The EHR makes you work harder
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https://news.illinois.edu/view/6367/1783163011
A study at two urgent care clinics found that adopting a new electronic health records system doubled the amount of cognitive effort health care workers expended to perform their work during the first six months after implementation.
The increase in cognitive workload also persisted for at least 30 months, the researchers found. The team reported its findings in a study published in the journal Applied Ergonomics.
In a collaborative study with Carle Health Systems in Urbana, Illinois, researchers examined how the urgent care clinics’ transition to the new EHR system affected staff members’ workloads as well as their perceptions of the old and new systems’ usability.
“What we found surprised us a little,” said the study’s first author, Karen Dunn Lopez, the director of the Center for Nursing Classification and Clinical Effectiveness at the University of Iowa. “After two and a half years of continuous use, clinicians’ cognitive workload remained very high, and they still found the new EHR system more difficult to use than the prior paper- and computer-based hybrid system.”
With the hybrid system, clinicians used paper forms for tasks such as prescribing, writing clinical notes and medical orders. Seldom used while delivering patient care, the computer system then was primarily a repository for doctors’ notes after they were dictated and transcribed, and for documents that were scanned and uploaded after seeing the patients, said co-author Daniel G. Morrow, an educational psychology professor at the University of Illinois Urbana-Champaign.
A couple of asides.
First of all, I went to see my (new) doc last week for my annual physical. She looked at the computer screen more than at me, at least when there was anything medical in the discussion. She did a "review of systems," a systematic list of questions asking about everything from headaches to bowel movements. The "ROS" is a good way to get a general assessment of the patient before focusing on specifics. "Back in the day," when I did a ROS, I had to, basically, memorize the questions I'd ask, going from one body system to another. I remarked to her how she could just read the questions off a computer screen, simplifying the process, and check the appropriate boxes. I would have to remember the answers the patient gave and then summarize in my admission note. Subjectively, it seemed like that summarization gave me a better feel for the patient, rather then a series of check-boxes.
Secondly, when our place went to EHR, there was no question that it was more time-consuming and frustrating than it was in the past. I've griped about how many clicks it takes to order a medication, find a lab result, etc. It took more time, it was less efficient, and much more annoying. For the bean-counters, it was a bonanza, but for the bean-pushers, it was a pain in the ass.
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https://news.illinois.edu/view/6367/1783163011
A study at two urgent care clinics found that adopting a new electronic health records system doubled the amount of cognitive effort health care workers expended to perform their work during the first six months after implementation.
The increase in cognitive workload also persisted for at least 30 months, the researchers found. The team reported its findings in a study published in the journal Applied Ergonomics.
In a collaborative study with Carle Health Systems in Urbana, Illinois, researchers examined how the urgent care clinics’ transition to the new EHR system affected staff members’ workloads as well as their perceptions of the old and new systems’ usability.
“What we found surprised us a little,” said the study’s first author, Karen Dunn Lopez, the director of the Center for Nursing Classification and Clinical Effectiveness at the University of Iowa. “After two and a half years of continuous use, clinicians’ cognitive workload remained very high, and they still found the new EHR system more difficult to use than the prior paper- and computer-based hybrid system.”
With the hybrid system, clinicians used paper forms for tasks such as prescribing, writing clinical notes and medical orders. Seldom used while delivering patient care, the computer system then was primarily a repository for doctors’ notes after they were dictated and transcribed, and for documents that were scanned and uploaded after seeing the patients, said co-author Daniel G. Morrow, an educational psychology professor at the University of Illinois Urbana-Champaign.
A couple of asides.
First of all, I went to see my (new) doc last week for my annual physical. She looked at the computer screen more than at me, at least when there was anything medical in the discussion. She did a "review of systems," a systematic list of questions asking about everything from headaches to bowel movements. The "ROS" is a good way to get a general assessment of the patient before focusing on specifics. "Back in the day," when I did a ROS, I had to, basically, memorize the questions I'd ask, going from one body system to another. I remarked to her how she could just read the questions off a computer screen, simplifying the process, and check the appropriate boxes. I would have to remember the answers the patient gave and then summarize in my admission note. Subjectively, it seemed like that summarization gave me a better feel for the patient, rather then a series of check-boxes.
Secondly, when our place went to EHR, there was no question that it was more time-consuming and frustrating than it was in the past. I've griped about how many clicks it takes to order a medication, find a lab result, etc. It took more time, it was less efficient, and much more annoying. For the bean-counters, it was a bonanza, but for the bean-pushers, it was a pain in the ass.
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My in-laws went in for wellness visits yesterday. For the practice, it was their third day on EPIC.
It was an absolute nightmare.
I know their doc well, I went to school with him. He was a single-horse practice for many years, before an aging patient population and economics forced him into working for one of the larger hospital satellite clinics.
Yesterday was the type day to make him consider retirement.
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My in-laws went in for wellness visits yesterday. For the practice, it was their third day on EPIC.
It was an absolute nightmare.
I know their doc well, I went to school with him. He was a single-horse practice for many years, before an aging patient population and economics forced him into working for one of the larger hospital satellite clinics.
Yesterday was the type day to make him consider retirement.
@jolly said in The EHR makes you work harder:
Yesterday was the type day to make him consider retirement.
I used to work with a neurosurgeon who was so opposed to it that, when his primary hospital instituted it, he left for another place. Of course, that other place followed suit within a couple of years.
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My daughter's currently doing an AP project for high school covering GP burnout. She's interviewed a number of doctors around the country, and they've all said the EHR is a nightmare.
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Also posted on TONCR:
I was putting in orders the other day.
I used to do this:
Grab chart, open to "orders".
Find pre-printed order sheet.
Sign.
Hand chart to unit secretary.
Now, I do this:
Sign into computer.
Launch appropriate program (Surginet).
Find patient, click on name.
Go to "power orders".
Click on "my favorites"
Find "George's Postop orders".
Click on "add".
Click on "orders for signature".
Click on "sign"
Click on "initiate"
Refresh screen.
Exit Patient chart.
Close application.
Log out of computer.
Don't get me started on what happens if there's a drug "allergy" - like nausea from codeine. I have to INDIVIDUALLY authorize EVERY single narcotic because of "treatment plan requirement.
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Good lessons for all the self serve software coming our way.
It’s just unexpected that docs were the pioneers. It’s coming to all of us.
@loki said in The EHR makes you work harder:
Good lessons for all the self serve software coming our way.
It’s just unexpected that docs were the pioneers. It’s coming to all of us.
None of this is particularly surprising. My entire life as a technical engineering manager is governed by the software environment I work in. I spend most of my life feeding the beast.
I used to do technical reviews by getting out engineering drawings and occasionally even talking to people.
I suspect the main reason we hear about it so much for doctors is that they're the most highly qualified people that the general public see on a regular basis.
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I'd like to find out who wrote Microsoft Dynamics and Workday and touch them all over so they couldn't have babies.
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@loki said in The EHR makes you work harder:
Good lessons for all the self serve software coming our way.
It’s just unexpected that docs were the pioneers. It’s coming to all of us.
None of this is particularly surprising. My entire life as a technical engineering manager is governed by the software environment I work in. I spend most of my life feeding the beast.
I used to do technical reviews by getting out engineering drawings and occasionally even talking to people.
I suspect the main reason we hear about it so much for doctors is that they're the most highly qualified people that the general public see on a regular basis.
@doctor-phibes said in The EHR makes you work harder:
@loki said in The EHR makes you work harder:
Good lessons for all the self serve software coming our way.
It’s just unexpected that docs were the pioneers. It’s coming to all of us.
None of this is particularly surprising. My entire life as a technical engineering manager is governed by the software environment I work in. I spend most of my life feeding the beast.
I used to do technical reviews by getting out engineering drawings and occasionally even talking to people.
I suspect the main reason we hear about it so much for doctors is that they're the most highly qualified people that the general public see on a regular basis.
You are correct. The train has left the station. It’s really important to be digitally savvy or you will be left behind. It’s hard because of the speed of updates and upgrades and staying current. The digital divide is coming on strong and being old is a risk factor.
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The problem is that the vast majority of data collected by all this effort is worthless. It is still difficult for physicians to see patient records from other health systems, and most would not if they could...only in really difficult situations is it of potential value.
Hell, when I was in the hospital for the leg infection in 2019 I could tell the majority of hospitalists had not even read my chart that was right there.
No, all this effort is about bean counting for the gummint.
“I am fond of pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.” ~Winston S. Churchill
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I should have designed one. It would actually work well and efficiently. I would also be a billionaire. lol
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The problem is that the vast majority of data collected by all this effort is worthless. It is still difficult for physicians to see patient records from other health systems, and most would not if they could...only in really difficult situations is it of potential value.
Hell, when I was in the hospital for the leg infection in 2019 I could tell the majority of hospitalists had not even read my chart that was right there.
No, all this effort is about bean counting for the gummint.
@mik said in The EHR makes you work harder:
The problem is that the vast majority of data collected by all this effort is worthless. It is still difficult for physicians to see patient records from other health systems, and most would not if they could...only in really difficult situations is it of potential value.
Hell, when I was in the hospital for the leg infection in 2019 I could tell the majority of hospitalists had not even read my chart that was right there.
No, all this effort is about bean counting for the gummint.
Preach on, brother!
Mr. Obama gave us a fuckin'. And surprisingly, I think he meant well. He just listened to a lot of people that didn't have a clue how front line medicine works.
