The 6 Things I Hate About Electronic Charting (EHR)

Computer charting was a big disappointment to me, and I miss pen and paper


 

Iwas about to start a new job and start using EHR i.e. computer charting – I was excited but that quickly faded. Computer charting made my work slower, tedious and overall more difficult. There are a few good features but on the average I was better off with the good ol’ paper and pen. Maybe it will improve in the future. There are flaws in the system and they should be repaired; but no one is listening to nurses. Unfortunately, computer charting for the time being is one more item preventing doctors and nurses to deliver good patient care, and here’s why:

Slow computing

Looking up information used to be as fast as your ability to open a book. With computers it is somewhat easy to find things but you are at the mercy of your machine’s speed and power. You have to wait until the information is downloaded to your screen and pray the computer is running fast that day.

New EHR systems can slow you down. If you go away for 5 minutes, the system will log you out so you have to log in again. If you are in a hurry, the system seem to slow down even further for some reason.

The system does not follow a nurse’s workflow – it has its own mind and dictates how things should be done. The writers of these software probably think nurses should conform to their system rather the other way around.

Slow Internet

Part of the problem is that a lot of these systems are cloud based. So it depends on the Internet connection or worse, on your WiFi connection. I figure that on the average it makes my job one hour longer per shift. I you have an emergency and need to stay away from the computer it get worse. They computer will punish you with a thousand red things. So if you don’t tend to the computer regularly throughout the shift it makes your work slower. When you work with paper and pen you can be as fast as you want. With EHR you are at the mercy of the computer machine or worse the system your employer purchased.

Way too many clicks

This is one of the biggest problem with the software – it takes an excessive amount of clicking to perform any given action. It seems that for every documentation there are many windows to open and in each window several options to click. This is not only time consuming but a health hazard as excessive clicking can cause carpal tunnel syndrome, specially if you do it in a hurry and that is often the case. There are a lot of options that could just be default options. If a patient has a certain condition 0.1% of the time why do we have to click NO 99.9% of the time? There is a disconnect between time spent documenting and documentation priority.

Too much attention to certain documentation that should not take so much time. Some tasks take way too long to document and too many clicks must be performed. The more clicks and parameter you have to fill the more chances of error. The computer catches the errors and require you do start again. Some simple things like entering an order for a PPD test can easily take a half an hour of your precious time if you are not very familiar with it. The problem is that you don’t need certain forms most of the time; so every time you have to do one is a head scratching ritual that can consume all of your time.

Never ending charting

My biggest criticism of EHR charting is that instead of simplifying the work, it does the opposite. In theory computer charting could be more simple but because it does cut a lot of corners they decided to fill that time with more detailed and precise charting – most of it, redundant and useless. More than ever the biggest part of our job is to create these amazing detailed spreadsheets some administrator can enjoy rather than doing real patient care. This is really unfortunate.

Making nurses obsolete

Ultimately I feel sorry for a number of nurses that are being made obsolete because of computer charting. These are older nurses not so technically inclined, which is fine because nurses are not suppose to be computer geeks. They are nurses with excellent patient care and people skills but find next to impossible to deal with all the obstacles imposed by computer charting. Because they have a hard time using the system they are looked down by the younger nurses how are computer savvy and by the administrators. This is very unfortunate because these “obsolete” nurses are being judge for their computer skilled and disposed for all their nursing and long years of experience with patient care. Sad.



Too much information

Information and accuracy is good to a point. But If the creation and storing of information takes more work than is necessary than this information is not only useless but an expensive distraction. This expensive bill is footed to the patient in the form of less time and attention. Sometimes if feels like we are doing computer care rather than patient care.

For example when inputting new drug orders or diagnosis you must first match them up with an existing database in the system in order to enter it. This in turn makes the work more cumbersome and there is even more chance for errors since you are no longer coping on information from one source to another but pulling it from a different database. Now you have one more task and that is make sure it all matches and that can be deceiving at times. But nurses are not the only victims.

Doctors, administrators, therapists all suffer this redundancy, time consuming madness of entering detailed database.

Less patient care and more computer work

In the end of the day I feel like I’m more of a data entry person than a nurse. It feels like I’m stuck in front of a computer most of the time. It’s kind of like: one minute with the patient and 5 minutes in the computer. It is a great loss for the patients that not only have to compete for the nurse’s time with other patients but now there is invisible robot that is hogging all the nurses’s time.

Out of sight, out of mind – computer filing does provide visual markers. If a file is a fax comes out of a printer you know is there. If a fax is in the computer it will simply have more chances of being forgotten.

The Good

Of course there are good things about electronic charting. The first one would be for example the end of doctors’ writing. Provided they know how to type (because we know they don’t know how to write) we can actually read the orders, and that is a good thing. The other good thing is that all the information is in one spot and can be easily retrieved. Communications between facilities such as labs, and comprehensive care is getting better i.e. others health care workers imputing data that can be share over a network. Not always possible but I believe that in the future this will become common place.

Writing a nurses note can be more accurately done and we don’t have to depend on other people’s hand writing to understand.

In the end of the day computer charting and EHR is in its infancy. We have to remind ourselves that its implementation was only done about 5 years ago. As technology improves it will make computer charting more efficient. Right now we are just in a trial faze and having to iron out the kinks.

I believe nursing should focus in patient care. To me electronic charting is only as good as its ability provide and improve patient care and help nurses to provide good patient care. Unfortunately good patient care takes time and that is exactly where electronic charting could be helpful by minimizing the time nurses have to chart and not making it longer and more complicated.

Final considerations

I think computers might be practical provided they work like they’re supposed to. However on the long run computers might be making us more dumb. Computer software has an uncanny ability to create check points on every step of charting. Information must be processed and collected exactly in the way the programmers planned. This is good and bad because programmers are not working in the field and have zero idea how things really work. Because with computers there is no cheating we have to comply with every single thing software impose on us. So ultimately nurses choose to complete charting over seeing patients because they need to protect their jobs. Patient quality care is the big looser in the end. Unfortunately there is a disconnect between software designers and what nurses need in order to provide good patient care. Software and database requirements end up wining in the end because management wants all the information they need and they are not paying attention to the cost it take for nurses to produce these insanely accurate and complex spreadsheets people in offices like so much.

Resources

  1. Electronic Health Records Documentation in Nursing: Nurses’ Perceptions, Attitudes, and Preferences
  2. Evaluating the Impact of Computerized Clinical Documentation
  3. Informatics: The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves?
  4. ELECTRONIC MEDICAL RECORD IMPLEMENTATION IN NURSING PRACTICE: 
    A LITERATURE REVIEW OF THE FACTORS OF SUCCESS

Image credit flickr

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Meet the Author

Marcos Taquechel

Marcos works as an RN in sub acute care and with the elderly. He believes you can heal yourself. By providing good useful information, others can use and transform their life. He keep searching for natural healing that produce results. Please leave a comment. Thank you

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