EHR’s: COWs, WOWs, and Flashlights

Timing is everything. In the case of EHR, timing, Apple’s timing for bringing the iPad to market, was three to five years too late. 

That is why hospitals spent millions on hard-wiring computers into patients’ rooms and nurses’ stations.  Would’a, could’a, should’a gone wireless.  But no one knew.  Hospitals were not prescient enough to have gone wireless in the middle of the prior decade as everyone still thought wireless technology was a canard.  Nobody even knew what an app was, let alone that an app for a user interface to the EHR could be run off of a tablet.

That is why most EHR desktops are hardwired to a wall.  And which wall is it?  It is usually the wall across from the foot of the patient’s bed, the one furthest from the patient, the wall that requires the healthcare professional (HCP) to turn away from the patient to be able to enter data.

Suppose for a moment your organization decided to learn just how effective was the investment in the hundred-million dollar EHR.  One way to do this is to audit some number of health records to investigate whether or not the data for the patient record is and complete valid.  That approach will provide you with a modicum of what you need to know.  That answers the question, is the EHR being used?

Valid data does not answer the following questions:

·       Who input the data

·       Was it input in real-time while the HCP was with the patient or was it input at the end of rounds?

·       Did the HCP use paper and pen to record data

·       Was non real-time input done from the information on the HCP’s paper? In other words was the data captured twice?

·       If the data was captured twice, are both instances of the data correct?  Which patient record is the record of record; the paper or the EMR?

·       Have each of the various stakeholders—nurses, therapists, physicians—developed their own way of using/not using the EHR?

·       Do they each have their own workarounds?

Here are some recent actual observations about the use of the EHR at a large hospital:

·       Most of the patient data is entered at the end of the HCP’s rounds.

·       Data is entered on a large number of manual forms

·       The data on the forms does not match the data required on the EHR screens

·       The forms do not match the screens

·       Data is pushed from the forms to the EHR

·       Hospital exams are recorded on paper

·       Charting while on rounds meant the HCP was only able to cover 2/3 of their patient load

·       HCPs had to login to the computer and to the EHR dozens of times to complete their rounds

Here is my favorite observation gleaned from shadowing the HCPs—the EHR is used as a flashlight.  HCPs stand next to the EHR screen and use the light emitted from the screen to help them see to write their notes on paper.

The items referenced above illustrate ineffectiveness and inefficiency.  Duplication of data, duplication of work. These will lead to errors and a loss in productivity.  The good news though is that the hospital now has several hundred large flashlights.

Also observed were COWs and WOWs with EHRs—Carts On Wheels and Workstations On Wheels.  It just goes to show you that you can learn something new every day.

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