Even the Best EHR Still Causes Pain

Paper is gone; there’s no going back. We’re all on electronic health record systems (cough, Epic) now, with all the corresponding frustrations and inefficiencies. Some have said, however, the blame lay not with the computer – but with the corporate giant whose leviathan was not designed to meet the needs of physicians in the Emergency Department, but rather support the larger hospital and primary-care enterprise. Unfortunately, as we see here, even a “custom” design doesn’t solve all the issues.

These authors report on their experience with their own homegrown system, eDoc, designed to replace their paper system, and built using feedback from health technology experts and their own emergency medicine clinicians. Their hypothesis, in this case, was that throughput would be maintained – ED length-of-stay as a proxy for operational efficiency. The interrupted time series analyses performed before-and-after the transition are rather messy, with various approaches and adjustments, including “coarsened exact matching”, but the outcome is consistent across all their models: the computer made things worse. The estimated difference per patient is small: about 6 additional minutes, but, as the authors note, in a mid-size ED handling about 165 patients a day, this adds 16 hours of additional boarding time – or the effect of shrinking your ED in size by up to 2/3rds of a room.

It is probably erroneous to simply blame “computers” as the culprit for our woes. Rather, it is the computer-as-vehicle for other onerous documentation requirements and regulatory flaming hoops. If the core function of the EHR were solely to meet the information and workflow needs of physicians, rather than the entire Christmas buffet of modern administrative and billing workflow, it is reasonable to expect a moderation in the level of suffering.

But, I think that ship has sailed.

“A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency”

https://www.ncbi.nlm.nih.gov/pubmed/28712608

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