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Acute on Chronic Electronic Health Records Dissatisfaction

The slideshow 6 Ways IT is Contributing to Healthcare Inefficiencies examines why there is general dissatisfaction with the Electronic Health Record.

Work-flow issues:

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.

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.

Finding the Information:

a. There is lots of relevant, yet buried data in the EHR. 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!

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.

Myths: Bigger is Better:

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.

Call for a National Database:

a. The lack of interoperability and lack of poor, difficult to obtain, communication remains a huge problem. One proffered solution is a National database that every EHR vendor uses as its' clinical data repository. in that way, any provider could see a problem list, test, treatments, hospitalization, and medications in real-time. Key elements from every encounter would automatically flow into the database. 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 the patient.

b. Its implementation, at least in theory would enable the EHR vendor to concentrate on workflow, navigation and simplification.

c. A national CPOE that could be locally modified according to the clinical settings could massively improve efficiency.

Xpress Technologies EHR, practice management, and billing has consistently concentrated on attempting to find solutions for these problems.


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