The Monstrous Electronic Health Record

Situation:

An Electronic Health record (EHR) might be the most hated thing in a hospital by doctors and nurses.

Background:

Since 2011, most doctors and nurses have had to excruciatingly embrace and live through the implementation of these monstrosities in their places of employment

Assessment:

Time consuming data entry results into a million clicks a day.

User interfaces that do not match clinical workflow meaning you may need to enter home medications before addressing the chest pain

Interference with face-to-face interaction adversely affecting the therapeutic relationship.

Insufficient health information exchange meaning if you go to another hospital across the street, your records will more than likely not be available there. In other cases the emergency room does not share information with the inpatient units.

Information overload that cause the doctor to get more warnings about drug to drug interactions million times a day causing alert fatigue.  Eventually they just click through them like an obstacle course.

Mismatch between (the Government and regulatory expectations) and clinical practice. This gap forces the doctor to do seemingly unnecessary busy work for compliance purposes only.

EHR’s are not cheap to purchase and implement. ¬†They cause a disruption in workflow and decrease staff productivity in the short term which also impacts the bottom line.

Template based one size fits all notes degrade the quality of clinical documentation producing long low quality non focused notes that do not serve other clinicians well.

Recommendation:

EHR’s will not fix workflow and practice issues, congruence is needed between workflow and the EHR

An EHR is a piece of technology and only works as well as the users use it properly and as intended.

Ongoing education to fill in the gaps of new hires and under utilized skills

Policies must support workflow and jive with the EHR, keeping policies updated will keep you compliant

Patients expect seamless technology to enable seamless transition of care, the surveys will be affected otherwise.

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