Study: Commercial EHR use increases ED task-shifting, poses safety hazard

Switching from a homegrown electronic health record system to a commercial one in a hospital's emergency department greatly increased the frequency of task-switching by physicians, which can have a negative impact on patient safety, according to a study published recently in the Annals of Emergency Medicine.

The researchers, from MedStar Health in the District of Columbia, and elsewhere, conducted a quasi-experimental study in an urban tertiary care academic emergency department with 90,000 annual patient visits, observing 14 physicians minute by minute to record their time allocation in five categories: use of a computer, verbal communication, time in patient room, time on paper and other. The study was conducted in three phases: prior to the transition from the homegrown EHR to the commercial one; during the transition; and three to four months after the transition.

Not surprisingly, they found an initial increase in computer-related tasks during the transition, which eventually returned to the baseline.

More troubling, though, was the finding that the number of tasks the physicians engaged in per minute increased significantly, the equivalent of 91 additional tasks per eight-hour shift.  

"The increase in task switching observed post-implementation imposes a cognitive burden on the physician and may provide quantifiable support for the perceived increase in stress and workload that many physicians have described in other qualitative studies," the study's authors warned. "In addition to increased stress and frustration, rapid task switching can have serious patient safety implications."

The authors surmised that the connection between the commercial EHR and increased task switching shows that the EHR is not customized to the provider's workflow environment and could be better designed. They also worried that this could have serious consequences in an emergency department, where EHRs are used to complete critical tasks, such as ordering medications. EHR use in emergency departments has been increasing.

Electronic health record design and EHR-related patient safety issues have long been a concern, contributing to provider dissatisfaction even as more of them adopt the systems.

To learn more:
- read the study (.pdf)