Presentation
DH4 - Beyond the EMR: A System Level Analysis of Physician Workflows to Optimize an Anticipated EMR Upgrade
SessionPoster Session 2
DescriptionThe increasing reliance on electronic medical records (EMRs) within healthcare has significantly reshaped physician workflows. This shift has led to more time spent on documentation and navigating complicated interfaces, often detracting from direct patient care and increasing the risk of medical errors. In addition, the cognitive burden of managing inefficient workflows contributes to burnout among physicians. Indeed, a survey of US physicians revealed that 85% of respondents reported that their work-life balance was negatively impacted by the use of EMRs. Among those who reported signs of burnout, 75% attributed it to the EMR.
Much of the research within the EMR field has focused solely on mapping EMR workflows to support technology implementation, without fully considering all related clinical workflows and how they are disrupted by EMR use. There is also limited research into the less visible workflows that evolve when using EMRs—namely, workarounds and non-EMR processes that physicians employ to adapt these systems to their real-world contexts post-implementation. In particular, there is little published on how human factors and systems thinking can be applied to uncover the root causes and contributing factors of these workarounds, helping to optimize future-state systems.
Hennick Bridgepoint Hospital (HBH), a 470-bed post-acute urban academic hospital within the Sinai Health System, in Toronto, Canada, is anticipating EMR system upgrade. HBH had previously been assessed to be HIMSS level 5 for EMR adoption, meaning the EMR is used for all documentation, order entry and closed-loop medication administration. To proactively identify opportunities for improvement, a current state analysis of physician EMR workflows was conducted to uncover key issues and workarounds that affect efficiency and care delivery. Through direct observations and follow-up interviews, we conducted a detailed qualitative analysis of the physical and cognitive tasks associated with physician-EMR interactions. Physicians were actively engaged throughout the process, providing valuable input on their day-to-day interactions with the EMR and the workarounds they employ.
We then applied a systems-level approach to map the physician’s journey from patient admission to discharge, which provided a comprehensive understanding of interconnected clinical workflows and revealed issues, workarounds, and broader system-level issues impacting care delivery. Key themes that emerged from our analysis included inefficiencies in data entry and retrieval, poor EMR integration between acute care and post-acute facilities, widespread interoperability limitations within HBH, and broader system level challenges such as staffing and policy constraints. Finally, despite the HIMSS level designation, we found a continued reliance on paper-based methods in many clinical scenarios where the EMR failed to align with clinical workflows, especially for forms, external referrals, certain tasks (like rapid note taking), and information retrieval from other health-care providers who likewise use paper workarounds for similar reasons. Workflows were analyzed quantitatively to identify the percentage of the workflows that were non EMR-related and still on paper.
These findings highlight significant gaps in understanding physician EMR workflows and relying solely on metrics such as HIMSS adoption scores to assess digital health maturity. To fully grasp physician workflows, it is essential to consider both EMR-related and non-EMR workflows to identify workarounds and uncover broader system-level issues.
This presentation will provide an overview of the current state findings from our study, highlighting practical takeaways. The primary message is the importance of using evidence from real-world workflows to drive future design decisions, ensuring that technology supports rather than hinders clinical practice.
Much of the research within the EMR field has focused solely on mapping EMR workflows to support technology implementation, without fully considering all related clinical workflows and how they are disrupted by EMR use. There is also limited research into the less visible workflows that evolve when using EMRs—namely, workarounds and non-EMR processes that physicians employ to adapt these systems to their real-world contexts post-implementation. In particular, there is little published on how human factors and systems thinking can be applied to uncover the root causes and contributing factors of these workarounds, helping to optimize future-state systems.
Hennick Bridgepoint Hospital (HBH), a 470-bed post-acute urban academic hospital within the Sinai Health System, in Toronto, Canada, is anticipating EMR system upgrade. HBH had previously been assessed to be HIMSS level 5 for EMR adoption, meaning the EMR is used for all documentation, order entry and closed-loop medication administration. To proactively identify opportunities for improvement, a current state analysis of physician EMR workflows was conducted to uncover key issues and workarounds that affect efficiency and care delivery. Through direct observations and follow-up interviews, we conducted a detailed qualitative analysis of the physical and cognitive tasks associated with physician-EMR interactions. Physicians were actively engaged throughout the process, providing valuable input on their day-to-day interactions with the EMR and the workarounds they employ.
We then applied a systems-level approach to map the physician’s journey from patient admission to discharge, which provided a comprehensive understanding of interconnected clinical workflows and revealed issues, workarounds, and broader system-level issues impacting care delivery. Key themes that emerged from our analysis included inefficiencies in data entry and retrieval, poor EMR integration between acute care and post-acute facilities, widespread interoperability limitations within HBH, and broader system level challenges such as staffing and policy constraints. Finally, despite the HIMSS level designation, we found a continued reliance on paper-based methods in many clinical scenarios where the EMR failed to align with clinical workflows, especially for forms, external referrals, certain tasks (like rapid note taking), and information retrieval from other health-care providers who likewise use paper workarounds for similar reasons. Workflows were analyzed quantitatively to identify the percentage of the workflows that were non EMR-related and still on paper.
These findings highlight significant gaps in understanding physician EMR workflows and relying solely on metrics such as HIMSS adoption scores to assess digital health maturity. To fully grasp physician workflows, it is essential to consider both EMR-related and non-EMR workflows to identify workarounds and uncover broader system-level issues.
This presentation will provide an overview of the current state findings from our study, highlighting practical takeaways. The primary message is the importance of using evidence from real-world workflows to drive future design decisions, ensuring that technology supports rather than hinders clinical practice.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer