Advances in health information technology such as Electronic Health Records (EHRs) can reduce the burden of complexity on clinicians, potentially improving quality, safety, and efficiency of healthcare. With the financial incentives offered by the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA), which linked payments to the development of "Meaningful Use" (MU) criteria for EHRs, these systems are becoming more prevalent and their acceptability to users and impact in clinical contexts are of increased importance. We propose an evidence-based, empirical approach for investigating three specific critical elements of clinical workflow: information seeking, team interaction, and decision making in the context of clinicians'use of EHRs. Although we focus our experiments on the use of EHRs in emergency departments (EDs), the results should generalize to other clinical settings in which EHRs must be integrated with clinical workflow. Clinicians'use of EHRs in relation to the three workflow elements will be evaluated using a set of five clinical quality and efficiency metrics during the implementation of features in response to Stage 2 MU criteria. We utilize a set of methodologies to capture, analyze and characterize the impact of EHRs so as to inform future MU-compliant implementation strategies. Our methods include environmental observations, clinician shadowing, log-file analysis, and radio frequency identification (RFID) sensor-based tracking. Such process-oriented studies, conducted in two adult emergency departments at two urban hospitals, supported by the evaluation of care outcomes, will guide the development of generalizable design guidelines that are better integrated within the social fabric of the clinical environment. We seek results that will contribute to the development of patient-safety and quality guidelines for EHR improvement, which will be suitable for incorporation into future MU stages. These results will also provide the Office of the National Coordinator (ONC) and the Centers for Medicare &Medicaid Services (CMS) with evidence to guide the evolving certification criteria for EHR vendors, and future regulations promoting meaningful use of EHRs.

Public Health Relevance

In recent years, the federal government has provided incentives to motivate the implementation and meaningful use of electronic health record (EHR) systems as a means for achieving better quality, safety, and efficiency in healthcare. However, we know very little about how EHRs affect workflow in complex clinical environments, such as emergency departments. The proposed research investigates how compliance with the meaningful use criteria affects the information seeking, team-interaction and decision-making activities of ED clinicians at two urban hospitals. The results will provide much-needed evidence to the ONC and CMS to support future regulations promoting the design and meaningful use of EHRs.

National Institute of Health (NIH)
Research Project (R01)
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Health Care Technology and Decision Science (HTDS)
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Lomotan, Edwin A
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New York Academy of Medicine
New York
United States
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