View source for You and me and the computer makes three: variations in exam room use of the electronic health record

== Background ==
This article discusses the challenges of bringing an EHR into the workflow of a clinical setting without too much disruption.  Through interviews and observation, the researchers looked at 20 outpatient clinicians and found many differences in the barriers faced with EHR implementation in the exam rooms and how that influences [[Describing and Modeling Workflow and Information Flow in Chronic Disease Care|workflow]] and the relationship between provider and patient.  <ref name="You and me and computer makes three">Saleem, J.J., Flanagan, M.E., Russ, A.L., McMullen, C.K., Elli, L., Russell, S.A., Bennet, K.J., Rehman, S.U., Schwartz, M.D., Frankel, R.M.  (2014). You and me and the computer makes three: variations in exam room use of the electronic health record. Journal of American Medical Informatics Association, 21, 147-151. Retrieved from http://jamia.oxfordjournals.org/content/21/e1/e147.short</ref>

== Methods ==
The researchers conducted interviews with various clinicians to understand the ways EHR use differed among the providers and the clinics.  Field observations also occurred to record the patient’s clinical encounter.  The data collected was organized into four categories: barriers, facilities, deviations, and routine variations.  

== Results ==
Although there were a great deal of differences in how the EHR was used throughout the clinic encounter, some of barriers encountered included: 
<ol>
# The amount of time spent on reviewing or documenting in the EHR depended on how familiar the clinician was with the patient or whether it was a new patient
# Communication with other clinicians for consults and care coordination became a barrier, since it required using the EHR rather than face to face communication
# The provider to patient interaction was affected by the extra glances to document in the EHR
# The time it took to complete a note also affected the workflow of clinicians
</ol>
== Conclusion ==
The researchers concluded that because of the great variations in EHR use, implementation needs to accommodate for this variation by designing the EHR to fit the clinician’s needs.

== Comments ==
I enjoyed this article as it identified many of the barriers for clinicians in introducing EHR systems into their workflows.  I think it would be interesting to list the types of barriers based on the type of clinicians interviewed.  The documentation for physicians and nursing is so different, that I believe they almost need to be looked at separately.  

== Related Links ==
#[[EHR-enabled_Research]]
#[[Health Information Technology: Integration of Clinical Workflow into Meaningful Use of Electronic Health Records]]


===References===
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[[Category: Reviews]]
[[Category: EHR]]
[[Category: Workflow]]