Recognizing that issues with workflow integration have contributed to slow rates of electronic health records adoption in healthcare settings such as ambulatory outpatient care, the National Institute of Standards and Technology has issued a report on integrating EHR into clinical workflow with recommendations for developers and outpatient care centers. 

The recommendations for improving workflow integration with EHRs are meant to increase efficiency, allow for better eye contact between the physician and patient, improve physician’s information workflow, and reduce alert fatigue. In addition, the recommendations cover scenarios such as supporting tasks accomplished over multiple interactions with an EHR by multiple users, for example, a nurse practitioner drafting medication orders that are verified and completed by a physician. 

In putting together their report, NIST used "two human factors workflow modeling tools, process mapping and goal-means decomposition" to collect, visualize, and document insights and end-user needs to improve EHR workflow for clinicians in outpatient care settings. The report identifies clinical activities that "require more relevant and flexible workflows in EHR designs to support end users’ needs" and provides process map visualizations and a goal-means decomposition diagram.

The purpose of the report is to "provide a first step in moving from a billing-centered perspective (i.e., focusing on ensuring maximum and timely reimbursement) to a clinician-centered perspective where the EHR design supports clinical cognitive work" and to "point the way towards a 'patient visit management system,' which incorporates broader notions of supporting workload management, supporting the flexible flow of patients and tasks and preventing common workarounds."

NIST references the fact that a frequent EHR workaround used by clinicians is copying and pasting text from a previous progress note for a patient to serve as a draft for the current progress note. Earlier this month, the American Health Information Management Association issued a position statement warning about the risky practice of copy and pasting within an EHR. According to AHIMA, one study found that as many as 90 percent of physicians use copy and paste in their daily progress notes and a majority of narrative notes contain copied text. 

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