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Sometimes, New Software Makes Workflow Even Worse

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Increased productivity is supposed to be one of the objectives of system-wide software upgrades. So why did one new system actually make workflow even worse?

This story comes from southern California and discusses the implementation of an electronic health record system, or EHR. It’s covered on the website FierceEMR:

In fact, EHR implementation had the exact opposite effect for residents at both Riverside County Regional Medical Center in Moreno, Calif., and Pomona Valley Hospital Medical Center in Pomona, Calif.; it increased the average time of residents for seeing patients and charting the visits from 21 minutes to 37 minutes.

“Some of us were really excited. We thought it would improve patient care,” Maisara Rahman, M.D., who helps to train family-medicine residents at Riverside County, said during a talk at the American Academy of Family Physicians’ annual meeting in San Diego in September, according to Medscape. “But when implementation started, we saw inefficiencies.”

Process Improvement and EHRs

© Flickr user jfcherry

It’s no surprise that often, what is supposed to be a process improvement initiative actually has a negative impact on overall employee productivity. That’s for many reasons, some of which we’ve covered before in posts about process improvement in medicine.

But there’s one factor that is often the most significant. The article hints at the problem:

…old software that required users to jump from screen to screen to write basic notes, a slow server and poor training.

Seven of 10 residents at Riverside received less than five hours of training, according to Rahman, who said that–not coincidentally–the same number of residents reported receiving subpar training.

Did you see it? If you guessed that the issues were caused by a lack of sufficient training, you’re close. If you blamed system design, you’re even closer.

But our opinion is that the the new EHR is going against existing workflow rather than just helping to streamline what already works.

Process Improvement and EHRs

© Flickr user AntoineMeu

Think about switching from a manual transmission to an automatic transmission. Driving a car is similar, there’s just one less step to do.

But the process isn’t the same if you replace a toaster with a microwave oven. It’s true that you can achieve many of the same tasks, but the workflow is different. Furthermore, there are some things you can do well with one (such as toast bread) that the other just can’t do!

If a new system requires a great deal of training, that could be a sign it won’t necessarily result in immediate improvement.

Sometimes, upgrades intended to result in business process improvement have the opposite effect. That’s why we need to study the way people currently work before designing and installing a new system. If we build tools that leverage what they already do and know, they will need less training, get more done, and feel more engaged as a result.

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