News: Clinicians’ EHR workarounds pose patient safety and quality risk, study finds

According to a new study published in PLOS One, hospital care teams frequently use handwritten notes and verbal comments to communicate patient information in order to bypass design and usability issues in their electronic health record (EHR) system. This practice, however, can pose a major threat to patient safety and quality of care, FierceHealthcare reported.

The study also found a high degree of variance in how clinicians use EHRs during their morning rounds. Most, according to the study, used the EHR before entering patients’ rooms, but only sometimes while they were in the room with the patient. Only about half of attending physicians, residents, interns, and physician assistants use the EHR after leaving the patient’s room, FierceHealthcare reported.

“If the information was presented in a more user-friendly way, then maybe we can have it up. I don't have to be as focused on trying to find a piece of information that I need to progress the patient's care,” one attending said, according to the researchers.

Clinician workarounds could be a problem, according to the researchers, because clinicians could potentially overlook important information that could result in a lack of synchronization between care team members.

“When the EHR is not used in the room, patients’ data is not necessarily accurate,” lead researcher Shiri Assis Hassid told FierceHealthcare. “What we saw is that the care team prints out the patient summary report, at the beginning of morning rounds, and some information, such as test results, are not necessarily updated by the time they get to the patient’s room; they don’t have the most recent information.”

To address EHR usability challenges and hopefully eliminate these provider workarounds, the researchers recommend three changes:

• EHR design changes and interface improvement: Consider different ways to visualize data to prevent information overload and make the system easier to use in real time in the patient’s room. Also, better integrate EHR systems for mobile devices that can be carried from floor to floor and integrate complementary tools that support clinicians’ needs and workflow.
• Hospital room adjustments and re-design: Possible approaches include whiteboards that allow projecting EHR data in the patient’s room and positioning the bedside computer so that it doesn’t require the clinician to turn his or her back toward other clinicians in the room and the patient.
• Care team training programs that consider EHR use during rounds: Programs need to address how the EHR can be better integrated into the workflow in ways that don’t impede communication and promote EHR use for improving communication and information sharing between clinicians.

Editor’s note: To read FierceHealthcare’s coverage of this story, click here. To read the study in its entirety, click here. For tips on how CDI can improve the EHR issues, read this article in the March/April 2019 edition of the CDI Journal.