Ambulatory IT shows 'adverse impacts on workflow'

'A number of work and workflow processes were altered after the health IT implementations'
By Mike Miliard
11:15 AM
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A new study from AHRQ examines "sociotechnical factors and the role they play in mitigating or augmenting health IT’s impacts on workflow." The effect on outpatient settings, it finds, is not always a good one.

The report, "Examining the Relationship Between Health IT and Ambulatory Care Workflow Redesign," examines the relation between technology implementation and ambulatory workflow, with a focus on how that might be magnified by various "disruptive events."

[See also: House draft budget would eliminate AHRQ]

AHRQ took a look at six practices from two participating healthcare organizations, three each on the East and West coasts.

"Organization West" rolled out a so-called "clinical advancement project" – including computerized provider order entry, e-prescribing, an electronic homepage, a standardized message center – to an existing electronic health record.

"Organization East" launched a new EHR to replace its locally-developed system.

Researchers then closely observed workflow at multiple data collection points before, during and after the implementations.

"The empirical research was conducted using a mixed methods approach consisting of ethnographic observations, time and motion observations, log analysis, semi-structured interviews and member checking focus groups," according to AHRQ.

"Ethnographic observations were used to delineate the overall characteristics of clinical work processes and workflow. Time and motion observations were used to quantify healthcare workers' time expenditures on different clinical activities, in addition to the sequence of task execution and frequency of interruptions.

"The log analysis used computer-recorded audit trails to reconstruct certain parts of clinical workflow to provide insights that could not be obtained using the time and motion data."

Meanwhile, "attitudes and perceptions" clinicians, staff, IT personnel and executives were gauged with a series of interviews and focus groups.

"A number of work and workflow processes were altered after the health IT implementations," according to the report. "These included a redistribution of clinicians' and clinic staff's time on different clinical tasks, repurposed usage of workspace, increased level of interruptions, multitasking and off-hours work activities."

This was thanks largely to two new realities, according to AHRQ: increased structured documentation requirements and new responsibilities for team members who found themselves serving different clinical roles.

While the new IT produced benefits such as less reliance on paper and more efficient aggregation and availability of patient data, "the results also show that  health IT was associated with adverse impacts on workflow at some study sites," according to the report.

These included "IT-induced workflow blocks that required circumventing workarounds and caused end-user dissatisfaction."

Read the full report here.