Electronic health records (EHRs) may sound like the answer to keeping tabs on patients and sharing information quickly.
However, EHRs may be making things more challenging in some emergency rooms, where fast access to accurate information is crucial.
Hospitals don’t have much choice in using EHRs, which are mandated under the Affordable Care Act. There can be penalties if hospitals fail to use them.
Dr. David J. Mathison, a pediatric emergency physician with the Children's National Health System, said that being able to access information in an emergency setting improves patient care.
EHRs also provide clinical decision support and medical alerts to improve quality and reduce errors, he noted.
“However, the attention required for staff to engage with the EHR removes doctors and physicians from patient care and disrupts the flow of the ED [emergency department],” Mathison told Healthline.
Mathison said that emergency room employees have spent more time documenting information and less time with patients since EHR adoption.
While the quality of care may not be affected, the patient experience may be affected.
“The laborious EHR user interface inevitably reduces the number of patients a provider can see on a given shift, making the need for scribes, transcription services, and midlevel practitioners increasingly important in emergency medicine,” Mathison added.
Dr. Corey K. Smith, an emergency medicine physician based in New Jersey, said he feels there are more medical errors since EHRs came into use.
Smith said companies have added more user-friendly features to accommodate the time crunch clinicians face.
Despite these attempts, the EHR system does provide more opportunity for error. The wrong patient history, physical description, or wrong medication may be mistakenly selected from a prepopulated list.
“The electronic health record also gives the reader less of a true feel of the patient encounter due to the fragmented template style of the generated chart,” he said.
An increase in multitasking since the EHR requirement was implemented has made it more challenging for physicians who work in the already complex and dynamic environment of the emergency department, said Raj Ratwani, Ph.D., scientific director and senior research scientist at the National Center for Human Factors in Healthcare in Washington, D.C.
He conducted a study on EHR use in emergency departments last year.
“Rapid task switching leads to increased stress and frustration and can have serious patient safety implications. Multitasking rarely improves human performance,” Ratwani noted in a press release about the study.
Are Scribes a Solution?
Dr. David Birdsall, an emergency room physician and vice president for CEP America, advocates the use of scribes.
Scribes are trained in EHR management and patient documentation. They are either undergraduates or postbaccalaureate students with an interest in the healthcare field.
“Most, but not all scribes, have the intention of attending medical, physician assistant, or nursing school. They get great experience, ED staff gets the help they need,” said Birdsall, whose company provides acute care staffing solutions for emergency rooms.
“At work the other day I had a scribe,” Birdsall told Healthline. “This allowed me to go into a room, sit down at the bedside, look the patient in the eye, and hold their hand while they told me their story. I didn’t have to worry about taking notes or documenting. The scribe took care of that while I took care of the patient.”
Birdsall was careful to point out that EHRs do enhance patient care overall, but medical professionals need to be vigilant about the patient and not just stare at screens.
“We have to look at the patient and make that provider-to-patient connection,” he said. “We’re dealing with people during what is often a scary time due to an accident or illness…We have to also make that human connection.”