'Paper-based paradigm' of computerized provider documentation problematic

Researchers say such tools often are seen as outdated by providers, lead to 'unintended consequences'
Tools

While computerized provider documentation has "dramatically changed documentation processes" for many healthcare professionals, it also often fails to meet user needs, as it is based on what researchers--publishing online this week in the Journal of the American Medical Informatics Association--call an "outdated paradigm."

For the study, researchers--led by Peter Embi of the Departments of Biomedical Informatics and Medicine at The Ohio State University--conducted 14 focus groups at five Department of Veterans Affairs sites. Fifty-four doctors or practitioners, 34 nurses and 37 administrators participated in the focus groups, which determined that confusion about a writer's intent often was a problem among CPD users.

"As with many such systems, the VA's CPD system was modeled after an electronic version of a paper-based medical record," the researchers said. "While understandable, the persistence of this paper-based paradigm as the basis for CPD capabilities and activities seems to have contributed to numerous problems and unintended consequences."

An additional problem--one of many, according to the researchers--included control and limitations of expressivity. One physician participating in the research went so far as to call it "a huge problem," adding that if a user is trying to fill out a consult, the CPD does not allow for that user to exit to view other information that might be necessary to the consult. "You cannot scroll around in your own note," the physician said.

"Tension between the perspectives of clinicians and administrators was especially evident in discussions of control functionality inherent in the CPD system," the researchers wrote. "In general, the administrative group valued the completeness afforded by templates, while the practitioner and nurse groups complained that while templates could help facilitate documentation, restrictive templates generated less informative documentation than free text."

At the American Medical Informatics Association's annual symposium in Chicago last November, Embi and his colleagues conducted a panel discussion focusing on the impact and implications of CPD on healthcare practice, quality and research in the era of Meaningful Use. Embi, in particular, talked about the necessity of formal CPD training for providers, and how it could help them to meet Meaningful Use for the implementation of electronic health records.

Usability also has been documented as a concern among providers for computerized physician order entry systems, in which providers enter instructions for the treatment of their patients; CPD enables the electronic recording a patient's history, clinical situation and plan of care.

To learn more:
- here's the JAMIA study
- here's the panel discussion abstract

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