A Generic Method to Monitor Completeness and Speed of Medical Documentation Processes[*]
received:28 September 2009
accepted:20 February 2011
20 January 2018 (online)
Background: Physicians dedicate approximately a quarter of daily work to documentation. Completeness and speed of medical documentation processes are important parameters, because they can affect quality of healthcare.
Objectives: A generic method to monitor these quality parameters is proposed and its utility is demonstrated in two examples.
Methods: Based on a generic event-driven process chain of a medical documentation process, completeness functions for created and finalized documents (available versus required documents by time) are defined. The 95%-quantile of process time is applied as performance indicator of documentation speed. A plotting function for these parameters is provided: completeness and speed of medical documentation (CSMD)-plot. Open source code and a sample data set are available in the Supplement.
Results: This methodology is applied to analyze the effect of an electronic dictation system on discharge letter documents. CSMD-plot detects significant differences regarding speed and completeness of the process before and after implementation of electronic dictation; in addition, it pinpoints differences regarding these quality parameters in documentation processes between different clinical departments. In a second example, CSMD-plot is used to analyze follow-up documentation of a clinical trial. Due to its generic design, CSMD-plots can be applied to other medical documentation processes such as order-entry processes.
Conclusions: Monitoring of completeness and speed of medical documentation is feasible and can provide quantitative information on these processes.
KeywordsMedical documentation process - completeness - electronic dictation system - CRF - clinical trial documentation
* Supplementary material published on our website www.methods-online.com
- 1 Ammenwerth E, Spötl HP. The Time Needed for Clinical Documentation versus Direct PatientCare - A Work-sampling Analysis of Physicians’ Activities. Methods Inf Med 2009; 48: 84-91.
- 2 Westbrook JI, Ampt A, Kearney L, Rob MI. All in a day’s work: an observational study to quantify how and with whom doctors on hospital wards spend their time. Med J Aust 2008; 188 (09) 506-509.
- 3 Blum K, Müller U. Time spent on documentation during physicians’ service in hospitals. Representative increase of the German Hospital Institute. Chirurg 2003; 74: M276-280.
- 4 Staes CJ, Evans RS, Rocha BH, Sorensen JB, Huff SM, Arata J, Narus SP. Computerized alerts improve outpatient laboratory monitoring of transplant patients. J Am Med Inform Assoc 2008; 15 (03) 324-332.
- 5 Scheer AW, Thomas O, Adam O. Process Modeling Using Event-driven Process Chains. In: Dumas M, van der Aalst WMP, ter Hofstede AHM. (eds) Process-Aware Information Systems: Bridging People and Software Through Process Technology. Hoboken, New Jersey: Wiley; 2005: 119-145.
- 6 R: A language and environment for statistical computing http://www.R-project.org
- 7 Agfa Healthcare http://healthcare.agfa.com/
- 8 Saleem JJ, Russ AL, Justice CF, Hagg H, Ebright PR, Woodbridge PA, Doebbeling BN. Exploring the persistence of paper with the electronic health record. Int J Med Inform 2009; 78 (09) 618-628.
- 9 Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280 (15) 1339-1346.
- 10 Dugas M, Eckholt M, Bunzemeier H. Benchmarking of hospital information systems: monitoring of discharge letters and scheduling can reveal heterogeneities and time trends. BMC Med Inform Decis Mak 2008; 8: 15
- 11 Georgiou A, Williamson M, Westbrook JI, Ray S. The impact of computerised physician order entry systems on pathology services: A systematic review. Int J Med Inform 2007; 76: 514-529.
- 12 Jha AK, DesRoches CM, Campbell EG, Donelan K, Rao SR, Ferris TG, Shields A, Rosenbaum S, Blumenthal D. Use of electronic health records in U.S. hospitals. N Engl J Med 2009; 360 (16) 1628-1638.