Despite the wide adoption and implementation of EHR technology (and continued EHR innovation), physicians still encounter challenges that disrupt clinical workflows. Multiple surveys document a handful of underlying problems that hinder productivity and impact providers’ ability to deliver quality patient care.
The Impact of Disrupted Clinical Workflow
For healthcare professionals, the stakes are much higher when it comes to workflow issues. Besides productivity losses for pharmacists, physicians, insurance providers, and other stakeholders in the continuum of care, there is a huge risk to patients in the form of improper care. Workflow issues may lead to preventable medical errors – the third leading cause of death in the U.S.
Given the risks introduced by workflow disruptions, providers must put in place clear plans for detecting and swiftly addressing workflow issues once they arise. When it comes to EHR usability, the onus lies on IT professionals to resolve such workflow issues before patients begin to experience the resulting negative impact. To help you get started, let’s consider some common challenges that disrupt clinical workflows.
Configuration and Data Input Issues
Since workflows are unique to a particular provider and designed to align with the needs of a specific user group, data set, and certain processes, it can be challenging to isolate issues disrupting clinical workflows. However, some of the common problems include “bad” data input configurations and gaps in design.
Configuration issues are usually the result of a disconnect between workflow design and the business process it was intended to support. They arise when a new process comes into play (but isn’t incorporated into the workflow), business requirements change, or errors in development remain undetected until after deployment. For instance, if a provider transitions to a new EHR system without thoroughly testing all impacted workflows, there may be some compatibility issues with existing systems in use.
Incorrect or Missing Data
Incorrect or missing data in EHR and other health IT systems is one major challenge hindering clinical workflows. According to an ECRI Institute survey, it was also the second greatest hazard to patients last year, causing disruptions in the proper delivery of care. Without proper data validation, missing data will certainly introduce risks downstream if allowed to proceed unchecked. Incorporating proper validation will detect such missing data and throw an error in the workflow in question while error handling can be used to reroute workflows to alternatives.
Limited EHR Interoperability
With EHR adoption exceeding 90 percent industry-wide, experts are shifting their focus to get disparate EHR systems to work well together. Although there has been some progress in this area through innovations like the FHIR and collaboratives like the CommonWell Health Alliance, the limited interoperability of most EHR systems makes it difficult to seamlessly exchange health data with each other. This is an issue with dire consequences for patient care. When patients receive treatment from another provider (owing to an emergency or the need to visit a specialist), it’s essential that the new provider has immediate access to the patient’s health history. Since EHRs aren’t going to become obsolete in the near future, developers must continue working towards seamless interoperability.
The impact of EHR systems on clinical processes (especially as regards the disruption of workflows and delivery of patient care) is well documented. Many providers state that EHR use limits their overall face-time with patients, resulting in lower patient satisfaction scores. Additionally, EHR usability issues and the need to attest to federal reporting programs sometimes makes it difficult for providers to focus on the patient, leading to poor health outcomes.
While there are no set rules, modeling approaches, or guidelines for solving these challenges, the pathway to successful resolution (improved care, better EHR systems, etc.) will require an industry-wide agreement of process conceptualization and documentation/modeling of workflows.
Since EHRs were designed to be patient information repositories, not support clinical processes or act as clinical care assistants, their job in supporting care delivery was relegated to providing data. “The underlying assumption is that providing data is the same thing as supporting clinical processes,” explains Jerome Carter, MD in a report for Clinical Workflow Center. However, this leads to the misconception that data availability problems are the sole reason for EHRs disrupting clinical workflows.
With greater awareness of the impact of EHR usability issues on clinical workflows, experts (such as software developers, human factors specialists, informaticists, and others) tasked with optimizing and modernizing EHR systems must have a deeper understanding of clinical processes.
With such knowledge, they can model, optimize, and build better systems that offer greater support to clinical workflows and deliver much better interoperability.