There may be additonal effort, although in talking to doctors in the VA who are paperless now...they seem to be able to get home in time for dinner by updating the medical record during the encounter... not sure what volumes that they have to deal with...but its quality that is important, right?

Regardless......one needs to sprinkle a little "systems thinking" into this.... without a well integrated EHR you have no basis for a system wide quality improvement feed back loop....in assessing the value of automation benefits should not just be measured at a discrete point in time or part of the "value chain" of care.

I am surprised that health informatics academics are not descending upon the VA in droves...or maybe they are....

Joseph

Daniel L. Johnson wrote:
On Fri, 2005-05-06 at 04:15, J. Antas wrote:

A study published at the Acta Anaesthesiol Scand. (2005 Jan;49(1):62-5.)
documents what seems to be an emerging (and rather unexpected) trend:
Clinical IT (HIS) systems increase the time that healthcare workers
spend documenting their activities and not the other way around.


With paper records, the nurses in my institution may spend an hour or
more *after* their scheduled shift is done, creating the paper record.

If an IT system requires concurrent documentation, any time-and-motion
study will find the IT system to require more time for record creation
because the record-creation activities often occur "out of sight" in the
paper world.

My own experience, rather limited I must say, is that getting *to* the
data-recording step with IT can be rather cumbersome, even if the actual
typing is easy.  A "smart" system will pop up the entry fields when
needed, but making it "smart" may be quite an undertaking indeed.

Dan Johnson md


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