Emergency Physicians' Perceived Influence of EHR Use on Clinical Workflow and Performance Metrics

Denton, Courtney A.; Soni, Hiral; Kannampallil, Thomas; Serrichio, Anna; Shapiro, Jason S.; Traub, Stephen J.; Patel, Vimla L.

doi:10.1055/s-0038-1668553

Cited by 22 publications

(32 citation statements)

References 22 publications

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“…Better efficiency [18,20,22,25,[27][28][29]34,[41][42][43][44][45][48][49][50]59,66,67,71,85,109,112,115,116,147,151] Better communication [17,25,27,34,38,[42][43][44][45]50,56,85,110,134,155] More organized at work [20,28,38,42,56,91,110,119] Decreased workload [26,44] Support disease and quali...…”

Section: Positive Effectsmentioning

confidence: 99%

“…Poor communication [34,40,47,48,70,78,120] Dysfunctional workflow [29,38,44,45,47,61,73,89,91,[112][113][114][115]141,148] Data and information Data quality and accuracy [40,48,78,91,122,137,145] Decreased accessibility [39,40,43,70,106,126] Care for patients Face-to-face or direct communication [43,45,84,137] Quality of care [20,28,34,38,81,82,94,106,116,126,137,…”

Section: Theme Category Sub-category Referencementioning

confidence: 99%

“…However, altered workflow emerged as a negative effect [91,112,113,115] related to some of the issues mentioned above, such as poor integration of current workflows in EHRs, poor cross-organizational connectivity in EHRs and communication ambiguity [29,44,47]. Nurses reported the difference in workflow in line with how PHR communication was handled in the same clinic [141].…”

Section: Work Organization/workflowmentioning

confidence: 99%

“…Enhanced quality of care following EHR/PHR adoption was suggested [17,24,27,43,45,46,49,57,64,67,75,84,85,107,111,112,115,128,131,133,135,146,150,153]. A randomized trial suggested a significantly lower prevalence in all-cause 30-day readmissions in patients who adopted PHR as compared to non-adopters [88].…”

Section: Quality Of Carementioning

confidence: 99%

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Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Tsai

Eghdam

Davoody

et al. 2020

Life

117

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Despite the great advances in the field of electronic health records (EHRs) over the past 25 years, implementation and adoption challenges persist, and the benefits realized remain below expectations. This scoping review aimed to present current knowledge about the effects of EHR implementation and the barriers to EHR adoption and use. A literature search was conducted in PubMed, Web of Science, IEEE Xplore Digital Library and ACM Digital Library for studies published between January 2005 and May 2020. In total, 7641 studies were identified of which 142 met the criteria and attained the consensus of all researchers on inclusion. Most studies (n = 91) were published between 2017 and 2019 and 81 studies had the United States as the country of origin. Both positive and negative effects of EHR implementation were identified, relating to clinical work, data and information, patient care and economic impact. Resource constraints, poor/insufficient training and technical/educational support for users, as well as poor literacy and skills in technology were the identified barriers to adoption and use that occurred frequently. Although this review did not conduct a quality analysis of the included papers, the lack of uniformity in the use of EHR definitions and detailed contextual information concerning the study settings could be observed.

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Section: Positive Effectsmentioning

confidence: 99%

Section: Theme Category Sub-category Referencementioning

confidence: 99%

Section: Work Organization/workflowmentioning

confidence: 99%

Section: Quality Of Carementioning

confidence: 99%

See 2 more Smart Citations

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Tsai

Eghdam

Davoody

et al. 2020

Life

117

View full text Add to dashboard Cite

show abstract

“…7 However, literature suggests that the introduction of EHRs has not always considered the nature of work in the ED, resulting in transformed and suboptimal workflow leading to substantial frustrations with the systems. 8,9 In the United States, studies investigating the impact of EHRs on clinical workflows suggest that the docu-mentation has increased over the last decade, with 50 to 65% time spent on EHR-related activities. 6,[10][11][12] Unlike other settings, EDs are unable to regulate their volume and need to bolster efficiency during peak patient loads.…”

Section: Background and Significancementioning

confidence: 99%

Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

et al. 2021

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Objectives We characterize physician workflow in two distinctive emergency departments (ED). Physician practices mediated by electronic health records (EHR) are explored within the context of organizational complexity for the delivery of care. Methods Two urban clinical sites, including an academic teaching ED, were selected. Fourteen physicians were recruited. Overall, 62 hours of direct clinical observations were conducted characterizing clinical activities (EHR use, team communication, and patient care). Data were analyzed using qualitative open-coding techniques and descriptive statistics. Timeline belts were used to represent temporal events. Results At site 1, physicians, engaged in more team communication, followed by direct patient care. Although physicians spent 61% of their clinical time at workstations, only 25% was spent on the EHR, primarily for clinical documentation and review. Site 2 physicians engaged primarily in direct patient care spending 52% of their time at a workstation, and 31% dedicated to EHRs, focused on chart review. At site 1, physicians showed nonlinear complex workflow patterns with a greater frequency of multitasking and interruptions, resulting in workflow fragmentation. In comparison, at site 2, a less complex environment with a unique patient assignment system, resulting in a more linear workflow pattern. Conclusion The nature of the clinical practice and EHR-mediated workflow reflects the ED work practices. Physicians in more complex organizations may be less efficient because of the fragmented workflow. However, these effects can be mitigated by effort distribution through team communication, which affords inherent safety checks.

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Human-Computer Interaction, Usability, and Workflow

Patel

Kaufman

Kannampallil

2021

Biomedical Informatics

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Emergency Physicians' Perceived Influence of EHR Use on Clinical Workflow and Performance Metrics

Abstract: Physicians' perception of EHRs is likely to influence their practices. With negative perceptions of EHR usability problems, positive aspects of EHR use, including the influence on MU performance metrics, may be overridden.

Cited by 22 publications

References 22 publications

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

Physician Workflow in Two Distinctive Emergency Departments: An Observational Study

Human-Computer Interaction, Usability, and Workflow

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