Review: EHRs can make healthcare workflow less efficient
EHR use will always require human input to recontextualize knowledge, according to a review published December in Milbank Quarterly.
Even though secondary work, such as auditing, research and billing, may be made more efficient through the use of EHRs, primary clinical work may be less efficient, according to Trisha Greenhalgh, MD, professor of primary healthcare at University College London, and colleagues.
Additionally, the authors’ findings further suggested that:
Using a meta-narrative method, the researchers conducted a literature review using “conflicting” findings to address questions about how previous researchers had differently conceptualized and studied the EHR and its implementation. They sifted through a total of 567 sources for the review: 49 seminal sources, 400 background sources, 24 systematic reviews and 94 empirical studies.
EHR literature reviews present challenges to systematic reviews, according to the authors, so they employed a meta-narrative method because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches.
“The meta-narrative should be regarded not as the unified voice of a community of scholars but as the unfolding of what they are currently disagreeing on,” the authors wrote.
According to Greenhalgh and colleagues, key tensions in the literature centered on:
While attempting to present the mainstream, traditionally positivist biomedical literature as incommensurable with studies written from interpretive, critical and recursive positions, the authors wrote that the latest evidence suggests a less polarized picture.
“Studies from both inside and outside the health informatics tradition are raising questions about both the scalability and the transferability of [EHR] systems, especially when such systems are developed commercially rather than grown organically as part of an emergent change effort,” they wrote.
Greenhalgh and colleagues additionally concluded that an agenda for further research is “urgently needed.”
Even though secondary work, such as auditing, research and billing, may be made more efficient through the use of EHRs, primary clinical work may be less efficient, according to Trisha Greenhalgh, MD, professor of primary healthcare at University College London, and colleagues.
Additionally, the authors’ findings further suggested that:
- Paper may offer a unique degree of ecological flexibility; and
- Smaller EHR systems may sometimes be more efficient and effective than larger ones.
Using a meta-narrative method, the researchers conducted a literature review using “conflicting” findings to address questions about how previous researchers had differently conceptualized and studied the EHR and its implementation. They sifted through a total of 567 sources for the review: 49 seminal sources, 400 background sources, 24 systematic reviews and 94 empirical studies.
EHR literature reviews present challenges to systematic reviews, according to the authors, so they employed a meta-narrative method because it covers multiple research traditions with different underlying philosophical assumptions and methodological approaches.
“The meta-narrative should be regarded not as the unified voice of a community of scholars but as the unfolding of what they are currently disagreeing on,” the authors wrote.
According to Greenhalgh and colleagues, key tensions in the literature centered on:
- EHR, itself (“container” or “itinerary”);
- EHR user (“information-processer” or “member of socio-technical network”);
- Organizational context (“the setting within which the EHR is implemented” or “the EHR-in-use”);
- Clinical work (“decision making” or “situated practice”);
- Process of change (“the logic of determinism” or “the logic of opposition”);
- Implementation success (“objectively defined” or “socially negotiated”); and
- Complexity and scale (“the bigger the better” or “small is beautiful”).
While attempting to present the mainstream, traditionally positivist biomedical literature as incommensurable with studies written from interpretive, critical and recursive positions, the authors wrote that the latest evidence suggests a less polarized picture.
“Studies from both inside and outside the health informatics tradition are raising questions about both the scalability and the transferability of [EHR] systems, especially when such systems are developed commercially rather than grown organically as part of an emergent change effort,” they wrote.
Greenhalgh and colleagues additionally concluded that an agenda for further research is “urgently needed.”