Essential Nurse Documentation: Studying EHR Burden During COVID-19 (ENDBurden)

Electronic health record (EHR) burden—the negative impact electronic clinical documentation has on medical staff—has been an ongoing issue for registered nurses since the advancement of EHR systems. Nurses spend an estimated 19 to 35 percent of their time documenting in the EHR, up from 9 percent when documenting on paper. Documentation requirements increase workload and staff burnout, along with correlations to poor patient outcomes. The COVID-19 pandemic introduced an urgent shift for increased patient care, resulting in an imbalance between time available for clinical documentation and patient care. To address this burden, many, but not all, States issued orders to relax the requirements of clinical documentation, requiring clinical staff to only document information deemed most essential to providing care for the patients.

The COVID-19 pandemic presented a rare opportunity to observe the impact of reducing clinical documentation requirements. This research aims to learn about nurses’ documentation from a data science and informatics perspective, discover which documentation patterns are deemed essential by nurses, and examine documentation pattern changes over time from before the pandemic through present day.

The specific aims of the research are as follows:

• Examine changes in the temporal trends of data entry and data viewing patterns of nursing documentation (e.g., types, amount) from 2019 through present day, inclusive of the COVID-19 pandemic timeline.
• Investigate how nurses define and decide what is essential to document for patient care and the impact of all-inclusive documentation (i.e., documentation that meets both clinical and regulatory demands) on EHR burden.
• Examine changes in data entry and data viewing patterns of nursing documentation and the impact of these changes on patient care activities and patient outcomes, while controlling for confounding factors related to workload, and nurse, patient, team, and organizational characteristics.

The research team will observe the EHR nursing documentation patterns of two health systems: New York- Presbyterian Hospital, where the documentation was deemed essential by nurses during the COVID-19 pandemic; and Washington University Medical Campus in Saint Louis, where documentation was all-inclusive of regulatory and other requirements. The team will compare the trends of changes in data entry and data viewing patterns by nursing staff at each hospital. They will then examine the relationship between patient care and patient outcomes, determining whether capturing essential data reduces EHR burden and strengthens the impact of care on patient outcomes.