Abstract in patient information management, they are also

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Since modern business management requires efficient information management, healthcare providers require enhancing the management of patient information.

Thus the concept of computer charting emerges. This paper identifies Charting by Exception, popularly referred to as CBE, as one of the most useful modern computer charting systems. Implementation of CBE is a complicated process, but can be effective undertaken through a simple project management model. As such, the paper describes CBE project implementation against the 4 D project management model. This model is preferred for its simplicity as well as ability to track project progress.


Modern business management requires efficient management of information.

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Within the healthcare industry, the management of patient information is vital as it determines the success of healthcare provision. The need to enhance the management of information has led to the development of computer charting a concept that incorporates the use of IT based patient information management tools. Computer charting systems have a broad based primary objective; however, the overarching aim seems to be improving efficiency in documentation of patient information. This is aimed at increasing accuracy in decision making regarding the patient care. As a result, the healthcare industry accrues numerous advantages from computer charting (Keenan, Yakel, Tschannen and Mandeville, n.d.).

The ever changing trends in healthcare information management require consistent changes to existing information management tools. While current computer charting systems ensure increased efficiency in patient information management, they are also time consuming since healthcare experts, especially nurses, spend a lot of time keying data in computer charting systems. This reduces the amount of time nurses spend with patients (Harrison, 2003; Huff, 2004). The need for improved computer charting systems in the healthcare industry is necessitated by the desire to reduce the time spent in documentation.

This translates to more time available for nurses to provide patient care. Additionally, other than reducing charting errors and omissions, the need to reduce redundancies in management of patient information necessitates systems change. This therefore calls for the transition from the current computer charting to Charting by Exception, CBE (Jaffe, 2011). CBE is an improved version of the traditional computer charting systems already in the market. Compared to other computer charting systems, CBE offers numerous advantages to tertiary healthcare providers. Other than creating a legally recognized patient data base, CBE eliminates the need for narrative documentation as it only focuses on variances or exceptional patient information. This is attained through recording information that varies from normal charting protocol. CBE uses standard information management tools such as graphs, sheets, among others.

Despite being a rather complex system to implement, CBE is recommended for tertiary healthcare institutions (Jaffe, 2011). Thus, the main objective of CBE is to increase time available for nursing care by reducing documentation time, further enhancing accuracy in decision making for tertiary healthcare providers. As mentioned earlier, CBE provides additional advantages in the management of patient information for tertiary healthcare providers as compared to other computer charting systems available. Additionally, CBE is a complicated system.

Therefore, its implementation needs a simple project management model. There are numerous project management models, but according to Fischer (2005), 4 D models are the most preferable since they are not only simple but also help project managers verify their project plans at both the strategic and tactical level. Additionally, 4 D models enable managers to minimize and optimize risks as well as enabling managers to follow project progress while addressing emerging opportunities for change.

Project management process

The 4 D model is linear and involves four sequential stages. Most projects fail due to lack of a clear project definition. As such, the 4 D model requires a clear detailed definition for the project at hand. A detailed definition for the project includes clear objectives.

Additionally, project managers need to identify the desired outcomes for the projects at the definition stage (Park and Meier, 2007). As indicated earlier, the main objective of CBE is to increase time available for nurses to provide care by reducing documentation time, while further enhancing accuracy in decision making for tertiary healthcare providers. In line with this, the desired outcome for CBE is to limit the time used by tertiary healthcare providers during documentation. Reduced documentation time implies that nurses have extra time. Additionally, CBEs main aim is to reduce errors and thus improve decision making. To achieve the objective stipulated above requires project managers to set realizable time based goals.

As such, since this involves transition to a complicated computer charting system, adequate time is needed to train nurses, manage transition, test and measure its effectiveness and correct changes before delivery. Depending on the size of institution, managers need one to two months to fully implement CBE (Jaffe, 2011). The most difficult stage is the designing stage. Designing largely involves planning how the objectives are to be achieved.

In this case, a step by step plan seems relevant (Park and Meier, 2007). Appropriate actions which culminate in the implementation of CBE are identified. Such actions mainly focus on testing CBEs viability, evaluation and feedback reporting, as well as incorporating necessary adjustments. To enable this, a project management checklist seems relevant. Such a list not only allows the manager to track the project progress but also record events. In the designing stage, a number of assumptions are made. For instance, the project manager assumes that the healthcare institution charting protocols meets State charting requirements. Additionally, the project manager assumes that nurses understand existing charting protocols.

To avoid any conflict with state authorities, the manager is required to consult attorneys as well as human service representatives within that State. While planning is aligned to the objective set, the project manager needs to also estimate the cost for the entire project. In this case, the cost for training nurses, the cost of the new system, materials needed, contingency plans, the cost incurred while testing and evaluation are factored in. A project of such magnitude involves a number of risks. It is the role of the manager to identify all the possible management and systems risks.

Since CBE offers legally valid patients data, there is the risk of using such data in a lawsuit against the healthcare provider. Additionally, since CBE only records variance or exceptions from the norm, it eliminates the need for narrative data, which poses future liability risks. Moreover, time and money budgeting is done on estimates, thus the risk of cost overruns (Jaffe, 2011). Of the four stages, the actual implementation takes the longest time.

The Doing it stage involves carrying out the activities according to plan (Park and Meier, 2007). This stage involves training the nurses on how to use CBE. After training, nurses gather all the standard CBE forms in a specific location. Using a CBE checklist, nurses read each of the patient notations according to the institutions charting protocol and mark against the checklist where patient data matches the existing charting protocol. Any variances noted are recorded in narrative form and entered into the system.

A resident physician is notified (Jaffe, 2011). Within the process, nurses also record the progress and challenges. Such records provide valuable feedback to the project manager. With the information provided from the feedback report, the manager leads the project management team in making a thorough review on the success of the project.

The purpose of conducting a thorough review is to identify opportunities for improvement. Adjustments are made to the systems design. This provides the manager with a system fully designed to serve the unique needs of the particular healthcare institution (Park and Meier, 2007). The system is thus ready for delivery. The delivery stage is the final phase of the project. This stage mainly involves measuring the actual outcomes against the initial objectives. The usefulness of the products is evaluated against the previous products. Thus, the manager tests whether CBE enables nurses to reduce documentation time, and whether errors and omissions are reduced.

The success of the products is determined by evaluating the extent at which CBE improves decision making regarding patients care. Additionally, managers evaluates whether the time saved is spent providing patient care (Park and Meier, 2007; Jaffe, 2011).


Despite the fact that computer charting is not a new concept, new trends in information management require healthcare providers to constantly evaluate the usefulness of existing information management tools. Since traditional methods of computer charting fail to address the concept of efficient time management, CBE seems relevant especially for tertiary healthcare providers.

Implementation of CBE is a complicated project, but the 4 D project management model significantly simplifies the process of implementation. Despite the numerous risks associated with CBE, the system accrues numerous benefits to tertiary healthcare providers. Most significantly, the system increases time available for nurses to provide care to patients, minimize errors thus enhancing decision making.

Reference List

Fischer, M. (2005). 4D Modeling: Applications and benefits. Retrieved from http://www.virtualbuilders.

org/VBR_Presentations/Martin_Introduction.pdf Harrison, B. (2003).

Becoming familiar with computerized charting. Retrieved from http://healthcaretraveler.modernmedicine.com/healthcaretraveler/article/articleDe tail.

jsp?id=65825 Huff, C. (2004). Off the Chart? Retrieved from http://news.nurse.com/apps/pbcs.

dll/article?AID=2004401010304 Jaffe, S. (2011). Nursing practice & skill.

Retrieved from http://atlantis.mendocino.edu/nursing/N%20126/charting%20JAFFE%202011.pdf Keenan, G., Yakel, E., Tschannen, D. and Mandeville, M. (n.

d.). Chapter 49. Documentation and the nurse care planning process.

Retrieved from http://www.ahrq.gov/qual/nurseshdbk/docs/KeenanG_DNCPP.pdf Park, B.

and Meier, R. (2007). Reality-based construction project management: constraint-based 4D simulation environment. Journal of Industrial Technology 23(1)

Categories: Decision Making


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