EHRs need better workflows, less 'chartjunk'

Electronic health records currently handle data poorly and should be enhanced to better collect, display and use it to support clinical care, according to a new study published in JMIR Medical Informatics.

The authors, from Beth Israel Deaconess Medical Center and elsewhere, state that the next generation of EHRs need to improve workflow, clinical decision-making and clinical notes. They decry some of the problems with existing EHRs, including data that is not displayed well, under networked, underutilized and wasted. The lack of available data causes errors, creates inefficiencies and increases costs. Data is also "thoughtlessly carried forward or copied and pasted into the current note" creating "chartjunk," the researchers say.

They suggest ways that future EHRs can be improved, including:

  • Integrating bedside and telemetry monitoring systems with EHRs to provide data analytics that could support real time clinical assessments
  • Formulating notes in real-time using structured data and natural language processing on the free text being entered
  • Formulating treatment plans using information in the EHR plus a review of population data bases to identify similar patients, their treatments and outcomes
  • Creating a more "intelligent" design that capitalizes on the note writing process as well as the contents of the note.

"We have begun to recognize the power of data in other domains and are beginning to apply it to the clinical space, applying digitization as a necessary but insufficient tool for this purpose," the researchers say. "The vast amount of information and clinical choices demands that we provide better supports for making decisions and effectively documenting them."

Many have pointed out the flaws in current EHR design that impede the optimum use of data and hinder workflow. Researchers have suggested that EHRs can be part of a learning health system to better capture and use data to improve clinical practice, create new evidence, educate, and support research efforts.

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