How nursing informatics helped Carolinas HealthCare eliminate 18 million clicks

The health system drastically reduced documentation time within its Cerner EHR after a three-year optimization project.
By Jessica Davis
03:06 PM
Carolinas HealthCare

In an industry populated with physicians bemoaning too many clicks, healthcare organizations need to create a culture that believes IT will do more than just improve patient care. Electronic health records and other technologies need to help clinicians improve workflow.

For Carolinas HealthCare System, that meant first zeroing in on its nursing team.

CHS went live with a three-year optimization project in May 2016 to simplify the EHR in the acute care venue. The health system has used Cerner technology for over 10 years and needed to update the systems to make things easier and give nurses a hand in using the technology.

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The goal? To reduce documentation, remove duplicate records and organize the tech in a user-friendly system.

"If you make things better for your nurse, you make things better for your patient," said Becky Fox, RN, Carolinas HealthCare assistant vice president and chief nursing informatics officer.


"If you make things better for your nurse, you make things better for your patient," said Becky Fox, RN, Carolinas HealthCare assistant vice president and chief nursing informatics officer.

By leveraging nursing informatics, Carolinas Healthcare reduced documentation time for head-to-toe assessment by 20 percent, which is equivalent to about 35,000 working hours returned to nurses directed back to patient care.

Additionally, CHS saw a 14 percent improvement in on-time medication administration, equal to about 400,000 eliminated clicks within the EHR. In total, CHS eliminated 5.8 million nursing tasks and reduced clicks by 17.8 million - or three or more clicks per task.

CHS also improved the quality of each assessment with 10 new screening tools, which generated third-party annual costs savings of $60,000.

The organization automated a clinical decision support tool to better identify patients at-risk of deteriorating conditions, Fox explained. Now, when nurses collect medical history during admission, it uses EHR and that data to automatically evaluate the risk level of the patient using established criteria.

While the nurses can use their own judgement, the program is designed to catch patients that would usually fall through the cracks, she continued.

We used a lot of analytics to drive design, Fox said. We also had a great partnership with bedside nurses, nursing managers, IT and our vendors. It was a significant change for clinicians.

"That's what's valuable to us: The nurses feel the computer has their back," explained Fox. "Nurses now feel part of the care team because they see the work they do makes a difference for the patient's care. It's really helped out nursing team feel the technology is part of the team."

The project has also helped to facilitate a cultural change, said Fox. We've really considered how to assure our clinicians we're putting the best tools in their hands.

"We had bedside clinicians involved in every step, which helped us get to a point where everyone was excited for the change," said Fox. "It helped us move into the direction that we're an evolving healthcare organization that helps our clinicians always be the best.

"When you give nurses back time, it comes out in your quality outcomes," she continued. "And it helps nursing staff deliver better care to their patients."

Twitter: @JessieFDavis
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