To achieve the full benefits that an EHR system has to offer, it is important to understand that electronic workflows should not look identical to those in the paper world. An article published in the New England Journal of Medicine entitled, “Can Electronic Clinical Documentation Help Prevent Diagnostic Errors?” notes that many inefficiencies exist in paper workflows, and that by selecting the right electronic record system, it can provide “…more thoughtful design, workflow integration, and distribution of the documentation burden to speed up charting, freeing time for communication, and cognition.”[1]
Selecting an EHR system is the first step toward positive process change. The next step is to analyze the current internal workflow in preparation for implementation and planning for a future electronic workflow. Identifying workflow limitations and areas of redundancy in a paper environment are critical to making a successful transition to an EHR system.
Access
In a paper world, there is one chart for each patient. Charts often become lost and pages misplaced, handwriting can be illegible, and access is limited to one person at a time. In contrast, an EHR system allows multiple users on-demand access to patient charts simultaneously. With an EHR system, the PACU nurse can complete charting while billing staff reviews information from within the file, providing greater efficiency and improved workflow. Regardless of a physician’s location, charts can be available to view — and sign — even when they are off-site.
Patient safety
In a paper environment, handwritten notes and red stickers are used to update patients’ allergy information. EHR systems can provide advanced medication and allergy-checking capabilities which significantly improves patient safety. Active reminders are prominently displayed on each EHR page. For example, if a physician attempts to write an amoxicillin prescription for a patient with a recorded penicillin allergy, the EHR alerts them that the patient is allergic. Alerts are also activated when possible interactions with other medications exist.
An additional patient safety feature offered through an EHR system is surgical safety checklists that are incorporated into pre-op documentation. These lists can be used as prompts for clinicians to assist in complying with The Joint Commission’s Universal Protocol.
Charting and standardized reporting
Illegible handwriting and inconsistent abbreviations are just some of the issues that make charting on paper an error-prone process. An EHR system that offers features such as automation of chart packs using checkboxes and drop-down menus can help replace this process. In addition to eliminating inappropriate and inconsistent abbreviations, documentation is more thorough and consistent.
Workflow efficiencies achieved through the use of standardized forms also promote best-practice documentation. For example, it is not uncommon for multiple clinicians to collect duplicate data from patients at various points leading up to and during a visit, from pre-op phone calls, nursing admission forms, patient’s history and physicals, nursing flow sheets, etc. Redundant workflows on paper are identified and eliminated with EHR implementation.
Chart packs and standardized reporting drive facilities toward best practices and compliance with regulatory guidelines. Creating standard processes and terminology removes the possibility of errors and, in turn, increases patient safety.
Compliance
Communicating new regulatory requirements in a paper-based environment typically entails sending email alerts to staff and posting signs throughout the center. It is a tedious process to monitor and difficult to ensure staff compliance.
An EHR system helps facilities achieve better compliance through built-in efficiencies within the patient records that provide proactive alerts and reminders. Tracking capabilities also enable facilities to quickly demonstrate compliance in the event of an audit.
Enhanced reporting
An EHR system provides management with greater insight into key metrics including inventory and supply management, billing, and outstanding claims. As a result, facilities are able to make more informed operational and financial decisions.
Additionally, an EHR system tracks quality measures at the patient chart level. For example, clinicians have the ability to indicate whether or not pre-op antibiotics were given within one hour before surgery, a typical quality indicator assessed when reporting to outside agencies or completing quality reviews.
Ergonomically friendly
To fully realize the efficiency and workflow improvements associated with an EHR system, consider investing in ergonomically-friendly tablets. Since the software runs on tablets, clinicians aren’t chained to a desk entering data far away from patients. Tablets are lightweight and highly portable enabling clinicians to quickly move from patient to patient without having to push a cart on wheels. Tablets offer the mobility of a paper file but with all the ease, flexibility, and safety of an EHR system.
In the transition to an EHR system, it is important to use it meaningfully to derive all the benefits that electronic recordkeeping has to offer over paper. In doing so, a facility can improve healthcare quality and delivery, create more efficient processes, and, most importantly, improve patient safety.
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References
HIMSS. (2010). Workflow Redesign in Support of the Use of Technology within Healthcare. Chicago, Illinois, Unites States of America.
IOM. (1999, November 1). Reports. Retrieved June 10, 2010, from Institute of Medicine of the National Academies: http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.ashx.
McCoy, M. J. (2010). acog.org/depts. Retrieved June 14, 2010, from American Congress of Obstetricians and Gynecologists: http://www.acog.org/departments/dept_notice.cfm?recno=47&bulletin=4882.
[1] Schiff, G. D. (2010). Can Electronic Clinical Documentation Help Prevent Diagnostic Errors? New England Journal of Medicine, 1067-1068.
