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 100Analysis Report Three - Information Systems and Healthcare Provider Interactions
Executive Summary
The report and research included highlights electronic health record or EHR systems and the way they have revolutionized the way healthcare organizers manage patient care. Along with that it will also dive deep into not only those benefits that it provides, but the many other challenges that EHR systems have brought along with their implementation. The assigned readings and external research show that these challenges will often outweigh the benefits as EHR increase workload demands and disrupt the workflow of organizations when not managed properly. These readings tell us about how EHR is not only an advancement in technology, but it also creates a new necessity for leaders to be more supportive then before and all around a better leader of people in the organization so that the EHR can properly be used and learned.
Through data from the MIMIC III database I will create visuals that help describe these things in further detail with a couple of visuals that helps prove how valuable EHR can be when implemented properly. We will see how things like specific caregivers and their respective documentation workloads can benefit from this information. Not to mention the ability to make decision better involving staffing, proper training of EHR, and identifying the right people and caregivers that actually utilize them and need the training. All in all, this information will help show us how to maximize the efficiency of EHR while leveraging the benefit it possesses and reducing the challenges it poses.
Introduction
In the modern world of healthcare we have seen electronic health records or EHRs become an integral part of their processes. The current use of EHR’s was not foreseen, but now with the potential being realized, we have seen this technology help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system (Evans (2016)). Due to this we have seen the federal government jump in as well with their meaningful use initiative that was established through the Health Information Technology for Economic and Clinical Health Act. This helped established financial incentives to encourage and promote the EHR adoption across American healthcare institutions (Rathert et al. (2019)). In that time we have seen EHRs become vital in healthcare today as they allow for providers to take patient information and manage it in a more efficient way than they could with paper.
On the other hand, while in practice it sounds great, in our readings and through other research we learn it is not as easy to implement as some may think. EHR’s bring a lot of benefits, but along with them come many challenges. We same that one of the main things is that EHR implementation is just as much as an organizational change as it is technological. If their is not a good leader in place to commit to this change we read that the adoption of these EHRs came with increased workloads, standardization issues, and Difficult and frustrating training. When we view it from the stages of grief framework from our reading it can help give better insight into why caregivers often are resistant to new technology such as EHRs ((mcalearny2025journey?)).
The Healthcare Context
We have seen that healthcare organizations across the United States are attempting to commit to the expansion of electronic health records along with other technology such as AI and CDSS. These technologies bring many benefits, but have also caused issues and challenges for the workers in the sense of finding a balance in using technology or not. As healthcare organizations continue to use technology, the workers are being expected to handle a larger work load since more information and work is coming in, while still being expected to provide high quality care for all their patients.
This has created tension among different groups in healthcare organizations today. The expectations of using all these new digital assets in correspondence with the reality of the workers being expected to use it has caused many issues. Even with the many incentives that have been provided for organizations to implement EHR we have seen the results from it be very mixed. There have been many reports of issues such as an increase in documentation demand, standardization across the systems is lacking, and many problems with training and there being an insufficient amount of it ((mcalearney2025journey?)). We see right now that for every hour spent on patient care 2 hours are spent on EHR related tasks. Additionally, Outpatient physicians spend approximately one-third of dedicated patient time interacting with the EHR, which can negatively impact the patient-physician relationship, clinician job satisfaction, and quality of the patient encounter (Makhni et al. (2025)).
Data Visualizations
Include the code and graphs for your two visualizations here. Both must involve the CAREGIVERS table and new concepts from this week’s practice. You should describe your data and the visualization, together with an explanation of why the example is relevant for healthcare organizations.
Your queries can be loosly based on Practice queries, but they must extend or adapt the practice in interesting ways.
Visualization One
ggplot(data = myquery1,
aes(y = description, x = chart_count)) +
geom_col() +
labs(title = "Top Caregiver Groups by Charted Events",
y = "Caregiver Group",
x = "Number of Charted Events")
The first visual I created evaluates the caregiver groups and which of them recorder the most charted events according to the MIMIC III database. Being able to efficiently manage the storage of patient information and documentation is a vital purpose of an EHR, and this visual will help us understand which caregivers in specific are more reliant on EHR and which ones are not. We are able to see that registered nurse have the greatest number of charted events according to the data. Registered nurses are often the caregivers that will be doing things such as assessments and medication administration for patients and a bunch of other routine things that come with something like an ICU stay. Having this information readily available can help organizations decide which caregivers specifically rely on EHR and in turn focus their training regimes on those groups and then the groups that do not use it as much do not need to have the extensive training that they are going through currently. This will take a lot of pressure off of learning unnecessary things, while also allowing those that use EHR to get even more training since there is more open training availability.
I created this visualization by joining together the caregivers and chartevents tables. To do this I used “cgid” which made sure that each charted event was accurately linked to the caregiver that documented said event. Next, the count function was used along with the group by clause which calculated the total number of charted events for each group. I then used that to create a bar graph using geom_col.
Visualization Two
SELECT caregivers.label, icustays.first_careunit, COUNT (*) as chart_count
FROM chartevents
INNER JOIN caregivers ON chartevents.cgid = caregivers.cgid
INNER JOIN icustays ON chartevents.icustay_id = icustays.icustay_id
WHERE caregivers.label = 'RN'
GROUP BY icustays.first_careunit
LIMIT 500ggplot(data = myquery2,
aes(x = first_careunit, y = chart_count)) +
geom_col() +
labs(title = "RN Chart Event Volume by ICU Care Unit",
x = "Care Unit",
y = "Total Chart Entries")
For this visual I realized that if registered nurses were using EHR the most then it would be beneficial to dive deeper into that aspect. In my family I have 4 different RNs that work majority of their time in the ICU, so with that in mind I dove deeper into that part specifically. Full time ICU nurses spent about 17.5% of their time on the EHR (Khan et al. (2022)). This visual and the data it gives us can help direct and identify which areas and care units are most reliant on EHRs. By obtaining that information we can make more educated decisions on how to properly staff these care units, which ones need the most training on EHR, and which ones may not need the training as they do not use it. All of these factor into prioritizing efficiency and patient care as we can make sure those that need the training get it, and those that do not use EHR often are not forfeiting useful time by learning how to use something they do not need to use. I joined the caregivers table with chartevents and icustays in order to attempt to put together the provider identity with the patients location along with the clinical activity.
Recommendations for Industry
I would recommend first of all that healthcare organizations accept the reality of implementing EHR. Yes, it brings many benefits, however, we see in many case the challenges it presents outweigh those benefits. When these organizations are better suited to pinpoint which areas the EHR actually will benefit and areas it will not is when they will ultimately get the most use out of it. We have seen through the assigned readings and external research the there are certain areas and caretakers that EHR just does not make sense to use or waste time on extensive training, as it is just not used often. By separating those caregivers that do use it and do not will ultimately help reap the most benefits while at the same time making the organization more efficient as a whole.
Furthermore, EHR needs to be viewed as more than just a technological advancement. It is also a way of managing and it needs a good leader in place to properly establish it. These leaders need to be able to take this technology and use it to build position specific training programs in order to make sure that those caretakers that are often using it and overwhelmed by the clinical documentation are getting the bulk of the training and help with these resource rather than allocating resources to those caretakers that do not do as much clinical documentation which leaves them not using EHR often. Using this technology to also manage the sectors and workers is a key part of EHR that is often overlooked, but once acknowledged will lead to a large increase in the benefits it gives and decrease in challenges that it presents.
References
Evans, R Scott. 2016. “Electronic Health Records: Then, Now, and in the Future.” Yearbook of Medical Informatics 25 (S 01): S48–61.
Khan, Ahsan R, Courtney D Rosenthal, Kelly Ternes, Ronald F Sing, and Gaurav Sachdev. 2022. “Time Spent by Intensive Care Unit Nurses on the Electronic Health Record.” Critical Care Nurse 42 (5): 44–50.
Makhni, Sonya, Paul Cerrato, Jose Rico, Shehzad Niazi, Jack O’Horo, Steve Peters, Vijay Shah, and John Halamka. 2025. “Meeting the Challenges of Electronic Health Record (EHR) Optimization.” Npj Digital Medicine.
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.