A human centered design approach to define and measure documentation quality using an EHR virtual simulation.

Area of Science:

• Health Informatics
• Human-Computer Interaction
• Quality Improvement in Healthcare

Background:

• Electronic health record (EHR) documentation is crucial for patient care, communication, billing, and healthcare system quality.
• Current methods for assessing EHR documentation quality are lacking standardized definitions and evaluation approaches.
• The need for a systematic approach to measure and improve EHR documentation quality is critical for learning healthcare systems.

Purpose of the Study:

• To define and describe a human-centered design (HCD) methodology for measuring EHR documentation quality.
• To assess the timeliness, accuracy, user-centeredness, and efficiency of EHR documentation in a simulated clinical setting.
• To identify usability challenges within EHR systems impacting documentation quality.

Main Methods:

• A human-centered design (HCD) approach was employed to develop a quality measurement method.
• A virtual simulated standardized patient visit was conducted using an EHR vendor platform.
• Nurse practitioners (NPs) documented an Age-Friendly Health System (AFHS) 4Ms clinic visit, with documentation efforts observed and recorded.

Main Results:

• Significant variability was observed in the time taken to document the 4Ms (what Matters, Medication, Mentation, and Mobility).
• Accuracy issues and increased documentation time were linked to navigation burdens within the EHR system.
• The EHR system exhibited poor usability (System Usability Scale scores 60-70) and high click burden for NPs.

Conclusions:

• The HCD methodology is a feasible approach for assessing EHR documentation quality.
• Findings reveal critical areas for EHR system enhancement, including usability and navigation.
• Improving EHR documentation quality can optimize user experience and data quality within learning healthcare systems.