Applied Medical Informatics for the Chest Physician: Clinicians Expectation
Clinician time spent and the value perceived in the EMR remains one of the primary concerns in the United States. In more recent studies, physicians have definitely ranked EMRs toward the top of the solutions to decreasing the number of medical errors. However, it is important to understand that, even in the most optimistic investigations, the physician use of EMRs, in particular order entry, takes more time compared to the physical process of writing orders on an order form at this point in time. this
Even in the realm of computer hardware in support of EMR use, there are emerging data suggesting that different clinicians (ie, physicians vs nurses) obtain differing value from the location of computer terminals. In a recent study, the use of bedside terminals and central station desktop computers saved nurses 24.5% and 23.5%, respectively, of their overall time spent documenting during a shift. However, in the same study, the use of central station desktop computers for physician order entry was found to be inefficient, increasing the work time from 98.1 to 328.6% of a physician’s time per working shift.
Finally, to realistically approach the issue of clinician expectations and the EMR, we need to know how our colleagues are reacting to it. For example, in a well-done recent survey study of the emotional aspects of CPOE, the implementation and use of systems provoked examples of positive, negative, and neutral emotional responses. However, negative emotional responses were the most prevalent, by far, in all of the observations.
The Oxford English Dictionary defines the word interoperability as “the ability of computer systems or software to exchange and make use of information.” In the world of the EMR, this one element has possibly caused more confusion and frustration than any other. Interoperability is essentially the ability to interconnect different computer systems (eg, the laboratory, the radiology department, the pharmacy, and the medical records department) and have them work well together. Although it is possible to have this occur (Fig 2), it is also quite common for the connections between systems, or interfaces, to be complex and error prone, and to require as significant maintenance as any of the changes in interconnected components.
Figure 2. Standards that Link information systems.