Study: Changing to Commercial EHR Technology Increases ER Doctors’ Task Switching

"Findings Point to Potential Safety Hazard"

The latest study published by researchers with the National Center for Human Factors in Healthcare finds that changing to a commercial EHR from a homegrown version caused busy emergency physicians to perform more tasks per minute at a rate that was sustained months after implementation of the new system, thus increasing the potential for patient safety hazards.

The study was published online on Sept. 18 in Annals of Emergency Medicine and is titled “Emergency Physician Task Switching Increases with the Introduction of a Commercial Electronic Health Record.”

To see how physicians had to adjust their work activities to accommodate new technology, the researchers observed 14 physicians over a four-month period in phases: one month before implementation of a commercial EHR, one week following implementation, and three to four months after implementation.

In particular, the researchers, led by Raj Ratwani, PhD, scientific director of the Human Factors Center, were interested in learning the amount of time it would take the physicians to perform certain tasks on the EHR,  and the number of tasks per minute each would perform, a measure of task switching.

What they found is that the time to complete tasks initially increased but then returned to baseline. However, the average number of tasks completed by each physician per minute increased significantly with the commercial EHR three months after use, from 1.7 tasks per minute during the preimplementation period to 1.9 during postimplementation, a difference of 0.19 tasks per minute.

Performing more tasks per minute, or rapid task switching, adds to the cognitive workload of a physician in an already stressful clinical environment.  Increased stress and frustration, and rapid task switching increase the likelihood of error and may pose serious patient safety risks.

One factor that may be leading to increased task switching is poor EHR usability. The EHR may not support the workflow of the physician, and therefore does not meet the needs of the end-user. The study concludes the importance of determining whether a commercial EHR can be easily customized to meet the workflow needs of clinicians and avoid the risks to patient safety from the added stress and burden of frequent task switching that may occur without customization to physician needs.

Ratwani and his MedStar Health colleagues have published other EHR studies recently, and he has been called on to provide expert testimony to policymakers regarding usability and safety of EHRs:

  • On Sept. 16, Ratwani testified before the U.S. Senate Health Education Pensions and Labor Committee that EHRs should be designed to work the way clinicians do, and that personal health records should present information which is meaningful and relevant to consumers.
  • On Sept. 8, the Journal of the American Medical Association published research by Ratwani, et al, that found EHR systems are not meeting government standards for following a user-centered design and usability testing processes, but are being certified under the meaningful use program that is incentivizing hospitals and health systems to implement EHRs.

Ratwani says of the latest study, “This work is one example of how important it is to design health IT systems with end-users in mind and to test health IT systems with actual users to understand how the new system impacts their work processes. This testing is an important component of a usability process that vendors should adopt for clinician and patient satisfaction—and importantly, for safety.”


 About the National Center for Human Factors in Healthcare

The National Center for Human Factors in Healthcare occupies a unique position in the United States as a large human factors program embedded within a healthcare system. It brings together human factors scientists, systems safety engineers, health services researchers, and clinicians to conduct safety science and applied research in medicine to improve safety, quality, efficiency, and reliability. The center is part of the MedStar Institute for Innovation and is affiliated also with the MedStar Health Research Institute. MedStar Health, the parent organization, is the largest not-for-profit healthcare provider in the Maryland and Washington, D.C., region, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.

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Ann Nickels
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