The effect of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction
Introduction
Clinical documentation is a narrative of patient care [1] that serves as the legal record of patient encounters, assists in billing, provides data for clinical decision support, assists in communication between different providers, and is used for secondary data analysis. Documentation templates are used by clinicians to generate clinical documentation [2]. Clinical documentation is generated using templates that are either traditional paper-based forms or electronic data-entry interfaces. Electronic template designs use standard data selection methods [3] (e.g., item selection through radio-buttons or drop-down menus) or insertion of complete blocks of text (i.e., auto-filling) that must be manually edited if actual patient care deviates from the pre-defined blocks of text [4].
Data-entry templates can be used with the data types: structured, unstructured, and semi-structured [5,6]. Data-entry templates can be used with structured data-entry designs that incorporate standard coded data that can improve documentation completeness; but because these designs are not flexible, correctness may be decreased if they fail to provide a true description of patient care [5,6]. Data-entry templates for unstructured data types involve using narrative text (user-defined comments) that incorporates natural language to provide a more correct description of patient care, but sometimes at the expense of completeness [5,7]. Data reusability is impaired by unstructured data because it is difficult to automate processing since unstructured data requires human interpretation [6,8]. Data-entry templates that use semi-structured data are created in electronic documentation systems by integrating structured and unstructured data simultaneously to improve correctness and completeness of the generated documentation [5].
Failure to adequately design and implement data-entry templates can result in unintended consequences such as using incorrect information to make patient care decisions, increased malpractice risk from poor documentation, and impaired clinical workflows [1]. Evidence-based guidelines to inform optimal template design are virtually absent from the published literature [9]. The purpose of this paper is to describe an exploratory study that assessed the impact of data-entry template design and anesthesia provider workload on documentation accuracy, documentation efficiency, and user-satisfaction for the purpose of identifying the most beneficial data-entry template configuration for use in future documentation interface design. For this study, template design will be evaluated in terms of how a single data-entry template (either computer-assisted, auto-filling, or paper-based) is paired to a single data type (structured, unstructured, or semi-structured).
Section snippets
Design and setting
An exploratory descriptive study using observational data collection and administration of psychometric instruments (measures for perceived workload and user-satisfaction) was conducted at three different hospitals each using different data-entry templates (auto-filling, computer-assisted data selection, and paper-based documentation) for generation of anesthesia documentation. Each site exclusively used the same type of data field (i.e., structured, unstructured, or semi-structured) for all of
Results
There were approximately 59 h of data collection over six weeks with the average observation lasting 118 min (SD = 56.8 min). See Table 1 for participant demographics. Also, 53.3% of the patients (N = 30) were categorized as high acuity (PS III and IV).
Discussion
This study identified important implications for documentation accuracy, efficiency, user-satisfaction, and workload. Context-sensitive display of documentation options improves documentation accuracy, efficiency, and user-satisfaction by displaying only the documentation options that are necessary at a specific moment in the anesthesia provider’s workflow. Context-sensitive documentation options decrease the mental effort required to generate documentation. Additionally, data-entry templates
Limitations
This study was exploratory in nature and does not provide confirmatory evidence. Generalizability to other settings may be somewhat limited because of the unique contextual factors (social, cultural, physical, and organizational setting) associated with the organizations where observations were collected, the unique customization of the data-entry templates to each organization, and the default data fields were limited to unstructured data (as opposed to default structured data). Also, the
Summary
The configuration of data-entry templates can greatly influence documentation accuracy, documentation efficiency, and user-satisfaction. In this study, computer-assisted data-entry was superior to paper-based documentation in terms of perceived workload, and superior to auto-filling in terms of documentation accuracy. There was no difference between computer-assisted data-entry and auto-filling in terms of user-satisfaction. Paper-based documentation consistently scored lower in documentation
Author’s contribution
All authors contributed equally to the creation of this manuscript.
Conflict of interest
The authors have no conflict of interest to declare. This study was funded by the American Association of Nurse Anesthetists Foundation by a doctoral grant.
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