Trend in data errors after the implementation of an electronic medical record system: A longitudinal study in an Australian regional Drug and Alcohol Service.

OBJECTIVES: To investigate trends in data errors over the 40 months after the implementation of an electronic medical record (eMR) system in an Australian regional Drug and Alcohol (D&A) Service. METHODS: One hundred and twenty three error reports and data on occasions of service were obtained from the D&A Service. Statistical analysis was conducted to describe types of errors, to compare distribution of error types among different documentation forms, D&A Service sites and job roles. Error rates were also analysed. RESULTS: In the 40 months after the implementation, a total of 18,549 errors occurred. These errors were grouped into four types: mismatched data fields (54.5 %), duplicate medical record (1.8 %), date/time error (8.2 %) and blank field (35.4 %). The distribution of error types differed in the forms being completed, the sites and the job roles. Quarterly error rate increased from 28.8 errors per 100 occasions of service in Year 1 Quarter 1-40.6 in Quarter 3, then decreased to 18.1 in Quarter 4. It dropped to 6.6 in Year 2 Quarter 2 and continued to decrease to 2.5 in Year 4 Quarter 1. Monthly error rate was the highest at 44.6 in Month 8, fell to the lowest at 1.0 in Month 18 and remained at under 7.3 from Month 19 to Month 40. CONCLUSIONS: After the implementation of the eMR system, the error rate increased in the first three quarters before decreasing. It reached stability about one and a half years after implementation. There were significant differences in the error distribution among the documentation forms, sites and job roles. The findings of this study could be used by eMR trainers to tailor training sessions for specific sites and job roles. These findings might also be useful for managers of other D&A Services to plan for the implementation of new electronic documentation systems.

Precision of EMR Data: The Case for a Drug and Alcohol Service.

Error-laden data can negatively affect clinical and operational decision making, research findings and funding allocation. This study examined the number and types of data errors in an electronic medical record (EMR) system in a Drug and Alcohol service. Specifically, errors in service data were examined. Three months after the implementation of the EMR system, 9,379 errors were identified from ten error reports generated between March 2015 and May 2016. The errors were grouped into four types: mismatched data fields (60.5%), duplicate medical record error (3.2%), date/time error (8.8%) and blank field error (27.4%). The errors can be prevented by adding functions, such as alert messages in the EMR system. How and why the errors occur need to be investigated in future studies.

Accuracy of outpatient service data for activity-based funding in New South Wales, Australia.

BACKGROUND: Despite increasing research on activity-based funding (ABF), there is no empirical evidence on the accuracy of outpatient service data for payment. OBJECTIVE: This study aimed to identify data entry errors affecting ABF in two drug and alcohol outpatient clinic services in Australia. METHODS: An audit was carried out on healthcare workers' (doctors, nurses, psychologists, social workers, counsellors, and aboriginal health education officers) data entry errors in an outpatient electronic documentation system. RESULTS: Of the 6919 data entries in the electronic documentation system, 7.5% (518) had errors, 68.7% of the errors were related to a wrong primary activity, 14.5% were due to a wrong activity category, 14.5% were as a result of a wrong combination of primary activity and modality of care, 1.9% were due to inaccurate information on a client's presence during service delivery and 0.4% were related to a wrong modality of care. CONCLUSION: Data entry errors may affect the amount of funding received by a healthcare organisation, which in turn may affect the quality of treatment provided to clients due to the possibility of underfunding the organisation. To reduce errors or achieve an error-free environment, there is a need to improve the naming convention of data elements, their descriptions and alignment with the national standard classification of outpatient services. It is also important to support healthcare workers in their data entry by embedding safeguards in the electronic documentation system such as flags for inaccurate data elements.

Pre-implementation investigation of the readiness of allied health professionals to adopt electronic health records.

There has been limited uptake of electronic health records (EHR) by allied health professionals. Yet, not much attention has been given to their information needs. For EHR to work for these health professionals, it is essential to understand their current practice of information management and their perceptions towards EHR. A qualitative interview study was thus conducted with four managers in four allied health practices in Sydney to understand their perceptions for the adoption and use of a new Australian e-health standards compliant EHR system. We found that these allied health professionals were highly confident with the use of electronic information system and were enthusiastically expecting the introduction of the EHR system to support their information management and practice. A number of issues related to the use of EHR in practice for small, independent allied health practices were also discussed. It appears that allied health professionals today are information technology (IT) savvy and ready to adopt EHR. EHR for allied health practices in Australia are long overdue. The health informatics community can no longer ignore the need and want of allied health professionals for EHR that are tailored and built to support their information and practice management.

The effect of an electronic health record system on nursing staff time in a nursing home: a longitudinal cohort study.

BACKGROUND: Nursing homes are increasingly introducing electronic health record (EHR) systems into nursing practice; however, there is limited evidence about the effect of these systems on nursing staff time. AIMS: To investigate the effect of introducing an EHR system on time spent on activities by nursing staff in a nursing home. METHOD: An observational work sampling study was undertaken with nursing staff between 2009 and 2011 at two months before, and at 3, 6, 12, and 23 months after implementation of an EHR system at an Australian nursing home. An observer used pre-determined tasks to record activities of the nursing staff at nine-minute intervals. RESULTS: There was no significant change in registered nurses and endorsed enrolled nurses' time on most activities after implementation. Personal carers' time on oral-communication reduced, and time on documentation increased at most measurement periods in the first 12 months after implementation. At 23 months, time on these activities had returned to pre-implementation levels. Nursing staff time on direct care remained stable after implementation. No considerable change was observed in time spent on other activities after implementation. CONCLUSION: Findings suggest that successful introduction of an EHR system in a nursing home may not interfere with nursing staff time on direct care duties. However, there is scope for improving the support provided by EHR systems through incorporation of functions to support collaborative nursing care.

The impact of an electronic nursing documentation system on efficiency of documentation by caregivers in a residential aged care facility.

AIMS AND OBJECTIVES: To examine the effect of the introduction of an electronic nursing documentation system on the efficiency of documentation in a residential aged care facility. BACKGROUND: Modern technology has the potential to free caregivers in residential aged care facilities from their burden of paper documentation and allow them more time to care for residents. To date, there is inadequate evidence to verify this assumption. DESIGN: Longitudinal cohort study with work sampling method for data collection. METHODS: This study was conducted between 2009-2011; two months before and 3, 6, 12 and 23 months after implementation of an electronic documentation system. A work classification tool was used by an observer to record documentation activities being performed on paper or on a computer by the caregivers. RESULTS: When compared with the proportion of time caregivers spent on documentation in the preimplementation period, personal carers' proportion reduced at three months after implementation. The proportion increased from six months and then dropped at 23 months. Recreational activity officers' proportion increased at three months after implementation. It stabilised at six months and increased again at 12 months. At 23 months, the proportion returned to the preimplementation level. Less than half of the caregivers' time on documentation after implementation was associated with computer-related tasks. CONCLUSIONS: Introduction of an electronic documentation system may not necessarily lead to efficiency in documentation for the caregivers. Charting some information items on paper and others on a computer may hinder realization of documentation efficiency. RELEVANCE TO CLINICAL PRACTICE: To optimise the efficiency benefit of electronic documentation in a residential aged care facility, it is not only necessary to automate all nursing forms but also to ensure that the system is aligned with caregivers' documentation practice. Continuous education and mentor support is essential to ensure caregivers' effective usage of the electronic system.

Does the introduction of an electronic nursing documentation system in a nursing home reduce time on documentation for the nursing staff?

PURPOSE: To determine whether the introduction of an electronic nursing documentation system in a nursing home reduces the proportion of time nursing staff spend on documentation, and to use this information in evaluating the usefulness of the system in improving the work of nursing staff. METHODS: An observational work sampling study was conducted in 2009 and 2010, 2 months before, and 3, 6 and 12 months after the introduction of an electronic nursing documentation system. An observer (ENM) used a work classification tool to record documentation activities being performed using paper and with a computer by nursing staff at particular times for periods of 5 days. RESULTS: Three hundred and eighty three (383) activities were recorded before implementation of the electronic system, 472 activities at 3 months, 502 at 6 months, and 338 at 12 months after implementation. There was no significant difference between the proportion of time nursing staff spent on documentation 2 months before and 3 months after the implementation of the electronic system. Six months after implementation, the proportion of time on documentation increased significantly and after 12 months, settled back to original levels that were recorded in the paper-based system. Over half of the proportion of time on documentation at 6 and 12 months after implementation was spent on paper documentation tasks. CONCLUSION: Introduction of an electronic nursing documentation system did not reduce the proportion of time nursing staff spent on documentation. This may in part have been a result of the practice of documenting some information items on paper and others on a computer. To reduce the use of paper documentation or to achieve a paper-free documentation environment in this setting, an in-depth understanding of nursing staff's information needs, and documentation workflow is necessary.

How nursing staff spend their time on activities in a nursing home: an observational study.

AIM: This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. BACKGROUND: Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. METHOD: A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. RESULTS: A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48·4% of their time on communication and 18·1% on medication management. Endorsed Enrolled Nurses spent 37·7% on communication and 29·0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. CONCLUSION: Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home.

The changes in caregivers' perceptions about the quality of information and benefits of nursing documentation associated with the introduction of an electronic documentation system in a nursing home.

PURPOSE: To date few studies have compared nursing home caregivers' perceptions about the quality of information and benefits of nursing documentation in paper and electronic formats. With the increased interest in the use of information technology in nursing homes, it is important to obtain information on the benefits of newer approaches to nursing documentation so as to inform investment, organisational and care service decisions in the aged care sector. This study aims to investigate caregivers' perceptions about the quality of information and benefits of nursing documentation before and after the introduction of an electronic documentation system in a nursing home. METHODS: A self-administered questionnaire survey was conducted three months before, and then six, 18 and 31 months after the introduction of an electronic documentation system. Further evidence was obtained through informal discussions with caregivers. RESULTS: Scores for questionnaire responses showed that the benefits of the electronic documentation system were perceived by the caregivers as provision of more accurate, legible and complete information, and reduction of repetition in data entry, with consequential managerial benefits. However, caregivers' perceptions of relevance and reliability of information, and of their communication and decision-making abilities were perceived to be similar either using an electronic or a paper-based documentation system. Improvement in some perceptions about the quality of information and benefits of nursing documentation was evident in the measurement conducted six months after the introduction of the electronic system, but were not maintained 18 or 31 months later. CONCLUSIONS: The electronic documentation system was perceived to perform better than the paper-based system in some aspects, with subsequent benefits to management of aged care services. In other areas, perceptions of additional benefits from the electronic documentation system were not maintained. In a number of attributes, there were similar perceptions on the two types of systems.

Development and testing of a work measurement tool to assess caregivers' activities in residential aged care facilities.

The introduction of computerized information systems into health care practices may cause changes to the way healthcare workers conduct their routine work activities, such as work flow and the time spend on each activity. To date the available work measurement tools are confined to activities in hospitals and do not cover residential aged care facilities (RACFs). There is little evidence about the effects of technology on caregivers' work practices, including the distribution of time on activities in a RACF. This requires the measurement of caregivers' activities using a valid and reliable measurement tool. The contribution of this research is to develop and test such a tool. The tool was developed based on literature research and validation in two RACFs. The final instrument contains 48 activities that are grouped into seven categories. They include direct care, indirect care, communication, documentation, personal activities, in-transit and others. This measurement tool can be used to measure the changes in caregivers' work activities associated with the introduction of computerized information systems in RACFs, including the efficiency gains of such systems.

Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

OBJECTIVE: In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. METHODS: UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. RESULTS: Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. CONCLUSION: Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.