools that help improve patient care, access to clinical information, as well as communication between patients and healthcare organizations. These systems technologies are useful, but for them to be implemented successfully, hospitals need to be able to support their healthcare workers with the transition. This week’s assigned reading and further research show that EHR system implementation is a big change to the healthcare organizations workflow, and can end up increasing documentation burdens on clinicians rather than reducing them. This leads to clinicians burnout and disrupts the workflows within the organization if it is not effectively managed [@mcalearney2015; @rather2019; @budd2023]. Looking at the MIMIC-III Caregivers table, it shows how EHRs can be used to understand and then help caregivers with their documentation workflows and implement a plan to improve the workflow. This analysis report will show that healthcare leaders should prioritize training, communication, workflows, and staff support to make sure that EHR systems improve caregiver experiences and patient outcomes [@rinne2023].
Introduction
Implementing Electronic Health Records has been shown to be one of the most significant organizational changes in modern healthcare. EHR systems can help improve accessibility and how patient information is shared, but they require clinicians and caregivers to have to adapt to new workflows and documentation practices that sometimes affect patient care. McAlearney et al. talk about EHR implementation changes being a process that is similar to the stages of grief, which requires healthcare leaders to have to manage the resistance from clinicians through continued education, communication, and support instead of just focusing on the technological aspects of implementation [@mcalearney2015]. Rathert et al. also talk about the challenges that come with EHR implementation, and this source notes that there are challenges that clinicians experience even years after EHR implementation; increased documentation workloads, user challenges, and workflow disruption [@rathert2019].Additionally, research adds to the findings that EHR implementation can increase documentation burdens, user errors with the complex system design, clinician cognitive overload, and other electronic errors that are contributors to caregiver burnout [@budd2023]. Instead of looking at EHR implementation as a simple installation of new software, healthcare organizations need to be able to understand that successful adoption and integration of the system depends on the support that clinicians and caregivers are receiving, because they are the ones who use the systems every day in their patient care.
The Healthcare Context
Healthcare organizations have continued to expand their use of Electronic Health Records so that they can improve patient safety, communication, and coordination of care with clinicians. These systems have proven to be beneficial compared with paper records; healthcare workers have continued to have increased administrative workloads and less time for direct patient care. After conducting research, there is a clear conclusion that EHRs are one of the largest contributors to clinicians’ burnout due to their electronic errors, excessive data entry requirements, poor usability, and cognitive overload [@budd2023]. Other evidence also shows that having successful EHR implementation in healthcare organizations requires the leadership to have a clear approach, instead of just relying on the technology itself. There was a multi-site study done within four of the US healthcare systems, and there were various ways found that successfully integrated new EHR systems. These include clear communication as of why the implementation is necessary, leadership having an understanding of the existing clinician and healthcare worker workloads, providing personalized and ongoing training, finding ways to reduce workloads prior to the new EHR systems launching, and investing in hiring experienced “super users” who are familiar with the systems to support staff [@rinne2023]. This research and findings align with the two visualizations within this report, because by analysing caregiver documentation activity with the MIMIC-III databases, health care leadership is able to pinpoint documentation workloads of caregivers and then utilize that information to improve workflows, training, and staffing. This goes along with the idea that healthcare organizations need to have a clear data strategy that uses that information not just to improve patient outcomes but also to help support employees and organizations deciosn making process [@dallemule2017].
Data Visualizations
Visualization One
This visual looks at the total # of EHR charting events submitted by each caregiver recorded. By looking at the Caregivers and Chartevents tables, it is clear which caregiver is performing the most documentation within the systems.
This can be used by hospital leadership to identify caregivers who use the EHR documentation systems and what additional training or practices need to be put in place to help other caregivers in their roles.
ggplot(data = myquery1,
aes(x = reorder(caregiver_role, total_chart_events),
y = total_chart_events)) +
geom_col() +
coord_flip() +
labs(
title = "Total EHR Charting Activity by Caregiver Role",
x = "Caregiver Role",
y = "Total Chart Events"
)
Visualization Two
This visual is measuring the average number of charting events done by each caregiver. Instead of just counting the documentation, this chart estimates the documentation burdens experienced by each caregiver.
Healthcare organizations are able to use this information to pinpoint caregiver roles that are having heavier documentation workloads and implement a strategy to reduce those workloads by providing training and support to reduce burnout.
--Put your SQL code in this block
SELECT
cg.description AS caregiver_role,
COUNT(DISTINCT cg.cgid) AS number_of_caregivers,
COUNT(ce.row_id) AS total_chart_events,
ROUND(COUNT(ce.row_id) * 1.0 / COUNT(DISTINCT cg.cgid), 2) AS avg_events_per_caregiver
FROM caregivers cg
INNER JOIN chartevents ce
ON cg.cgid = ce.cgid
GROUP BY caregiver_role
HAVING number_of_caregivers >= 5
ORDER BY avg_events_per_caregiver DESC;ggplot(data = myquery2,
aes(x = reorder(caregiver_role, avg_events_per_caregiver),
y = avg_events_per_caregiver)) +
geom_col() +
coord_flip() +
labs(
title = "Average EHR Charting Burden per Caregiver",
x = "Caregiver Role",
y = "Average Chart Events per Caregiver"
)
Recommendations for Industry
Healthcare organizations need to treat Electronic Health Record implementation as a people focused change rather than a technology upgrade within their systems. Healthcare leadership needs to be able to communicate clearly, involve clinicians and caregivers in the planning of the implementation, and provide continued training and support throughout each stage of the implementation so that there is better acceptance of the new systems [@mcalearney2015; @rinne2023].Hospitals should also use EHR data to track caregiver workloads and pinpoint roles that have higher documentation demands. This information should then be used to improve those workflows and offer support so that caregivers are able to provide better patient care and avoid burnout. This way, the new EHR systems will assist clinicians and caregivers rather than stall and disrupt clinical practices [@budd2023; @dallemule2017].].
References
DalleMule, L., & Davenport, T. H. (2017). What’s Your Data Strategy? Harvard Business Review.
McAlearney, A. S., et al. (your assigned reading on grief and EHR implementation).
Rathert, C., et al. (your assigned reading on EHR experiences after Meaningful Use).
Budd, J. (2023). Burnout Related to Electronic Health Record Use in Primary Care. Journal of Primary Care & Community Health.
Rinne, S. T., Brunner, J., Mohr, D. C., Bearak, A.-C., & Anderson, E. (2023). Practices Supporting Electronic Health Record Transitions: Lessons from Four US Healthcare Systems. Journal of General Internal Medicine.
DalleMule and Davenport (2017)
DalleMule, Leandro, and Thomas H Davenport. 2017. “What’s Your Data Strategy.” Harvard Business Review 95 (3): 112–21.