Reducing Misses and Near Misses Related to Multitasking on the Electronic Health Record: Observational Study and Qualitative Analysis

Abstract

BackgroundClinicians’ use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians’ EHR workload, stress, and burnout.ObjectiveWe aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems.MethodsThis observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with “misses” (errors that were not caught at the time) or “near misses” (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes.ResultsAll workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about “misses we don’t even know about.” Risk factors included the computer’s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems.ConclusionsCME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

Nurses’ experiences and viewpoints about the benefits of adopting information technology in health care: a qualitative study in Iran

“…Other studies have also reported that IT adoption increases the quality of patient care and improves the standards in healthcare organizations [ 6 ] by supporting clinicians in making clinical decisions efficiently [ 22 – 24 ]. Moreover, it reduces the risk of making errors by decreasing the clinicians’ cognitive workload, synthesizing and organizing information in accessible and usable formats [ 25 ]. IT improves providers’ performance by reducing delays in care at the time of shift change and maintains continuity of care [ 23 ].…”

“…In the present study, “facilitating the communication management in the technological environment” along with its subcategories was identified as another perceived benefit for IT. Similarly, two studies maintained that IT improved communication between/among wards and staff [ 23 , 27 ], teamwork and team support [ 25 ]. A systematic review on this topic reported several themes, including the impact of EHR on information exchange between patients and clinicians; maintaining positive relationships, and partnering with patients; and the EHR as an amplifier of existing communication behaviors [ 28 ].…”

“…IT has increased access to resources and educational content at any time and place, saved time and cost and created more opportunities to learn different ways and improve the quality of education and standard of nurses training [ 1 , 17 , 37 ]. Another study found that the adoption of IT by healthcare providers contributed to gradual system evolution [ 34 ], improved EHR design [ 25 ], and stimulated users to add useful functions to the system [ 38 ]. In a study by Zakane et al nurses argued that the application of a clinical decision support system increased their knowledge, and these systems could be used as continuous training for nurses [ 39 ].…”

Data-Driven Scheduling for Improving Patient Efficiency in Ophthalmology Clinics

“…[9][10][11] Without approaches to manage these pressures, the situation may become untenable and result in decreased quality of care and physician burnout. 12,13 Reducing clinic inefficiencies can help physicians manage these pressures. For example, ophthalmology clinics generally maximize efficiency by using multiple exam rooms and ancillary staff, so that patients are examined during multiple stages (e.g., before and after dilation of eyes, before and after ophthalmic imaging studies).…”

Finding Meaning in Medication Reconciliation Using Electronic Health Records: Qualitative Analysis in Safety Net Primary and Specialty Care

“…Meanwhile, multitasking EHR use comprised almost half of medication reconciliation time, a higher proportion of time than in the visits as a whole [ 17 ]. Many clinicians may not believe they are multitasking when updating the EHR medication list while talking to patients because both tasks are concordant with the goals of reconciling medications [ 36 ]. However, research in cognitive psychology suggests that the act of reading or entering computer data while listening or talking with another person may increase both the risk of errors and the time required to complete each task [ 16 ].…”