Hospitals utilize electronic health records (EHRs) with the goal of exchanging health information digitally to improve patient outcomes and provide high-quality patient care. However, many of the processes integrated into EHRs by institutions are used to maintain regulatory status and are counterproductive for the priority users.
Rather than improving quality patient care, EHRs contribute to poor workflow, lousy communication between interdisciplinary team members, and poor productivity due to their chaotic processes, duplicative work, and incessant notifications.
So why have IT companies who develop EHRs never developed them with the end-users (nurses and physicians) in mind?
Healthcare professionals should play a significant role in optimizing and developing the EHR platform to ensure the success of the product as well as to improve patient care.
The Advantages of EHRs
The importance of EHRs in health care are well known. The shift from paper charting and documentation to the new digital age has changed healthcare as we know it. HealthIT.gov lists the specific advantages of electronic health records, check them out:
- Enables providers to improve efficiency and meet their goals
- Reduces costs related to decreased paperwork
- Enables safer and reliable prescribing
- Promotes legible and complete documentation
- Enhances privacy and security of patient data
- Provides accurate and up to date information regarding patients and their point of care
- Enables quick access to patient care
Are the “Advantages” Being Utilized or Developed to their Full Potential?
Physicians make decisions regarding patient care and nurses deliver the care, so it only makes sense to include them in the development and optimization of EHRs, right?
I think so.
The EHRs in use today by thousands of facilities throughout the U.S. have excessive documentation and confusing processes for simple tasks such as locating patient charting information or duplicating files.
According to a journal article on Nurse Readiness and Electronic Health Records, studies have shown that EHR usage leads to an increased cognitive workload for nurses resulting in increased exhaustion and nursing burnout.
In surveys taken by both nurses and physicians, they state that their main complaint with EHR is the insufficient amount of time they have to complete tasks related to system alerts. One study revealed that for every eight hours of face-to-face patient care, physicians spent five hours completing screen-related charting.
EHRs should be created with those caring for the patients in mind.
Thoughts on Optimization from a Nurse’s Perspective
What would our patient outcomes be like if we spent more time with them rather than charting their assessments, accepting orders, and documenting the same information in multiple places?
Measures should be developed and optimized to be actionable, usable, transparent, and trustworthy. EHRs have the full potential to be efficient.
Many people can type information and checkboxes faster than they can write it by hand, and I am not discrediting that. However, the user must be confident in their ability to navigate the tool, which may require adequate training.
From my experience working as a nurse in a high-acuity ICU, I had many frustrations related to my charting system.
Let’s use ordering blood or TPA STAT as an example.
When your patient is crashing, and you call the pharmacy to have them send you blood or TPA STAT for your patient, what is their response?
“Is it on the computer?”
“I have to have an order, and I have to verify it.”
How long does that process take? Your patient could die while you are waiting for unnecessary steps to take place.
Processes like these are put in place for regulatory checklists and legality reasons; however, it takes away from human interaction and immediate, necessary interventions to save a patient’s life.
“Time-out” procedures are another great example.
Electronic charting of a time-out note requires multiple signatures and questions, potentially up to 10 of them. It creates a time restraint, added anxiety, and conflict between the team when the nurse is trying to chart, and the doctor is rushing to put a central line in to save the patient’s life.
Some of these processes try to standardize healthcare. What we must understand is that every patient is an individual and that these processes could be simplified to have the same result.
Too many nurses and physicians are burned out at the end of the day from various aspects of their roles in caring for patients. EHRs should exist to alleviate that burden, not add to it.
The development and optimization of EHR’s by IT companies who create and manage them should refine their processes and function with nurses and physicians in mind.
They should be a part of bringing workflow efficiency and simplification to the processes of documentation and providing quality patient care.