Electronic health records (EHRs) were created to save time for healthcare professionals, but as nurses know, that hasn’t been the result. Research from 2014 shows up to 92% of nurses are dissatisfied with their organization’s EHR system. What’s more, an extensive investigation from Kaiser Health News published earlier this year found the widespread adoption of EHRs could be creating risks to patient safety, which continue to go unacknowledged. These reasons and many more were the inspiration for Project Joy.

What is Project Joy?

Project Joy is a multi-year UCHealth nursing initiative with the goal of streamlining its EHR system to more efficiently capture relevant patient data and give nurses more time at the bedside. Three Joy team members — lead researcher Bonnie Adrian, Ph.D., RN-BC, Hannah Pfiefer, BSN, RN, and Sam Wehlage, MSN, RN, CNRN — presented their work at the American Nurses Credentialing Center’s 2019 Magnet Conference.

The data they presented at MagnetCon came from more than 1,000 RNs over more than 27,000 shifts. They found that the average acute-care nurse spent over 30% of a 12-hour shift filling out EHRs. In addition, on a scale of -100 to 100, nurses rated their satisfaction with the system a -38. “The documentation didn’t tell the story of the patient,” Pfeifer says.

Enter Project Joy. Before beginning their journey, the team created some guiding principles to ensure that every choice they made when reviewing existing EHR fields would directly benefit patients (without disregarding external reporting mandates). They also outlined specific criteria for determining which fields in the EHR they would keep and which they would eliminate.

Examples include:

• It is needed to provide care to the patient and could be accessed by other care team members and/or the patient.

• Nursing staff collection and entry of the information is the best or only way to capture it.

• It triggers a meaningful, useful, and necessary practice alert.

What Did Project Joy Accomplish?

In collaboration with clinical informaticists and EPIC analysts, the Project Joy team eliminated 60 top-level flowsheet rows, going from 92 to 32. They also reorganized the chart structure to make it more logical for the RN user. Overall, they got rid of 271 rows and added 65 new ones.

After optimizing just two flowsheets, the team found Project Joy reduced the time spent in the EHR by 18 minutes per 12-hour shift. The researchers estimate that Project Joy resulted in 170 million fewer actions in EHRs annually.

“The work that we did really impacted my day and the days of my coworkers,” Wehlage recalls, adding that fellow clinicians often commented on the difference — “Things like, ‘This is really easy. There’s no issues,’” she says.

In addition to simplifying the arduous task of filling out the charts, the team adds that Joy established a more “synchronized” documentation strategy across UCHealth’s ten hospitals. “It’s like we’re one,” Wehlage explains.

What Can Health Professionals Learn from Project Joy?

While the idea of cleaning up your EHR can be daunting, the Joy team stresses that it’s “totally worth it.”

“You just have to make the business case,” Dr. Adrian adds. “It’s possible to save measurable time. Every hospital wants to improve patient experiences and scores.”

Project Joy can also reduce missed care and be a substantial “nurse satisfier,” Dr. Adrian continues. “It makes a nurse happier to work for an institution, and it could get to a point where somewhere’s EMR is so much better” that a nurse will switch employers.

EHR Tips for Clinicians

The team also offered some tips for improving your charting experience if a total EHR revamp isn’t an option.

• Invest in learning the “advancer user” skills for your system.

• Talk to leadership about what’s required to document and what isn’t.

In Team Joy’s experience, you’re probably wasting time on unnecessary fields, and these expectations likely aren’t written down because “making it a policy can lead to downstream problems,” Dr. Adrian explains.

• Ditch the “not documented, not done” mentality. Clinicians often fly through EHRs and indicate that something was completed when it wasn’t.

• Find out when you need to write a note and when you need to complete a form or flowsheet.

• When in doubt, remember: What did you see? What did you do about it? To whom did you communicate it?