Example 5: Managing Expectations About How EHR Implementation Will Affect Workflow

Issues Encountered

Clinicians at a college student health center complained that the introduction of an EHR significantly increased their workload. In particular, physicians and nurse practitioners complained that the additional time they had to spend learning to use the new system, combined with the additional burden of documenting patient visits in the EHR, reduced their capacity to focus on delivering patient care. One physician said: "In the EHR I have to click all these buttons, and when you see 20-plus patients a day all that clicking time really adds up." In addition to the time spent interacting with the EHR during the patient visits, the physicians were also unhappy with the additional time spent maintaining the patient record outside of the clinic. Another physician complained that he spent several hours each day documenting in the EHR and that the time he spent doing that was "totally uncompensated."

Finding a Solution

Changes in both the flow and distribution of work are natural byproducts of EHR implementation. The side effects described in the example above are very common. These are still open problems that do not have straightforward solutions. Some recommended practices for avoiding user dissatisfaction with the increased workload include being honest and upfront about the workload implications of EHR implementation (i.e., make sure you have "buy-in"). Organizations may also compensate for the increased documentation burden by scheduling fewer patients for a period after the introduction of the EHR. This approach will allow users to gain comfort and proficiency with the EHR.

Lesson Learned: 
  • To foster buy-in, involve clinicians in the planning, selection, implementation, and maintenance of the EHR.
  • Clinicians need to be aware of the workload implications of EHR introduction.
  • Reduce the clinicians' workload during the learning period.

This material was derived from responses to a membership survey about unintended consequences that the American Health Informatics Management Association (AHIMA) conducted in 2009. For further information, contact Spencer Jones at the RAND Corporation at sjones1@rand.org.

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