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Distributed Electronic Documentation Practices of Homecare Admission: Informing Electronic Health Record Design Guidelines

机译:家庭护理入场的分布式电子文档实践:告知电子病历设计指南

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Home care nurses complete many activities as part of the admission process. A pilot study of the home careadmission process indicated that a nurse distributes data entry tasks between the patient’s home and a postdocumentationperiod later in the day. We found evidence of a strategy to document information that requires directobservation (either from the patient or through viewing the home environment) in the home. We found evidence of astrategy to document outside of the home for data elements based on clinical judgment or assessments as well asinformation supported by clinical decision support in the Electronic Health Record (EHR). These finding informrecommendations for data entry and navigation design guidelines for home care admission EHR systems.
机译:入院过程中,家庭护理护士完成许多活动。对家庭护理入院过程的一项初步研究表明,护士在当天晚些时候在患者家中和记录后期间之间分配数据输入任务。我们发现了一种策略的证据,该策略可以记录需要在家中进行直接观察(无论是从患者还是通过观察家庭环境)的信息。我们根据临床判断或评估以及电子健康记录(EHR)中临床决策支持所支持的信息,找到了在家中为数据元素进行文件记录的策略证据。这些发现为家庭护理入院EHR系统的数据输入和导航设计指南提供了信息推荐。

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