IN RESEARCH FINDINGS THAT SHOULD surprise very few health information management (HIM) professionals,
attending physicians and the colleagues they conduct morning rounds with think electronic health records (EHRs)
aren’t well suited for rounding in patient rooms. Their disdain for this now pervasively adopted tool has led them
to make handwritten notes on hard copies of patient summaries when they are in patient rooms. However, those
handwritten notes may or may not be integrated into the patient’s electronic chart once morning rounds have
concluded, according to research published in the journal PLOS.
There’s plenty of research linking physician burnout rates and life-threatening errors in pediatric cases to poor
EHR design and workflow, but now researchers are looking at the critical caregiving decisions clinicians are making when they’re face to face with patients. They found that rounding—and the handoff periods before and after
rounding—are prime examples of when clinicians are more likely to use workarounds to convey important clinical
information. The study included photos of handwritten notes taken on the spot. Physicians who were studied also
mentioned the numerous phone calls and emails they exchange—important information that isn’t always merged
into an EHR.
In interviews with clinicians about which workarounds they use and why, researchers wrote that “One resident
explained that using handwriting helps process patient information: ‘The information that I have in handwriting, I
write down all the morning labs based on what I see on the EHR. I do this by hand because it’s easier for me to pro-
cess the information when I’m writing that for myself. Then I also have mostly check boxes that are to-dos. These
are tasks that need to be done during the day. Whether it’s talking to a consultant, making sure that this lab or this
order is made in the EHR, this medication is started, or follow up on this result.’”
Investigators concluded that in terms of usability and workflow, there is much work to be done before EHRs will
become a physician’s preferred method of patient documentation. Vendors should take note.
“Although EHRs can improve healthcare quality and have done so in many ways, our findings show that there
are many challenges in the current inpatient environment that need to be addressed if EHRs are to reach their full
potential,” the researchers wrote. ¢
Paper Workaround Defeats