The assault on usability of electronic health records continues, though this time it comes not from physicians, but from nurses. And it makes sense, because nurses frequently are the ones responsible for the bulk of patient documentation.
Sunday’s New York Times contained an op-ed from nurse and author Theresa Brown, whose book, “The Shift: One Nurse, Twelve Hours, Four Patients’ Lives,” is scoring positive reviews on Amazon.com and Goodreads.
“Computer documentation in health care is notoriously inefficient and unwieldy, but an even more serious problem is that it has morphed into more than an account of our work; it has replaced the work itself,” Brown wrote.
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Consider this:
A nurse could spend 10 minutes documenting a patient’s fall risk, or 10 minutes trying to keep patients from falling. It seems obvious that a computer record of “fall risk” cannot in and of itself prevent falls, but completing those records is considered essential in hospitals. As a result, real fall-prevention efforts — encouraging patients to use the call light, ordering a bedside commode, having an aide do hourly check-ins — get short shrift.
Indeed, that is along the lines of what Brown said happened to a friend of hers who was hospitalized after a cycling accident. According to Brown, a nursing student asked the patient to assess her pain level. The student recorded the number, then promptly left without doing anything about the pain, for only one reason: “Our charting, rather than our care, is increasingly what we are evaluated on,” Brown noted.
Nurses might make their scores, but patient care can suffer. Brown shared this story from her own work in home hospice care:
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I once had an oxygen-dependent centenarian patient in heart failure seeking admission to hospice. The hospice physician asked for further proof that the patient met the strict standards for hospice admission. It was a weekend, and during the time it took for me to collect that information, the patient died.
Brown concluded that EHRs need to be realigned to “serve just one master: the patient.” But who is to blame for these shortfalls?
It’s easy to lay responsibility at the feet of the vendors, but just as with interoperability problems, workflows are just as much a culprit. Perhaps institutions need to re-evaluate how they measure care quality.
Photo: Flickr user DIBP Images
