Assessing EHR use during hospital morning rounds: A multi-faceted study

Abstract

Background: The majority of U.S hospitals have implemented electronic health records (EHRs). While the benefits of EHRs have been widely touted, little is known about their effects on inpatient care, including how well they meet workflow needs and support care.

Objective: Assess the extent to which EHRs support care team workflow during hospital morning rounds.

Design: We applied a mixed-method approach including observations of care teams during morning rounds, semi-structured interviews and an electronic survey of hospital inpatient clinicians. Structured field notes taken during observations were used to identify workflow patterns for analysis. We applied a grounded theory approach to extract emerging themes from interview transcripts and used SPSS Statistics 24 to analyze survey responses.

Setting: Medical units at a major teaching hospital in New England.

Results: Data triangulation across the three analyses yielded four main findings: (1) a high degree of variance in the ways care teams use EHRs during morning rounds. (2) Pervasive use of workarounds at critical points of care (3) EHRs are not used for information sharing and frequently impede intra-care team communication. (4) System design and hospital room settings do not adequately support care team workflow.

Conclusions: Gaps between EHR design and the functionality needed in the complex inpatient environment result in lack of standardized workflows, extensive use of workarounds and team communication issues. These issues pose a threat to patient safety and quality of care. Possible solutions need to include improvements in EHR design, care team training and changes to the hospital room setting.

Fig 1. Example workflows showing variation in EHR use patterns during morning rounds.

Colored squares identify the stages at which the EHR was used. Different colors represent different EHR users in the workflow.

Fig 2. Use of handwriting on patient summary report during rounds.