A qualitative analysis evaluating the purposes and practices of clinical documentation.
An important challenge for biomedical informatics researchers is determining the best approach for healthcare providers to use when generating clinical notes in settings where electronic health record (EHR) systems are used. The goal of this qualitative study was to explore healthcare providers' and administrators' perceptions about the purpose of clinical documentation and their own documentation practices.
Author(s): Ho, Y-X, Gadd, C S, Kohorst, K L, Rosenbloom, S T
DOI: 10.4338/ACI-2013-10-RA-0081