Productivity

Physicians Provide Feedback on Order Entry

As clinicians become more dependent on their EHR systems and more sophisticated in their use of advanced functionalities, a capability that provides significant value is order entry. However, training, systems design, workflow integration, and usability all impact the ability to use these advanced features effectively. The following comments were submitted by clinicians who have completed the AmericanEHR Partners’ EHR satisfaction survey:

  • Order entry is the main burden of all systems. The burden of order entry has shifted to the doctor — unless the practice has enough ancillary support to un-burden the doctor and to have MAs or LVNs doing order entry that the physician just authorizes. The order entry is the one thing that slows up the doctor and interferes with efficiency. Review of lab and x-ray information, accessing things over time, is the greatest asset of all of these systems.
  • Order entry, prescription entry and data review are not particularly user-friendly. These items require learning non-traditional formats to order tests, prescribe medications, and rapidly review test results and office notes. While implementation of EHR in our practice has allowed compliance with government-required mandates, overall practice efficiency and patient care have not been enhanced and in fact, have suffered somewhat. It is uncertain what testing was performed prior to implementation of this system (i.e. were health care providers allowed to give feedback) as many of the available features are in relatively unfamiliar formats — while feedback is given in our practice, it doesn’t appear to result in design/programming changes.
  • Our EHR is still being phased in — we do not have on-line notes (they are dictated), order entry is less than one year old — that said, we do know that the EHR system has many limitations and will not ever provide the functionality we need.
  • This is our second EMR. No matter what system we use we cannot regain the efficiency in terms of numbers of patients we can see with any EMR. Prescription writing and order entry is VERY tedious and time consuming. We cannot get help from MA and nurses for ePrescriptions and must look all the info about labs and future and past visits that is needed info to refill prescriptions. More and more of the work that we could delegate is now falling on our shoulders because of the nature of these systems. The communications among physicians and staff that these systems allow DOES NOT make up for the revenue loss from our inability to see the volume of patients. We spend more time pointing and clicking to fulfill documentation rules and less time talking to examining and thinking about patients. The quality of our care IS IN NO WAY improved by having an EMR and we have been at this EMR thing since ’04. There is NO EMR that will save doctors time. This one is as good or bad as any.
  • Most of my concerns relate to the use of the EHR product in my current location. I have prior EHR experience both inpatient and outpatient. My former institution was a superuser including computer order entry. My current institution has not yet started computer order entry and has not embraced all of the system’s functionality. Overall, the support issues and dissatisfaction are related mostly to the lack of institutional investment in maintaining the support at the level needed. As a surgeon, all EHRs are based off of a primary care platform making it difficult to use in a specialty practice for tracking pathology reports and setting surveillance reminders. I do surgical oncology and I have yet to meet the product that can help me do it better… I just adapt. Last point, I would not go back to non-electronic charting and believe it ultimately makes it easier to access information and provide patient care once the new language is learned.

What is your experience with order entry? Is it a benefit or limitation in your EHR system?

Comments:

4 responses to "Physicians Provide Feedback on Order Entry"
  • July 27, 2012
    Janet Thurston RN MSN
    said:

    What would be the most effective support in post implementation, regarding EHR use. Is there anything that helps improve efficiency?

  • July 31, 2012
    Alan Brookstone, MD
    said:

    Based upon member feedback, more training and practice. Usability is a limiting factor. If EHRs are not optimized for usability, improving efficiency beyond a certain point can be very difficult.

  • August 2, 2012
    William Reed, MD
    said:

    Someone observed that in data entry, any time spent using a mouse is time wasted. What softwares use keying as the predominant if not sole means of data entry?
    On a related note, does American EHR Partners do testing on the time it takes to do any given function on multiple softwares?

  • August 8, 2012
    Alan Brookstone, MD
    said:

    As EHRs moved away from text-based entry towards graphical user interfaces, mouse entry has become more common, however I agree that it is not an efficient mechanism to enter data into an EHR. Some EHR applications allow for keyboard shortcuts and key-strokes in order to enter data, however we are not aware exactly which applications do so and in which functional areas.

    At this time, AmericanEHR does not test the functions of specific EHRs. Key challenges are the sheer number of EHR applications and also the effect of version on the performance of a specific EHR. In one version, a particular function may be slow, but this could be corrected in the next version update making it very difficult to measure and report on.

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