Data Sparse on E-Health Records, Workflow

Exactly how electronic health records will affect workflow in outpatient settings remains unclear, according to a new report.

Studies to date have been "anecdotal, insufficiently supported, or otherwise deficient in terms of scientific rigor," according to the report, prepared by the Agency for Healthcare Research and Quality by the Center for Quality and Productivity Improvement at the University of Wisconsin-Madison.

Notwithstanding those deficiencies, previous studies found that EHR implementation resulted in "nearly universal" increases in workload for physicians, according to the report submitted to the AHRQ. Workflow can include activities by patients, clinic providers or clinic staff, exchanges between organizations or work that happened during or between clinic encounters, the researchers said.

The report found that:

• In most cases, a computer terminal in the examination room was distracting for the provider, shifting attention away from the patient. To compensate, some providers reviewed patient records ahead of time, allowed patients to see the computer screen, printed out the records or waited until the patient left to document findings in the computer.
• Several studies found clinics saved time using features such as text templates, automatic billing data transfers, and computer-printed prescriptions and letters.
• Other tasks took more time with EHRs, including data entry and working with records divided between paper and electronic records.
• Computerized provider order entry (CPOE) often wasted time by duplicating efforts, but studies differed on whether more time was saved or wasted.
• Physicians' workloads appear to increase. Reasons include having to enter data after patient visits on several different computer workstations, and the shifting of duties from support staff to physicians.
• Remote access to clinic records often saved physicians time and helped prepare them for appointments in advance.
• Most providers say EHRs and EMRs are more beneficial than detrimental, but reports of problems with usability abound.