HIT Implementations Negatively Impact Clinical Workflow
Health information technology is supposed to improve workflow efficiency by reducing redundancies in patient care, streamlining clinical tasks, and enabling coordination among multiple providers and a variety of care settings.
However, a new study conducted across six ambulatory care practices from two participating healthcare organizations found health IT-caused interruptions to clinical workflow across all study clinics and work roles.
The study, funded by the Agency for Healthcare Research and Quality, examined the impacts of HIT implementation on healthcare workers workflow in a diverse set of ambulatory care practices. A total of 120 clinicians and clinic staff participated in the study.
Also See: EHRs Going Against the Flow
In addition to negative impacts on clinical workflow, the study noted differences in the quantity of interruptions that occurred during pre- and post-implementation of HIT. For instance, clinicians and staff at one clinic experienced a more than three-fold increase in the frequency of interruptions following the HIT implementation, while other clinics experienced no difference.
These differences can only be explained when a comprehensive understanding of between-clinic contextual factors is gained, argues the report. For example, more interruptions may be due to a highly collaborative work environment where colleagues actively seek assistance from one another on health IT and other issues.
The study observed that patient interruptions are also common when new HIT is introduced, as documentation requirements demand more computer time for providers, who are increasing the time spent on the computer during patient visits. In those instances, the report finds that the new health IT has not been adequately integrated into the workflow design, which includes the provider-patient interaction. Moreover, providers in the study often had less time to talk to patients during a visit following the HIT system implementation.
Health IT can create additional work and impact workflow unfavorably by creating inefficiencies or disruptions, concludes the report. These impacts are attributable to the changes that health IT implementations introduce to established clinical work processes and workflow. While some of these changes are deliberately made to enable redesign of existing clinical practices, others may be manifestations of deficiencies and oversights in the design of health IT or in the implementation processes, such as poor software usability, misaligned end user incentives (i.e., end users are not incented to enter electronic data, especially structured data), adverse impacts on workflow, and other subtle behavioral, organizational, and societal factors such as culture and professional autonomy.