Casella Jean-Baptiste Meredith, Vital Julmiste Thamar Monide, Ball Ellen
Hôpital Universitaire de Mirebalais, Sante Fanm, Mirebalais, Haiti.
Partners In Health, Boston, MA, United States.
JMIR Form Res. 2024 Jun 14;8:e55000. doi: 10.2196/55000.
Journey to 9 Plus (J9) is an integrated reproductive, maternal, neonatal, and child health approach to care that has at its core the goal of decreasing the rate of maternal and neonatal morbidity and mortality in rural Haiti. For the maximum effectiveness of this program, it is necessary that the data system be of the highest quality. OpenMRS, an electronic medical record (EMR) system, has been in place since 2013 throughout a tertiary referral hospital, the Hôpital Universitaire de Mirebalais, in Haiti and has been expanded for J9 data collection and reporting. The J9 program monthly reports showed that staff had limited time and capacity to perform double charting, which contributed to incomplete and inconsistent reports. Initial evaluation of the quality of EMR data entry showed that only 18% (58/325) of the J9 antenatal visits were being documented electronically at the start of this quality improvement project.
This study aimed to improve the electronic documentation of outpatient antenatal care from 18% (58/325) to 85% in the EMR by J9 staff from November 2020 to September 2021. The experiences that this quality improvement project team encountered could help others improve electronic data collection as well as the transition from paper to electronic documentation within a burgeoning health care system.
A continuous quality improvement strategy was undertaken as the best approach to improve the EMR data collection at Hôpital Universitaire de Mirebalais. The team used several continuous quality improvement tools to conduct this project: (1) a root cause analysis using Ishikawa and Pareto diagrams, (2) baseline evaluation measurements, and (3) Plan-Do-Study-Act improvement cycles to document incremental changes and the results of each change.
At the beginning of the quality improvement project in November 2020, the baseline data entry for antenatal visits was 18% (58/325). Ten months of improvement strategies resulted in an average of 89% (272/304) of antenatal visits documented in the EMR at point of care every month.
The experiences that this quality improvement project team encountered can contribute to the transition from paper to electronic documentation within burgeoning health care systems. Essential to success was having a strong and dedicated nursing leadership to transition from paper to electronic data and motivated nursing staff to perform data collection to improve the quality of data and thus, the reports on patient outcomes. Engaging the nursing team closely in the design and implementation of EMR and quality improvement processes ensures long-term success while centering nurses as key change agents in patient care systems.
“迈向9加”计划（J9）是一种综合的生殖、孕产妇、新生儿和儿童健康护理方法，其核心目标是降低海地农村地区孕产妇和新生儿的发病率和死亡率。为使该计划发挥最大效力，数据系统必须具备最高质量。自2013年起，电子病历（EMR）系统OpenMRS已在海地米雷巴莱大学医院（一家三级转诊医院）全面应用，并已扩展用于J9的数据收集和报告。J9计划的月度报告显示，工作人员进行双重记录的时间和能力有限，这导致报告不完整且不一致。对电子病历数据录入质量的初步评估表明，在这个质量改进项目启动时，J9的产前检查中只有18%（58/325）通过电子方式记录。
本研究旨在使J9工作人员在2020年11月至2021年9月期间，将门诊产前护理的电子记录从18%（58/325）提高到85%。这个质量改进项目团队所遇到的经验可以帮助其他机构在新兴的医疗保健系统中改进电子数据收集以及从纸质记录向电子记录的转变。
采取持续质量改进策略作为改善米雷巴莱大学医院电子病历数据收集的最佳方法。该团队使用了多种持续质量改进工具来开展此项目：（1）使用石川图和帕累托图进行根本原因分析，（2）进行基线评估测量，（3）通过计划 - 执行 - 研究 - 行动改进循环来记录渐进式变化以及每次变化的结果。
在2020年11月质量改进项目开始时，产前检查的基线数据录入率为18%（58/325）。经过十个月的改进策略，每月平均有89%（272/304）的产前检查在护理点通过电子方式记录在电子病历中。
这个质量改进项目团队所遇到的经验有助于在新兴的医疗保健系统中从纸质记录向电子记录转变。成功的关键在于拥有强大且专注的护理领导层来推动从纸质数据向电子数据的转变，以及积极主动的护理人员进行数据收集以提高数据质量，进而提高患者结局报告的质量。让护理团队密切参与电子病历的设计和实施以及质量改进过程，可确保长期成功，同时将护士作为患者护理系统中的关键变革推动者。
