Unintended Consequences of an EMR
Everyone is implementing EMR systems in their hospitals, clinics, and facilities in order to meet government requirements. Even with the best planning and intentions, there can be things that make those systems interrupt your organization in ways that were not planned. These items can make user acceptance perish, stop or halt implementations, and at times harm patients. No one wants these things to happen, so you need to be aware while implementing a new system or updating/optimizing your existing system. Some of the things to watch out for include:
1. Create more work for your staff and takes more time
a. Nurses, doctors, and pharmacists are seeing more work on their part which slows down their ability to complete their daily tasks. This is especially prevalent for those less technically savvy employees because instead of just writing or typing their documentation, they must now maneuver around and put in discrete data. Sometimes this gets better over time, but special attention needs to be paid to how documentation is laid out on the screen. Also, when upgrades or enhancements are made to the system, it takes even more time for them to learn the “new” way.
2. Lack of Communication between staff
a. Some users assume since they document in the patient’s chart that the data is readily available for others to see, so they do not communicate with other staff members like they used to before there was an electronic system. For example, a pharmacist or provider may not call the nurse to inform her about medication changes because they updated the computer system and assume the nurse will notice the changes. Some organizations have seen inter-departmental communication really fall apart. The nurse orders a radiology exam and assumes the radiology department is sitting at the computer and is notified of an emergent exam needing to be done on a patient, but the radiologist is busy and hasn’t checked the screen except in regards to the patient they are currently performing work on.
3. Miscellaneous
a. If the user does not enter the documentation in the proper section, the data may be missed. For example if they document vitals under miscellaneous notes instead of opening the nursing vitals documentation, the vitals are not discrete data which does not display in the proper place in the EMR, is no longer able to be trended since it isn’t with the rest of the vital data, and could possibly be missed altogether or waste another employee’s time redoing vitals since they do not see the vitals were taken recently. This could cause frustration or unnecessary concern with the patient wondering why their vitals are being retaken – was there something out of the ordinary causing them to be redone?
4. Dependence on technology
a. People become complacent and start losing their knowledge when they get used to the computer warning them of things like interactions, adverse reactions, dosage checks, and medication times. The computer does help with this, but it places the patients at more harm when the system is down and people now have to rely on their old practices and they have become rusty since they don’t use that knowledge as much.
5. Delays in results
a. Computer systems can make results available much faster and more accurately, but if there are delays or downtime, if you do not have a good procedure on notifying departments of results, this could cause harm to patients.
6. Improper results
a. Several hospitals have found out that incorrect mapping of tests or inaccurate setup in the interface has results (especially lab tests) showing under improper tests or not showing at all in the EMR system.
7. Hardware Issues
a. Not having enough computers for all the staff can cause users to not use the system or become very frustrated.
b. Not having enough room to use the computers (too much stuff around the computers or a very small mounted system) can cause frustration and workarounds that may not be what was intended. If the computers are mobile, but the rooms aren’t big enough to get the computers in and out of easily can also result in workarounds that you don’t want.
8. Impersonal care
a. People need training on how to properly document while dealing with a patient and their family, so it is not perceived as the patient is being ignored while that person is playing on the computer.
9. Ignoring Alerts
a. Sometimes users become immune to seeing alerts or messages pop up on the screen and they just click through without reading them or following the recommendations.
10. Gaming the System
a. Users tend to find workarounds or “easier” ways to use the system. Every department from admissions to nursing and lab to billing and medical records needs to periodically evaluate the workflow of people in their departments. People get lazy and quit following procedures or find quicker/easier ways for them to use the system. A lot of times the only way to find out about these is to listen to users explain to other users how they use the system, or for you to watch them using the system.
If you are aware of these issues while you are implementing or upgrading or optimizing your EMR, you will help your staff and patients have a more accurate and helpful EMR system.