EHR challenges, information overload often lead to staff workarounds
While the benefits of electronic health records have been widely touted, and EHRs are now ubiquitous across hospitals in the United States, a study of a major teaching hospital in New England indicated care teams commonly use EHR shortcuts and workarounds – potentially impacting quality and safety.
WHY IT MATTERS
The report, published in peer-reviewed science journal PLOS One, found that EHRs are not used for information sharing and frequently impede intra-care team communication, while also revealing a high degree of variance in the ways care teams use EHRs during morning rounds.
Through a series of interviews, and an electronic survey of hospital clinicians, the researchers found care teams "pervasively" used workarounds at critical points of care.
Some workarounds, such as handwritten notes were used as a cognitive aid for clinicians, while others were used due to lack of system support, the report noted.
In order to compile evidence, researchers observed care teams during their morning rounds, taking structured notes to record EHR use before entering the patient's room, in the patient's room and after leaving the room.
Items for observation included which care team clinicians used the EHR, the device used to access the system, its functional use in the room and use of printouts in the patient's room.
The study, led by Harvard University's Shiri Assis-Hassid, revealed a lack of standardized workflows, workarounds, team communication challenges and system usability issues as among the major challenges of utilizing and maintaining an EHR system.
The study said possible solutions would need to include improvements in EHR design, care team training and changes to the hospital room setting, and noted many challenges remain to effective EHR use, including prolonged documentation time, usability difficulties and low user satisfaction.
In addition, health systems should different ways of visualizing data to prevent information overload and make the system easy to use in real time in the patient's room, researchers said. The report also pointed to a need to better integrate mobile devices that are easy to carry around between different floors/units in the hospital.
Other solutions may involve the incorporation of handwriting recognition and using white boards or computer touch screens, placed on the wall facing the patient's bed, to project relevant data from the EHR and share it with the patient and care team.
When it comes to care team training, programs need to address how the EHR can be better integrated into the workflow in ways that do not impede team communication – especially during rounds – and promote EHR use for improving communication and information sharing between care team clinicians.
THE LARGER TREND
For years and years, physicians and nurses have been finding ways to make their EHR systems more tolerable to their own preferred workflows and busy daily schedules. But those shortcuts – such as copy-and-paste and the note bloat it creates – can come at a cost, potentially risking patient safety.
Recently, as the cost of clinician burnout and the burden of EHRs has become more apparent, many organizations are redoubling their efforts to improve the way these systems are designed and deployed, with the aim of improving user experience – and encouraging optimal usage.
ON THE RECORD
"Gaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues," the report noted. "These issues pose a threat to patient safety and quality of care.
"Although EHRs can improve healthcare quality and have done so in many ways, our findings show that there are many challenges in the current inpatient environment that need to be addressed if EHRs are to reach their full potential," the paper concluded.
Nathan Eddy is a healthcare and technology freelancer based in Berlin.
Email the writer: firstname.lastname@example.org
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