View source for Workstation Assessment for EHR Implementation at a tertiary care center

This decade has witnessed an increased adoption of [[EMR|Clinical Information Systems]]. The adoption has been seen in large hospitals and small practices with the aim of improving patient care, transition of care and, improved quality at the point of care and medical outcomes. Constant evaluation of these systems, esp the hardware and software used, is critical for improvement. 

The most prominent hardware systems used for [[CPOE]] implementation are desktop computers, carts on wheels (COWs) and wall mounted units (WMUs). COWs have been proposed to be particularly helpful to nurses entering data and for clinicians to enter notes and review clinical data at patient bedside. I conducted a study on physicians, nurses and other healthcare personnel at a tertiary care centre where we initially assessed the utilization of the available desktops, WMUs and COWs every 15 minutes to assess the popularity of each and then a survey was conducted on the physicians, nurses and health care professionals to assess the reasons for differences, if any. 

The study showed that the desktops were the most popular and most utilized and COWs were actually the least popular among the three hardware devices. When interrogated for utilization every 15 minutes for 3 days in a Unit, desktop occupancy was 66.2% versus 25.4% for wall mounted units and 5.6% for carts on wheels. COWs were noted to be cumbersome and often discharged, preventing their use. Interestingly, most healthcare personnel did not want to enter patient data at patient bedside. Physicians and nurses liked to put in their notes and orders while sitting, esp. after long and stressful days, making desktop computers popular. Wireless carts also do not provide access to a chairs or phones which were identified as important requirements. Easy access to phones was important to communicate with colleagues, referring physicians, consultants, labs and the family and their proximity to the desktop units made them the most popular. It was seen that the WMUs were also less popular, mainly due to inaccessibility to seating and phones. 

To make the wireless carts more useful and usable, it was found that it could be helpful to attach a small chair and a telephone and allocate charging responsibility in an efficient manner. It was felt that availability of desktop computers at the nursing stations seem to be the most used of the three hardware devices but physicians also felt that their availability in physician and discharge lounges would be of great benefit. 

EHRs have the potential to transform healthcare but their adoption needs to be adequately supported to get maximum value for an organization. Some of the key issues that may impede the successful implementation of inpatient EHRs should be identified and the proposed alternatives that can help overcome the challenges should be readily embraced. 

==Related Articles ==

*[[Using a medical simulation center as an electronic health record usability laboratory]]

[[Category: EHR]]