Two EHR Issues Frequently Misunderstood by Practices

One of the most common complaints about EHRs is that they do not conform to the way providers and their staffs actually work. There are two aspects of this complaint that are frequently misunderstood, and effectively addressing the complaint requires clarity regarding the roots of the problem.

Multi-tasking vs. multiple tasks
In most cases, computer programs are designed to begin each operational work flow at the beginning and plod straight through to the end.  Typical EHRs are no exception, for instance:
1. Patient enters the exam room.
2. MA takes and records the vitals.
a. MA gathers subjective information from the patient.
3. Provider gathers the objective information
a. Provider assesses the patient
b. Provider develops and activates a plan
4. Encounter is complete.

But a provider's reality often does not match the typical EHR's expectations.  Interruptions and exceptions make the straight-line process above inadequate.  The common complaint regarding this among providers and staff is that physicians multitask and EHRs do not support multitasking. 

In the strictest sense, however, neither computer programs nor human beings are capable of multitasking. What looks like successful multitasking is actually suspending one activity, executing another, and resuming the suspended task - at exactly the same point and without losing any data.  In smooth operations, the transitions are so rapid that they are transparent to any observer. 

Computers do this exceptionally well.

The actual problem is that EHRs tend to impose a lot of switching overhead.  A program often forces the provider to complete a defined process before doing something else; it does not allow interruption and seamless resumption.  A related inadequacy is that the provider must step through parts of a work flow that are superfluous to the task at hand in order to get to what she really needs to do. 

The root problem is that work in most EHRs is not sufficiently granular.  Physicians do have work flows and processes and, in a perfect world, they would move through the steps from start to finish.  In the real world, however, the elements of the work flow often need to be accomplished as standalone events.  The issue is not supporting multitasking, but enabling multiple, discrete tasks with minimal switching overhead.

Conflict between office conventions and EHR work flows
Another complaint is that the EHR does not match the standard practices of the office or clinic.  This is especially common in ambulatory settings that have adopted a system designed or optimized for an inpatient facility. 

The EHR is actually innocent in this situation.  The fault is with the selection committee and/or the implementation.

The solution is to conform the EHR to the practice, or conform the practice to the EHR.  The first step is to choose an EHR that is generally consistent with ideal or current practice operations. 

Once the practice has committed to a system, it has two choices:  Modify the EHR to match practice operations, or modify practice operations to match the EHR.

For effective, efficient, reliable practice operations, what providers and staff are doing must match the EHR's expectations.  It may not be fair, and it is certainly frustrating, but the EHR will always impose its will.  Human beings will never be able to wear it down or wait it out.

It is useful to be very specific about EHR complaints, because it enables users and vendors to communicate effectively.  Both must have the same understanding of underlying issues so that problems get resolved instead of patched.