Post date: Oct 14, 2010 12:55:50 PM
The presumption for most electronic medical record systems is the increased effectiveness and efficiency of clinical work. A few days ago I ran across the Furukawa et al (2010) study of medical surgical units in California hospitals between 1998-2007. They reported significantly higher inefficiency with nursing documentation, electronic medication administration records, and clinical decision support. So maybe this finding was just in California?
Today I ran across a review article that suggests the increase in clinical effectiveness has come at a cost of inefficiency. Niazkhani et al (2009) in their JAMIA article concluded:
"When put in practice, the formal, predefined, stepwise, and role-based models of workflow underlying
CPOE systems may show a fragile compatibility with the contingent, pragmatic, and co-constructive nature of workflow. This in turn can cause an interruption in workflow and challenge the integration of these systems into daily practice." p. 546
Greenhalgh et al (2009) in the Milbank Quarterly had similar findings in a review article:
(1) the EPR may be alternatively conceptualized as an “itinerary,” “organizer,” or “actor”; (2) seamless integration of different EPR systems is unlikely because human work will always be needed to bridge the model-reality gap and recontextualize knowledge for different uses; (3) while secondary work (audit, research, billing) may be made more efficient by the EPR, primary clinical work is often made less efficient; (4) the EPR may support, but will not drive, changes in the social order of the workplace; (5) paper will not necessarily disappear, as it offers a unique level of ecological flexibility (although workable paperless systems have been developed in one or two centers); and (6) smaller, more local EPR systems may often (though perhaps not always) be more efficient and effective than larger ones." p. 767
Two review articles from journals with different research traditions that resonate with each other. If the presumption is better efficiency but the outcome is less efficiency - doesn't that mean there has been an HCIT failure? At what cost should we push EMR's if we know that there is growing evidence that inefficiency in many cases is the likely price. Have these systems changed so much in the past few years to refute this growing body of evidence? Raising the awareness of the research community to these findings is the goal of this website as the problems are complex and multi-disciplinary research needs to be the norm to help our respective countries find solutions (or at least understand) to the rising cost of healthcare.