The clinical problem under discussion is the ruptures in organizational workflow and their impact on the quality of work and care given. Broadly defined, the workflow is an array of tasks, and the human resources required to fulfill them as intermediary steps to achieve the predetermined objective. In a clinical setting, the workflow can be predesigned or evolve spontaneously.
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Logical as they may seem when reviewed separately, the processes that comprise the workflow often present problems to the logic of it and subsequently exacerbate the efficiency of health care delivery. Redundancy of recorded and stored information is one of the sources of workflow bottlenecks as health care specialists often waste their time to reconcile the data from assorted resources (Cain & Haque, 2008).
EHR (Electronic Health Record) software is making its way into workflow improvement. The data fed into and stored within such software is used to facilitate more prompt exchange between the providers. The software can be characterized by the significant potential in terms of information flow improvement (Cain & Haque, 2008). Moreover, directly entering the data into the electronic record system, instead of manual recording and assembling it into charts, increases the speed of recording and, consequently, the speed with which the data is processed.
The implementation of the software can trigger some expenditures. Apart from those related directly to the installation, operation, maintenance, and repairs of the software, the staff has to be retrained to comply with the new standards of practice. At the first stage of implementation, therefore, the workflow can slow down further still, and the data processing might decrease in efficiency. However, with the usage of comprehensive EHR operation guides, the speed of data flow is likely to be stabilized shortly afterward.
Several studies suggest the efficacy of EHR software in terms of workflow improvement. Assessing the quality of EHR systems concerning healthcare quality improvement, one such study conducted a meta-analysis of medical publications devoted to EHR implementation (Campanella et al., 2015). The findings reveal an association between EHR software utilization and the overall reduction in documentation time. Apart from that, the usage of electronic records implies a more precise drug distribution and administration, as well as generally enhanced adherence to guides and instruction.
Other studies suggest that EHR, when improperly used, can present safety issues (Meeks et al., 2014). The threat arises because of the intricacy and complexity of EHR systems, which, again, require careful usage and sufficient staff training. Much of the safety, however, is evidenced to depend on the software providers, explaining the need to choose the provider with precaution (Olayiwola, Rubin, Slomoff, Woldeyesus, & Willard-Grace, 2016).
The process of EHR implementation starts with current situation assessment and subsequent goal-setting. The managerial part of the process requires that the issues with the workflow are singled out and a plan be developed to address each of them. As the issues may vary in each clinical setting, the software – and, more importantly, the vendor – should be chosen to comply with each establishment’s individual needs. In other words, the implementation of EHR is impossible without a clear-cut set of features the system must possess.
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The terms are then negotiated with the vendor, the software is purchased and installed. The staff is trained to operate the software and record the data; the training occurs either through hands-on sessions or educatory materials and templates. The outcomes of the implementation are then derived through constant measurement (Mooney & Boyle, 2011).
EHR and other similar software are known to slow down the recording process (and the workflow) at first stages of implementation. While some establishments are prepared to take it as a given and manage all the calculated risks related to the slowdown, the procedure of change can be made less painful for the persons involved.
For instance, the reported unsafe usage can be dealt with if the training is conducted before the software is purchased. This would require incentives for the medical personnel but would prove sustainable in the long run as the prepared personnel would be able to more efficiently acquaint themselves with the fill-in forms and record the data faster. Although assorted vendors provide different kinds of the interface to their software, some standardized training that encompasses the subject matter of the process (rather than the interface-related specifics) would ease the change even for those who are still uncomfortable with computerized recording.
As stated, the major risk to the organizations willing to shift to EHR is the initial slowdown of the process. The implementation of the change, naturally, requires that the staff be retrained to insert their data in digital format (Stokowski, 2013).
While it is possible to guesstimate that most personnel will be average-skilled PC users, some problems might occur. If the training occurs out of time, the slowdown in the workflow will further exacerbate the quality of data processing and, subsequently, the care delivery in this intermediary stage of EHR adoption. Timely training in safe EHR usage can prevent wasteful steps and decrease record processing time.
Cain, C., & Haque, S. (2008). Organizational Workflow and Its Impact on Work Quality. In R. G. Hughes (Ed.), Patient Safety and Quality: An Evidence-Based Handbook for Nurses (n.pag.). Rockville, MD: Agency for Healthcare Research and Quality.
Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2015). The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. The European Journal of Public Health, 25(3), n.pag.
Meeks, D. W., Smith, M. W., Taylor, L., Sittig, D. F., Scott, J. M., & Singh, H. (2014). An analysis of electronic health record-related patient safety concerns. Journal of the American Medical Informatics Association, 21(6), 1053-1059.
Mooney, B. L., & Boyle, A. M. (2011). 10 steps to successful EHR implementation.
Olayiwola, J. N., Rubin, A., Slomoff, T., Woldeyesus, T., & Willard-Grace, R. (2016). Strategies for Primary Care Stakeholders to Improve Electronic Health Records (EHRs). Journal of the American Board of Family Medicine, 29(1), 126-134.
Stokowski, L. A. (2013). Electronic Nursing Documentation: Charting New Territory.