Variation in Electronic Health Record Workflow Patterns: A Multisite study

Abstract

Abstract Objectives Electronic health records (EHRs) continue to have significant usability challenges in part due to differences in workflow. The objective of this study was to examine workflow pattern variations for one specific task: emergency physicians placing a magnetic resonance imaging (MRI) order. Methods A between-subjects usability study was conducted using two different major EHR vendor products across four different provider sites (n = 55). A clinical scenario concerning for spinal cord compression was read to participants who then completed an ordering task using a training environment representative of their native EHR. The primary outcome measures were accuracy, time on task, and number of clicks. Results We identified four different workflows to complete the same order. One workflow required two steps (enabled at one site), one workflow required four steps (enabled at two sites), and two workflows required six steps to complete the task (available at all sites). Of the 12 physicians who employed the two-step workflow, 8 (67%) had the correct order and correct indication, the average time on task was 29.65 (standard deviation [SD] = 13.77), and the mean number of clicks was 13.5 (SD = 18.87). In contrast, for the 43 physicians who employed other workflows, 7 (21%) had the correct order and correct indication, with the average time on task of 73.1 (SD = 30.12) and mean clicks of 27.64 (SD = 13.25) (p < 0.01 for all three comparisons). Discussion These different approaches were made possible by technical specifications leading to multiple workflow options available to physicians in the EHR environment. EHR design maximizing usability can reduce the work effort and improve the accuracy of physician ordering.