Ratanawongsa Neda, Matta George Y, Bohsali Fuad B, Chisolm Margaret S
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.
University of California, San Francisco Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, United States.
JMIR Hum Factors. 2018 Feb 6;5(1):e4. doi: 10.2196/humanfactors.9371.
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.
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.
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.
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.
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.
临床医生在执行多项任务时使用电子健康记录（EHR）系统可能会增加犯错风险，但在使用EHR系统时保持沉默可能会降低患者满意度。将EHR系统的使用推迟到患者就诊结束后，可能会增加临床医生的EHR工作量、压力和职业倦怠。
我们旨在描述临床医生、教育工作者、管理人员和研究人员对于他们认为与临床医生在使用EHR系统时执行多项任务相关的失误和险些失误的看法。
这项观察性研究是对63名继续医学教育（CME）参与者在2次研讨会和1次互动讲座中所表达观点的主题分析，这些活动围绕临床医生使用EHR系统时以关系为中心的沟通面临的挑战和策略展开。研讨会促使参与者反思在使用EHR系统时同时执行多项任务与“失误”（当时未被发现的错误）或“险些失误”（在导致错误之前被发现的失误）相关的难忘时刻。我们采用编辑分析方式进行定性分析，以识别编码，然后选择具有代表性的主题和引述。
所有研讨会参与者都分享了在EHR系统订单录入、文档记录或医患沟通中出现失误或险些失误的故事，并对“我们甚至都不知道的失误”表示担忧。风险因素包括电脑位置、EHR系统可用性、记录内容和格式、信息过载、有问题的工作流程、系统问题以及医护人员与患者的沟通行为和期望。减少在使用EHR系统时执行多项任务所导致失误的策略包括：临床医生在需要安静使用EHR系统（如开处方）时保持透明，对EHR系统的使用进行口述，在使用EHR系统时提高患者的参与度，调整就诊安排和工作流程，改进EHR系统设计，以及加强团队支持和系统建设。
CME参与者分享了许多他们认为与EHR多任务处理相关的EHR任务和沟通中的错误及险些失误的故事。然而，他们集思广益，提出了在安全使用EHR系统的同时维护患者关系的各种策略。
