Assessing EHR use during hospital morning rounds: A multi-faceted study

BackgroundThe majority of U.S hospitals have implemented electronic health records (EHRs). While the benefits of EHRs have been widely touted, little is known about their effects on inpatient care, including how well they meet workflow needs and support care.ObjectiveAssess the extent to which EHRs support care team workflow during hospital morning rounds.DesignWe applied a mixed-method approach including observations of care teams during morning rounds, semi-structured interviews and an electronic survey of hospital inpatient clinicians. Structured field notes taken during observations were used to identify workflow patterns for analysis. We applied a grounded theory approach to extract emerging themes from interview transcripts and used SPSS Statistics 24 to analyze survey responses.SettingMedical units at a major teaching hospital in New England.ResultsData triangulation across the three analyses yielded four main findings: (1) a high degree of variance in the ways care teams use EHRs during morning rounds. (2) Pervasive use of workarounds at critical points of care (3) EHRs are not used for information sharing and frequently impede intra-care team communication. (4) System design and hospital room settings do not adequately support care team workflow.ConclusionsGaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues. These issues pose a threat to patient safety and quality of care. Possible solutions need to include improvements in EHR design, care team training and changes to the hospital room setting.研究背景：美国大多数医院已普及电子健康档案（electronic health records, EHRs），尽管其优势已被广泛宣扬，但学界对其在住院诊疗领域产生的影响却知之甚少，包括其在多大程度上契合临床工作流程需求、能否为诊疗工作提供有效支持。 研究目标：评估电子健康档案在医院晨间查房过程中对医疗团队工作流程的支持程度。 研究设计：本研究采用混合研究方法，涵盖医疗团队晨间查房现场观察、半结构化访谈，以及针对医院住院临床医师的电子问卷调查。研究人员通过观察过程中记录的结构化现场笔记，提炼工作流程模式以供分析；同时运用扎根理论（grounded theory）法从访谈转录文本中提取新兴主题，并采用SPSS Statistics 24软件对问卷结果进行统计分析。 研究场景：新英格兰地区某大型教学医院的内科病房。 研究结果：通过对三类分析结果的数据三角验证，本研究得到四项核心发现：（1）医疗团队在晨间查房时使用电子健康档案的方式存在显著差异；（2）在诊疗关键环节普遍存在变通操作；（3）电子健康档案未被用于信息共享，且频繁阻碍医疗团队内部的沟通；（4）系统设计与病房环境均未充分适配医疗团队的工作流程需求。 研究结论：电子健康档案的设计与复杂住院诊疗环境所需的功能之间存在的差距，导致临床工作流程缺乏标准化、变通操作被广泛采用，以及团队沟通问题频发。上述问题均对患者安全与诊疗质量构成威胁，可行的改进方案需涵盖电子健康档案设计优化、医疗团队培训完善，以及病房环境调整等方面。