Workarounds are 'pervasive': Study finds EHR usability issues at an academic medical center

Researchers observed how medical teams in a New England-based academic medical center used their EHR and found significant challenges with functionality and workflow, potentially putting patients at risk.

"Gaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues," researchers wrote in their study, published Feb. 25 in PLOS One. "These issues pose a threat to patient safety and quality of care." 

Researchers used a "mixed-method" approach to gauge how well EHRs were meeting the needs of clinicians at an unnamed teaching hospital. To help address the small sample size, the researchers used both quantitative and qualitive methods that involved observing care teams during morning rounds, interviews with clinicians and an electronic survey. All clinicians who participated in the study had at least 2.5 years of experience with the teaching facility's current EHR, which was new as of May 2015.

Four key takeaways:

1. The way care teams used the EHR varied widely. Variation was observed in who uses the EHR, when they use it and what device — tablet, smartphone or computer — was used to access it.

2. Workarounds are "pervasive." Some observed workarounds included hand-writing, emails, phone calls and verbal discussion. Many clinicians preferred to hand-write notes because it was easier to process and remember the information that way. Clinicians also printed patient summary reports and took notes on them by hand during rounds.

 "[T]he extensive use of handwriting as well as other observed workarounds pose a threat to quality of care and patient safety, as they could potentially cause overlooking important information and result in lack of synchronization between care team members," the researchers wrote.

3. The care team typically shared EHR information before entering the patient room. If the EHR was used during the visit, visually sharing the screen was rare, and it often kept the clinician using the computer from facing the rest of the care team. Clinicians said they felt if a teammate was using the computer, they were more focused on the screen than on communicating with the rest of the care team.

However, when surveyed about using the EHR during rounds and whether the tool interrupted communication within the care team, most respondents said "never" or "sometimes."

4. EHR system design did not support workflow. Most clinicians responded in the survey that EHRs were useful "most of the time" or "always" to keep care teams on the same page, but anecdotally told researchers about frustrations with workflow. One attending physician said they often called their two residents at night to give verbal updates rather than use handoff features. Another said the way the information was presented in the software made it difficult to find what they needed.


More articles on EHRs:

Kaleida Health rolls out 1st features of new $125M Cerner EHR
VA officials defend pace of progress on $16B Cerner EHR conversion
Flatiron, FDA extend cancer data research collaboration  

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