When Technology Owns You Meaningless Use of Health IT
The following scenario comes from Health Information Technology
(HIT) incidents reported to CHPSO:
Our hospital purchased an Electronic Health Record (EHR) two
years ago. We hired a consulting firm to rapidly roll out the
software and, within two months, the hospital went live on the
new EHR. We didn’t have much training and many clinicians were
left guessing where to type in notes or enter vitals. An incident
occurred where laboratory data was displayed in with oldest value
at the top as opposed to reverse chronological order. A patient
did not receive a statin because the most recent cholesterol test
result was listed at the bottom of the screen. The physician only
reviewed the results that were at the top of the screen.
These problems could have been prevented if clinicians – the
daily users of the EHR – were involved in both the system
development and the implementation process. Clinicians were
spending too much of their valuable and costly time navigating
through the EHR that had been implemented without thorough review
of workflows in that hospital.
A 2014 JAMA survey shows it, too. On average, 48 minutes are lost
to EHR use each day. In a five-day workweek, this translates to
four hours, or half of a workday, inputting data into a computer
instead of providing patients with more attention and care.
Technology, in this case, is a tool that fails to function
efficiently, and steals time from both clinicians and patients.
As more health care facilities implement EHRs or other software,
technology will constitute a significant part of the daily
routine for more clinicians. “We will never make fundamental
improvements in our system without the thoughtful use of
technology,” says Dr. Robert Wachter, professor of Medicine at
UCSF in a recent NYTimes article. “Despite the problems [with
current implementations], the evidence shows that care is better
and safer with computers than without them.”
The SAFER guides (Safety
Assurance Factors for
EHR Resilience), issued by the
Office of the National Coordinator for Health Information
Technology (ONC), includes a
section on Organizational Responsibilities detailing steps to
include appropriate clinician involvement. CHPSO was one of the
organizations asked by the ONC to review the guides. Examples of
the recommended practices are:
Practicing clinicians are involved in all levels of EHR
safety-related decision making that impact clinical use.
Workflow analysis to map how work is actually done is
EHR training and support are assessed regularly to optimize
complete and safe use of the EHR.
Clinical staff is assigned responsibility for ensuring that
CDS content, such as alerts and protocols, supports effective
clinical workflow in all practice settings.
Communication mechanisms ensure that EHR users learn of EHR
changes promptly, and users are able to give feedback on related
Clinicians are in a unique position to understand the
capabilities of EHRs and it is crucial for these daily users to
take part in implementation discussions or conversations on areas
of improvement. The scale at which clinicians can champion the
success of an EHR will ensure buy-in from the organization and
more importantly, help improve patient care.