The adoption of technology, more specifically EMRs and clinical decision support systems, is critical for reducing healthcare costs, improving quality and supporting clinicians in their increasingly complex roles. It’s naïve to think, however, that we will achieve these outcomes by adding more technology and more tasks to the clinician’s work flow. Technology adoption cannot happen at the expense of providing top-notch clinical care. After all, one of the tenets of medicine is “first do no harm.”
Clinicians do need support when and where it matters most — the exam room. Clinicians need simple, clinically smart solutions that capture the complete clinical picture in real time without changing or adding to the work flow. Every added piece of technology needs to work in harmony to enhance patient care and improve outcomes.
Two related issues driving physician pushback of EMR adoption include usability concerns and work flow disruption. Time spent looking at a computer is time not spent engaging a patient face to face. The Journal of General Internal Medicine article “Primary care physicians’ use of an electronic medical record system: a cognitive task analysis” reported that using EMRs increases physicians’ average screen gaze time by more than 100%, rising from 25% to 55% of consultation time, inevitably resulting in less eye contact and less meaningful conversation with the patient.
Clinicians have long-established work flows that often include documenting patient encounters in free text. While EMRs allow free-text notes, only the data residing in structured fields is available for analysis. The way for clinical decision-support tools to be effective is by bringing alerts to physicians and providers in their existing course of action at the point of care, or when they enter both structured and free-text notes. By receiving prompts while the clinician is with the patient in the exam room, physicians and other healthcare providers may alter treatments and courses of care to reduce variances and drive improved outcomes.
A New England Journal of Medicine column, titled “Off the Record — Avoiding the Pitfalls of Going Electronic,” warns that structured text fields, namely drop-down menus and discrete data fields lead physicians “to ask restrictive questions rather than engaging in a narrative-based, open-ended dialogue,” which can be “key to making the correct diagnosis and to understanding which treatment best fits a patient’s beliefs and needs.”
The same is true of a robust clinical decision support tool. To be truly effective, a guidance tool must offer prompts based on the complete clinical picture of a patient, comprised of information recorded by a physician’s structured and narrative notes.
Is your health organization taking measures to analyze free-text notes of clinicians?
What have been your biggest pain points associated with this approach?
Dan Neuwirth is President and CEO of MedCPU Americas.
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