ELECTRONIC DOCUMENTATION SYSTEM AS A STRATEGY TO IMPROVE

QUALITY OFCARE: A SYSTEMATIC REVIEW OF

Lecturers: Ns. Septi Dewi Rachmawati, M.Ng

English Courses

By:
Sujarwo
NIM. 166070300111027

MASTER OF EMERGENCY NURSING

MEDICAL FACULTY
BRAWIJAYA UNIVERSITY
2017
 INTRODUCTION
The quality of service become important issues in the world of healthcare today,
improvement of quality of service has become a priority even be an indicator of success for
providing services in hospitals (Kieft, et al, 2014). According to the Institute Of Medicine
defines quality as the extent of the service provided to patients can increase overall (Kelley.,
Et al, 2011). In the organization of health services many things that can affect the quality of
services, one of which is the documentation system. System documentation is a fundamental
in nursing practice. Quality of documentation is often a reflection of the quality of the care
provided. This is due to the documentation of care is very important, in which there are the
data related to patient treatment planning, treatment evaluation, communication among care
professionals as well as providing evidence for legal issues (Kim., H., Et al, 2011).

According to Carter (2010) documentation is the key to get the necessary information,
thus the system should be integrated with good documentation. Documentation of treatment
is a record that contains all the information needed to determine the nursing diagnosis,
nursing plan, implement, and evaluate action systematically arranged, valid and reliable both
morally and legally. Errors in documentation will make an impact in the treatment process,
the result would be a decrease in the quality of service to patients (Penoyer, et al, 2014).

In an effort to improve standardized care services and professionalism, require the

support of technology devices. One of the uses of technology in the field of medical
documentation that can help improve the quality of care is medical electronic documentation
systems or electronic medical record and electronic health record (EHR) (Payne, et al, 2010).
EMR and EHR is a systematic documentation tool. EMR / EHR is a computer application
that helps medical and nursing staff to create, edit, store and retrieve electronic medical
information quickly. In some countries have implemented methods EMR system medical
care, this they did not without reason, paper-based systems or traditional paper based
medical record (PBMR) has many disadvantages such as records were lost, writing is not
legible and the slow pace of information retrieval that use PBMR is less effective and
efficient in delivering services, making it one of the innovations made to improve the quality
of service that is using a systematic medical electronic documentation (Chustz, 2011).

In hospital services, system electronic documentation very important role in the

management of data and the provision of quality service to patients, even according to The
Institute of Medicine,the use ofelectronic medical record (EMR) is recommended to improve
the quality of health care providers at the hospital (Kelley. , et al, 2011), especially in the
department of emergencies is the entrance patients who need help quickly and precisely as in
trauma patients, there by saving time is something that is very valuable for patient safety and
helper (Zikos., et al, 2014). Based on this, the authors are interested to do a analysis of
systematicthe reviews related to the effects of use of electronic documentation to the
improvement of quality of care in the hosptal.
METHODS
The shape of this research is systematic reviews that describe the effects of electronic
documentation to the improvement of services. In this systematic review authors wanted to
test the effectiveness of the use of electronic documentation systems to the improvement of
service quality. Resources obtained from the study of literature and electronic search results
that use search engines PubMed,Medline, Proquest, Sciendirect, Schollar and Elsevier with
the keywords used to search the international journal is the electronic documentation system
and Quality of care.Article publication period of the research is years 2009-2017.
RESULTS AND DISCUSSION
In this systematic review initial literature search identified 125 abstracts begin with,
then gained 20 potentially relevant articles were evaluated in the full text. From the article
later in the evaluation again and gained 6 articles that meet the criteria to be used in a
systematic review of this article (1artikel be systematically review).
Results of research conducted Walsh, et al (2010) stated, two of seven indicators of
quality measurements show that the use of a system Electronic Health Record (EHR) and the
use of EHR systems combined with a system of paper based experienced a significant
improvement to the quality of service is compared with simply using paper based system (p =
0.0128). These results are consistent with research conducted by Tall, et al (2015) by
collecting 61 626 private patient records were then analyzed. Data collected and analyzed are
divided into 3 period that is prior to the Electronic Medical record (EMR), as implemented
EMR and after EMR done. The results showed the use of EMR systems can improve service
quality, significant results were found in patients treated in the department emmergency (p =
0.00001).
The retrospective study conducted by Plantier et al (2017) using data from the third
national database in 2011, IPAQSS (an indicator of improving the quality and management of
health), IPAQSS Hospi-Diag (performance indicators RS French) and a database of national
accreditation in the analysis , The data showed a significant positive impact on the use of
electronic documentation based on four indicators of quality. Based on the indicators of the
quality of patient records, have averaged better results using a system of electronic
documentation (p = <0.001), the same result as well in getting on indicators of the quality of
the delay in sending information to hospitals, as well as the evaluation of the status of the
patient's pain had an average better results using an electronic documentation system (p =
<0.001).
Zikos, et al (2014) also conducted research related to the effect of use of electronic
documentation system on the trauma patient length of stay in emergency departments which
implies the quality of service. Of the total 200 patients, consisting of 99 patients were
monitored using an electronic documentation system and 101 using paper documentation.
The result shows the waiting time of patients in the electronic documentation is lower
compared with the use of documentation paper based (p = <0.001), as well as the long time of
receipt and completion of treatment as well as the length of time between the completion of
the treatment until it comes out of the department of emergency was lower in electronic
documentation compared to using paper based documentation (p = 0.001).
In a systematic review Kalley, et al (2011) explain, five studies advertise that there is a
significant effect on the efficiency of time spent nurses in documenting the use of electronic
records, but three studies suggest, the use of the system electronic documentation is less
effective, because the data related to the patient is limited and 2 research has shown the use of
electronic documentation hold up a nurse work because of difficulties in the operation of an
electronic documentation system as well as the two results of the study also said a decline in
communication between nurses and patients and electronic documentation system can not
describe the desired results nurses.
The observational studies conducted Han, et al (2016) of the 797 patients admitted to
the MICU consisted of 281 patients prior to electronic documentation system and 516
patients diimpelementasikan post using electronic documentation system. Statistics show that
the risk of death in the four months after the implementation of electronic documentation to
decline (N ¼ 41 per 247) before the implementation of electronic documentation (N ¼ 43 per
281) and 8 months after the implementation of electronic documentation (N ¼ 26 per 269)
decreased significantly ( p = 0.001) as well as the waiting time of patients also decreased
after the implementation of electronic documentation (p = ¼ 0.002).
The results from several different studies that showed an improvement in the quality
of service when the system is electronic documentation is executed, such as the use of time,
meaning by using system EMR / EHR use of time is more effective than documentation using
conventional paper, the remaining time can be used by nurses to perform other actions , The
use of this system also helps to reduce the waiting time of patients as well as a well-
integrated documentation, so the impact on the improvement of the quality of services to
patients, but not all of the implementation of electronic documentation can be run well.
According Kalley, et al (2011) unpreparedness of nurses in operating and understanding the
electronic system into problems faced by nurses when an electronic documentation system is
run. Basic standard patient documentation required for a high quality service and awareness
of nurses in the use of electronic documentation and readiness of all the elements of great
concern in implementing this system so that the system can be optimized.
CONCLUSION
Electronic documentation system can be a means of improving services more
effective and efficient with the end goal is the creation of quality patient care better. But that
its application needs a good preparation in systems and human resources when it will
implement it, so that a system can be integrated optimally.
 REFERENCES
Penoyer, Daleen Aragon, Cortelyou-Ward, Kendall H, Noblin, Alice M, Bullard, Tim
(2014) Use of Electronic Health Record Documentation by Healthcare Workers. Journal of
Healthcare Management. 59, 2; ProQuest
Hyeoneui Kim, Patricia C., Dykes, Debra Thomas, Linda A. Winfield, Roberto A.
Rocha (2010) A closer look at nursing documentation on paper forms: Preparation for
computerizing a nursing documentation system. Elsevier
Payne, Thomas (2010) Improving Clinical Documentation In An EMR World.
Healthcare Financial Management; Feb 2010; 64, 2; ProQuest
Mark Harvey Chustz (2011) The Economic Impact of Electronic Medical Records in
Rural Hospital Emergency Departments. Dissertation, Proquest By
Mary Norine Walsh, Wendy Gattis S, Mandeep R. Mehratough (2010). Electronic
Health Record And Quality Of Care For Heart Failure
Jill M. Tall, Marie Hurd, Thomas Gifford (2015). Minimal Impact Of An Electronic
Medical Records System
Dimitrios Zikos, Marianna Diomidous, Vassiliki Mpletsa (2014). The effect of an
electronic documentation system on the trauma patient's length of Stay in an emergency
department Emergency Nurses Association. Volume 40, Published by Elsevier Inc.
Morgane Plantier, Nathalie Havet, Thierry Durand, Nicolas Caquot, Camille, Amaz
Pierre, Biron Irene, Philip, Lionel Perrier (2017). Does the adoption of electronic health
records improve the quality of care management in France. International Journal of Medical
Informaticshttp: //dx.doi.org/doi: 10.1016 / j.ijmedinf. 2017.04.002
Kelley, Tiffany F, Brandon, Debra H, Docherty, Sharron (2011). Electronic Nursing
Documentation as a Strategy to Improve the Quality of Patient Care. Journal of Nursing
Scholarship, doi: 10.1111 / j.1547-5069.2011.01397.
Jenny E. Han, Marina Rabinovich, Prasad Abraham, Prerna Satyanarayana, Vivan Liao,
Timothy N. Udoji, George A. Cotsonis, Eric G. Honig, and Greg S. Martin (2016) Effect of
Electronic Health Record Implementation in Critical Care on Survival and Medication Errors.
The American Journal of the Medical Sciences, Volume 351 number 6 June 2016. By
Elsevier
Renate AMM Kieft, Brigitte BJM de Brouwer1, Anneke L Francke and Diana MJ
Delnoij. How nurses and their work environment Affect patient experiences of the quality of
care: a qualitative study. BMC Health Services Research 2014, 14: 249 1472-6963 / 14/249