EHRs can support and revolutionize the way information is used to provide high quality and safe patient care. At the same time, issues with workflow integration have contributed to slow rates of EHR adoption in some settings such as in ambulatory outpatient care.
In response to workflow integration challenges with EHRs, clinicians often develop workarounds to complete clinical tasks in ways other than the system designers intended. For example, a frequent workaround is copying and pasting text from a previous progress note for a patient to serve as a draft for the current progress note.
The National Institute of Standards and Technology (NIST) recently published the report “Integrating EHRs into Clinical Workflow: An Application of Human Factors Modeling Methods to Ambulatory Care”.
Some of the suggestions to improve workflow are to:
- Provide at-a-glance overview displays to enable physicians to adapt patient schedules to smooth out predicted workloads
- Assist in remembering tasks to accomplish during a subsequent patient visit
- Provide summarized laboratory results
- Provide ways to draft predicted orders a day before a patient’s visit to save time
- Support moving from the initial working diagnoses to a formal diagnoses
- Support dropping or delaying tasks under high workload conditions
- Support communications with specialist physicians on referrals and consultations
- Help track consults and laboratory results
The report’s recommendations targeted to EHR developers and outpatient care centers would improve workflow integration with EHRs, allow for better eye contact between the physician and patient, improve physician’s information workflow, and reduce alert fatigue.
Also, these recommendations point the way towards a “Patient Visit Management System” that would incorporate broader methods to support workload management and the flexible flow of patients and tasks.
Go to http://NVLpubs.nist.gov/nistpubs/ir/2014/NIST.IR.7988pdf to view the report (NISTIR 7988).