Int J Med Inform - The effects of EMR deployment on doctors' work practices: a qualitative study in the emergency department of a teaching hospital.

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Resumo

JECTIVE: The goal of this study was to examine the effects of medical notes (MD) in an electronic medical records (EMR) system on doctors' work practices at an Emergency Department (ED).METHODS: We conducted a six-month qualitative study, including in situ field observations and semi-structured interviews, in an ED affiliated with a large teaching hospital during the time periods of before, after, and during the paper-to-electronic transition of the rollout of an EMR system. Data were analyzed using open coding method and various visual representations of workflow diagrams.RESULTS: The use of the EMR in the ED resulted in both direct and indirect effects on ED doctors' work practices. It directly influenced the ED doctors' documentation process: (i) increasing documentation time four to five fold, which in turn significantly increased the number of incomplete charts, (ii) obscuring the distinction between residents' charting inputs and those of attendings, shifting more documentation responsibilities to the residents, and (iii) leading to the use of paper notes as documentation aids to transfer information from the patient bedside to the charting room. EMR use also had indirect consequences: it increased the cognitive burden of doctors, since they had to remember multiple patients' data; it aggravated doctors' multi-tasking due to flexibility in the system use allowing more interruptions; and it caused ED doctors' work to become largely stationary in the charting room, which further contributed to reducing doctors' time with patients and their interaction with nurses.DISCUSSION: We suggest three guidelines for designing future EMR systems to be used in teaching hospitals. First, the design of documentation tools in EMR needs to take into account what we called "note-intensive tasks" to support the collaborative nature of medical work. Second, it should clearly define roles and responsibilities. Lastly, the system should provide a balance between flexibility and interruption to better manage the complex nature of medical work and to facilitate necessary interactions among ED staff and patients in the work environment.

Resumo Limpo

jectiv goal studi examin effect medic note md electron medic record emr system doctor work practic emerg depart edmethod conduct sixmonth qualit studi includ situ field observ semistructur interview ed affili larg teach hospit time period papertoelectron transit rollout emr system data analyz use open code method various visual represent workflow diagramsresult use emr ed result direct indirect effect ed doctor work practic direct influenc ed doctor document process increas document time four five fold turn signific increas number incomplet chart ii obscur distinct resid chart input attend shift document respons resid iii lead use paper note document aid transfer inform patient bedsid chart room emr use also indirect consequ increas cognit burden doctor sinc rememb multipl patient data aggrav doctor multitask due flexibl system use allow interrupt caus ed doctor work becom larg stationari chart room contribut reduc doctor time patient interact nursesdiscuss suggest three guidelin design futur emr system use teach hospit first design document tool emr need take account call noteintens task support collabor natur medic work second clear defin role respons last system provid balanc flexibl interrupt better manag complex natur medic work facilit necessari interact among ed staff patient work environ

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