A dirty little secret about a lot of EHR implementations is that there are often negative impacts on productivity post implementation. This is about much more than leading your team through the valley of despair associated with almost any change. This is about the fact that an EHR implementation fundamentally changes the way nurses and physicians actual practice. A recent article by Paul Roemer over at healthsystemCIO.com points out a very important reason for this:
You EHR was not designed to work efficiently in an non-linear exam. Chances are good that your EHR was never really designed at all. Were designers, professionals with advanced degrees in human factors — cognitive psychology, heuristics, taxonomy, and anthropology — asked to determine how the EHR would need to work? Did they watch users work prior to writing code? Did the EHR firm iteratively build prototypes and then measure how users used it in a research lab that tracked hand and eye movements? If not, that is why I think it is fair to characterize EHRs as having been built, not designed.
Most software, including EHRs, were built using linear logic. Step 1, Step 2, Step 3, etc. When you’re dealing with patients who often are scared, confused, in pain or all three (or more besides) linear logic breaks down. Healthcare providers need the ability–provided by their EHR–to jump around with the patient to make sure that everything gets documented as completely as possible in order to take advantage of all of the benefits that EHR offer. It’s also another good argument for the need for patient-centered EHRs.
