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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 conducted regularly. 
  • 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 safety concerns.

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.

References:

McDonald CJ et al. Use of Internist’s Free Time by Ambulatory Care Electronic Medical Record Systems. JAMA Intern Med. 2014;174(11):1860-1863.

SAFER guides: Safety Assurance Factors for EHR Resilience.

Wachter, Robert. “Why Health Care Tech is Still So Bad.” New York Times. 21 March 2015.

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