Provider workflow suffers after poor EHR implementation process

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While one intention of electronic health record implementation is to improve provider workflow, that was hardly the case for pair of southern California hospitals, Medscape Medical News reported.

In fact, EHR implementation had the exact opposite effect for residents at both Riverside County Regional Medical Center in Moreno, Calif., and Pomona Valley Hospital Medical Center in Pomona, Calif.; it increased the average time of residents for seeing patients and charting the visits from 21 minutes to 37 minutes.

"Some of us were really excited. We thought it would improve patient care," Maisara Rahman, M.D., who helps to train family-medicine residents at Riverside County, said during a talk at the American Academy of Family Physicians' annual meeting in San Diego in September, according to Medscape. "But when implementation started, we saw inefficiencies."

Rahman said the workflow issues became so bad that residents who were supposed to be attending her lectures instead were skipping out to give themselves more time to document patient encounters in the hospital's EHR. She blamed the charting issues on several factors, including use of old software that required users to jump from screen to screen to write basic notes, a slow server and poor training.

Seven of 10 residents at Riverside received less than five hours of training, according to Rahman, who said that--not coincidentally--the same number of residents reported receiving subpar training.

Research published from the Johns Hopkins University School of Medicine in April in the Journal of General Internal Medicine concluded that doctors spend too much time behind computers, and not enough time at their patients' bedsides. The researchers said they thought that better-designed electronic health record systems could help reduce time looking for patient histories.

Meanwhile, a study of leaders at the Department of Veterans Affairs published in April in the Journal of the American Medical Informatics Association concluded that the "next generation" of EHR systems needs to improve integration of information and space, and must move beyond the concept of serving simply as computerized paper charts.

In June, registered nurses at Affinity Medical Center in Massillon, Ohio called for a delay on the go-live of their hospital's EHR system, citing insufficient training.

To learn more:
- read the Medscape Medical News article (registration required)

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