In this LinkedIn discussion about California Nurses Slamming Sutter’s Epic EHR, Cameron Collette offers some of the best real life examples of hospital workflows causing issues with an EHR system. Carmeron’s comments are a great extension to my previous post about EHR implementation finger pointing. There are plenty of fingers to go around.
Much of the complaints I have witnessed come from a basic flawed work flow that has been going on in many hospitals for a long time. This can often be compounded by EMRs that allow high levels of customization… thus “gamming the system” becomes the tail of the day and issues come to the surface rapidly.
For example, I was in one hospital some time ago where ED physicians were placing the admit orders for the admit physicians. This created an electronic signing issue due to the fact that the system was not designed to account for the ordering doctor to be different from the actual admit doctor. And… the system was correct. The practice was incorrect.
I have also been to places where a good deal of care was handed to the nursing staff and even expected by the physicians. For example, in one facility I recall it was totally common place for a physician to write up to 35 PRN medication orders. This was done so that the physicians could avoid getting a call. Effectively this forced the nursing staff into clinical decision making where the physician should have been more involved. However, nursing complained that the system took too much time as they had to input “all of these orders”. Interesting point to me was that they did not complain about being put into a position where if something was to wrong with the patient, they were clearly the point of blame.
Each place is different, but more often than not a work flow issue is the underlying problem. There are two work flows to note. First, the EMR system has been configured, or worse, architecturally designed, poorly. Legacy systems are notorious for poor usability IMO. Second, actual real work work flows are not good practice or they are at best in need of some revamping.