Giving a patient medications in the ER, having them pop positive on a test, and then withholding further medications because…
Readers Write: Mandating Physician Data Entry 1/23/13
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Mandating Physician Data Entry
We constantly hear about how EMRs slow physicians down in clinic. I’m on the IT side, and while I agree that every EMR needs to work on usability, it seems that part of the problem is physicians have to use the computer in cases when they would hardly touch paper.
Example: the physician used to just dictate his note and tell his nurses about any tests he was ordering. The note goes to a transcriptionist, and later comes back and is filed to the paper chart. The nurses grab whatever paper forms were needed for the tests, which the MD signs so it can be faxed over.
An analogous workflow in the EMR would be: physician dictates his note (not using Dragon, still using a transcriptionist) and the note is interfaced back into the EMR to be signed. The nurses queue up the orders and the MD signs them (or the nurse just places the order and they’re sent to the MD for signing later). This is all technically possible in Epic and I imagine in other EMRs too.
This workflow seems ideal and maintains the original division of labor. Or you could even hire a scribe to write the note and queue up the orders instead of relying on transcription interfaces and forcing nurses to deal with order entry. But it seems that hospital leadership has an assumption that physicians’ hands need to be on the computer constantly. Is there a reason for this, besides health systems not wanting to pay for the extra staff?
In an ideal world I can see mandating that physicians enter data to ensure accuracy, but maybe that’s a goal for later when EMR usability improves.
The author has chosen to remain anonymous.
The scribe thing is apparently harder than it looks. We do a lot of the labor-dividing stuff you mention (pending orders, for example) but only a little scribing. One challenge with scribing is achieving clarity on what constitutes compliant scribing. If you use a scribing company (more expensive) in a setting where scribing has a foothold (ED) it can work well. When you try to use existing non-licensed clinic staff to do scribing (trying to squeeze efficiency out of the system, remember) it seems like it’s nearly impossible to keep the boundary between scribing and practicing medicine clear.
The alternative to scribing is to focus on the efficiency of physicians’ documentation tools so there’s no need to scribe. There, too, there is temptation: As long as the doc is engaged with the computer can we get *one more* data point entered? And another? And just one more… it’s only a click!
I agree with you 100%. However we all who work in the EMR community realize that total workflow consultation is a desperate needed tool before implementing the system. The issue you just so accurately describe is one of many issues that cause a slack in patient care by taking useful time that can be otherwise refocused on patient care. However, in order to eliminate these redundant and uneccesary “Best Practices,” we all need to really stress to a green hospital beginning there implementation of EMR process to really take workflow analyzing important and know that it is a vital tool to escape the flawed practices as just explained above.
The highest paid individuals in a hospital are the administrators – who do very little data entry, utilizing assistants because it’s not worth their time. The highest paid laborers in the hospital are the doctors, who similarly find it a waste of time to be sitting in front of a keyboard instead of practicing medicine. Nobody likes data entry, but it makes even less sense to have your highest paid people doing that task.