Ways In Which The EMR Might Change The Clinical Workflow And The Logic For Why They Are Changed?

1. Discuss ways in which the EMR might change the clinical workflow and the logic for why they are changed.
EMRs are generally made to fit workflows rather then used to change workflows. EMRs are generally seen as means to automate existing clinical pathways. As Sicotte (2017) showed “User satisfaction was high when [they] can largely apply innovative uses of information technologies that automate their clinical processes.” p. 8. Yet the true advantage of an EMR is improving workflows. As Vishwanath (2010) discussed the benefit of an EMR is its “ability to reduce the costs of healthcare delivery and improve the overall quality of care – a promise that is realized through major changes in workflows within the healthcare organization. p778.
Nurses and medical assistant can review the information for accuracy, but no longer need to spend hours on data entry. On the outflow end, call backs for annual exams mammograms, test, colonoscopies, use to be very time consuming and labor intensive. Now the EMR can generated and perform these reminders with little or no human oversight. Vishwanat (2010) further pointed out the “some of the research to-date points to reduced satisfaction among physicians after implementation of the EMR and increased time, i.e., negative workflow effects p778. A large part of this dissatisfaction with with the EMR on the part of physicians is due to a refusal to adjust and modify workflows. Many providers are stuck in the dictation mode from days gone by when they used transcriptionist. Todays EMR allow for ease of charting which can not only document the physicians finding, but pull in data, labs, and even generate prescription all from the field used to create the progress note. Use of the new workflows result in quicker filling of script for patients, more complete medical records that support billing, and ultimately
IT has allowed institutions to collect this data which is then reported to CMS and other organizations for evaluation. Without IT the process would be quite laborious. Using IT to capture this data has also allowed institutions to evaluate their progress on a regular bases and implement change, measure the benefit of that change, and achieve better compliance. On the inpatient side, the early use of PQRS and now value based purchasing has improved patient outcomes. Guidelines such as SCIP has also improved perioperative outcomes. As Weston (2013) discussed, “The Surgical Care Improvement Project (SCIP) started in 2006 as a core measure to reduce perioperative morbidity and mortality, with many measures addressing perioperative antibiotic usage and timing” p.424. I have personally seen these measures put into practice with improve antibiotic stewardship and out comes. Yet these compliance with these guidelines come at a cost. As Weston further discussed, “this improved compliance comes at the cost of significant time, money, and staff resources.” p. 424. The proper use of IT and an EMR should and does reduce the time and staff needed, but is a major source of increased cost. Probably the biggest worst outcome of PQRS and value based purchasing is the effect on the opioid crisis. While many legislator continue to admit the