Reducing misses and near misses related to multitasking on the electronic health record: Observational study and qualitative analysis

Neda Ratanawongsa, George Y. Matta, Fuad B. Bohsali, Margaret S Chisolm

Research output: Contribution to journalArticle

Abstract

Background: Clinicians� use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians� EHR workload, stress, and burnout. Objective: We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods: This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with �misses� (errors that were not caught at the time) or �near misses� (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about �misses we don�t even know about.� Risk factors included the computer�s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions: CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

Original languageEnglish (US)
JournalJournal of Medical Internet Research
Volume20
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Electronic Health Records
Observational Studies
Communication
Continuing Medical Education
Workflow
Education
Patient Participation
Workload
Administrative Personnel
Patient Satisfaction

Keywords

  • Electronic health records
  • Patient safety
  • Physician-patient relations

ASJC Scopus subject areas

  • Health Informatics

Cite this

Reducing misses and near misses related to multitasking on the electronic health record : Observational study and qualitative analysis. / Ratanawongsa, Neda; Matta, George Y.; Bohsali, Fuad B.; Chisolm, Margaret S.

In: Journal of Medical Internet Research, Vol. 20, No. 2, 01.02.2018.

Research output: Contribution to journalArticle

@article{c0d36181bf5d4aed827bf587f1c6ac3d,
title = "Reducing misses and near misses related to multitasking on the electronic health record: Observational study and qualitative analysis",
abstract = "Background: Clinicians� use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians� EHR workload, stress, and burnout. Objective: We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods: This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with �misses� (errors that were not caught at the time) or �near misses� (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about �misses we don�t even know about.� Risk factors included the computer�s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions: CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.",
keywords = "Electronic health records, Patient safety, Physician-patient relations",
author = "Neda Ratanawongsa and Matta, {George Y.} and Bohsali, {Fuad B.} and Chisolm, {Margaret S}",
year = "2018",
month = "2",
day = "1",
doi = "10.2196/humanfactors.9371",
language = "English (US)",
volume = "20",
journal = "Journal of Medical Internet Research",
issn = "1439-4456",
publisher = "Journal of medical Internet Research",
number = "2",

}

TY - JOUR

T1 - Reducing misses and near misses related to multitasking on the electronic health record

T2 - Observational study and qualitative analysis

AU - Ratanawongsa, Neda

AU - Matta, George Y.

AU - Bohsali, Fuad B.

AU - Chisolm, Margaret S

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Background: Clinicians� use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians� EHR workload, stress, and burnout. Objective: We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods: This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with �misses� (errors that were not caught at the time) or �near misses� (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about �misses we don�t even know about.� Risk factors included the computer�s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions: CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

AB - Background: Clinicians� use of electronic health record (EHR) systems while multitasking may increase the risk of making errors, but silent EHR system use may lower patient satisfaction. Delaying EHR system use until after patient visits may increase clinicians� EHR workload, stress, and burnout. Objective: We aimed to describe the perspectives of clinicians, educators, administrators, and researchers about misses and near misses that they felt were related to clinician multitasking while using EHR systems. Methods: This observational study was a thematic analysis of perspectives elicited from 63 continuing medical education (CME) participants during 2 workshops and 1 interactive lecture about challenges and strategies for relationship-centered communication during clinician EHR system use. The workshop elicited reflection about memorable times when multitasking EHR use was associated with �misses� (errors that were not caught at the time) or �near misses� (mistakes that were caught before leading to errors). We conducted qualitative analysis using an editing analysis style to identify codes and then select representative themes and quotes. Results: All workshop participants shared stories of misses or near misses in EHR system ordering and documentation or patient-clinician communication, wondering about �misses we don�t even know about.� Risk factors included the computer�s position, EHR system usability, note content and style, information overload, problematic workflows, systems issues, and provider and patient communication behaviors and expectations. Strategies to reduce multitasking EHR system misses included clinician transparency when needing silent EHR system use (eg, for prescribing), narrating EHR system use, patient activation during EHR system use, adapting visit organization and workflow, improving EHR system design, and improving team support and systems. Conclusions: CME participants shared numerous stories of errors and near misses in EHR tasks and communication that they felt related to EHR multitasking. However, they brainstormed diverse strategies for using EHR systems safely while preserving patient relationships.

KW - Electronic health records

KW - Patient safety

KW - Physician-patient relations

UR - http://www.scopus.com/inward/record.url?scp=85042102554&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042102554&partnerID=8YFLogxK

U2 - 10.2196/humanfactors.9371

DO - 10.2196/humanfactors.9371

M3 - Article

C2 - 29410388

AN - SCOPUS:85042102554

VL - 20

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

IS - 2

ER -