a. When a healthcare IT system impedes workflow, it becomes a major hindrance to efficiency and satisfaction. An EHR should naturally and smoothly integrate into the time-honored workflow of a facility, not the other way around.
b. Therefore, changing workflow for the convenience of the electronic record, for billing, for data collection, while ignoring the working process of the providers is an obvious misstep.
2. Training that never ends.
a. When a product is not user-friendly and needs multiple classes to teach the provider to navigate through the mess, one has a built-in disaster.
b. In such situations, the interface is not naturally intuitive, and most providers will have to relearn the entire process after a two-week vacation.
c. One would think that the American Heart Association’s experience with poor retention after CPR classes would have demonstrated that easier is better.
d. Lots of visual prompts work better than lots of training and re-training. CPR has been changed to “push on the chest”, defibrillate if possible, and call 911.
e. Success rates improve with simplicity. Providers agree that most EHRs need to simplify or provide real-time guidance through prompts and orderly flow.
3. Finding the Information
a. There is lots of relevant but buried data in the E HR. But it sits underneath layers in very separate silos. These take significant know-how and effort to access.
b. It has been noted that finding a key nursing note can be so onerous that the provider gets burned out on the process and when writing WNL actually means “WE NEVER LOOKED”.
4. Alert fatigue is a dangerous issue.
a. Warnings and alerts especially in Computerized Provider Order Entry (CPOE) modules wear the provider out psychologically.
b. Not uncommonly, risk adverse programming triggers these bells and whistles. Workflow takes a serious hit when the alarms are always going off.
5. Myths: Bigger is Better; more words are better than a few.
a. Ask any provider to point out relevant information from a 17 page document and find out what otherwise obvious key data points are only recognized after a problem comes to light.
b. The retrospectoscope is a more functional modifier of workflow when it is viewing just a compact presentation and report.
6. Call for a National Data Base
a. The lack of interoperability and lack of poor, difficult to obtain, communication remains a huge problem. One proffered solution is a National-Data-Base that every E HR vendor uses as its’ clinical data repository.
b. In that way, any provider could see a problem list, test, treatments, hospitalization, and medications in a real-time basis. Key elements from every encounter would automatically flow into the data base. Pharmacies could also list all prescriptions filled with dates, times, refills etc. The provider would know if the patient is actually filling their prescriptions and what other providers are writing for that patient.
c. Its implementation, at least in theory would enable the EH R vendor to concentrate on workflow, navigation, and simplification.
d. A national CPOE that could be locally modified according to clinical settings could massively improve efficiency.
e. What a benefit it would be for all if there were common interfaces between EHRs . Providers would not have to learn multiple systems. But, no, vendors tend to be in favor of non-standardized interfaces.
f. When is the last time you tried to pay for groceries with a card swipe that worked the same as the one you used at the store down the block. Never happened. Never will.
g. If cross-system standardization a fundamental goal, a national data base and national CPOE effort might actually work. With agreed upon standards, across the healthcare IT industry, the money that was spent on meaningful could possibly have created some actual clinical value. But no. We need to have it different on the first floor than on the third; different on this street, than on the next; different in this city than in another. Back to the drawing board.