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Study Examines Electronic Health Information’s Effect on Clinical Workflow


Health information technology (HIT) offers many advantages: centralized information, improved text readability, and mechanisms to promote evidence-based practice guideline adherence and patient safety. While HIT has enhanced many aspects of patient care, it also has introduced new challenges, such as reactive alerts that interrupt workflow, and computer system downtimes. This study sought to assess aspects of HIT that impact clinical workflow – and to identify a set of HIT characteristics that support patient care processes. Investigators conducted 20 interviews at one VAMC, with a fully implemented electronic health record (EHR), and elicited both positive and negative examples of how HIT affects the work of healthcare employees. Ideally, HIT designs should support the workflow, tasks, and goals of all types of healthcare employees. Therefore, interviews were conducted with a variety of VAMC employees (e.g., physicians, nurses, administrators) between 10/07 and 3/08.

Investigators identified many examples of how HIT affects workflow, but characteristics were strongest within four primary domains: 1) Trustworthy and reliable (e.g., inconsistent incomplete, incorrect information in EHR; 2) Ubiquitous (e.g., poor accessibility due to lack of computer workstations or lengthy secure login processes, but good information availability ); 3) Effectively displayed (e.g., problems locating scanned documents in the EHR, lack of searchability , information not well-organized or prioritized); and 4) Adaptable to work demands (e.g., EHR is not portable or customizable, difficult to modify information). The findings from this study underscore the value of obtaining input from healthcare employees and may be used to enhance HIT design, clinical practice, and patient safety. The authors suggest that additional characteristics may be identified through larger, multi-site investigations of VA and/or non-VA electronic health records.

PubMed Logo Russ A, Saleem J, Justice C, et al. Electronic health information in use: Characteristics that support employee workflow and patient care. Health Informatics Journal Dec 2010;16(4):287-305.

This study was supported by HSR&D. Drs. Russ, Saleem and Justice are part of HSR&D’s Center of Excellence on Implementing Evidence-Based Practice located in Indianapolis, IN.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.