Measurement and automation of workflows for improved clinician interaction: upgrading EHRs for 21st century healthcare value.

Abstract

In this editorial, we highlight 5 manuscripts that address aspects of clinician interaction with the electronic health record (EHR). A Perspective describes the efforts of the Office of the National Coordinator for Health Information Technology (ONC) in establishing priorities for workflow automation in healthcare settings.1 A second Perspective summarizes a panel sponsored by the American College of Medical Informatics (ACMI) at the 2021 AMIA Symposium that examined a provocative question: Are EHRs dumbing down clinicians?2 Three manuscripts focus on what can be learned from EHR audit log data.3–5 First, Zayas-Cabán et al1 describe how the ONC led a multidisciplinary effort of stakeholders from industrial engineering, computer science, and finance to investigate automation in health care. They define automation as “the creation and application of technology to monitor and control the delivery of products and services.”6 The process of key informant interviews, focus groups, and a review of pertinent literature identified 6 priorities and their related strategies for advancing workflow automation. These priorities focused on leveraging high quality, interoperable data, and engaging clinicians in the EHR design, implementation, and evaluation processes. Then, relevant, and effective workflows could be identified that add value, not a burden, in clinician processes. The supporting strategies revolved around education, convening multiple interested parties, prioritizing appropriate workflows, and using policies and the market to incentivize automated solutions' development, testing, and evaluation. Examples of priority workflows for automation include reimbursement and prior authorizations, medication reconciliation, care management for newly diagnosed patients, and public health and adverse event reporting. The goal is to upgrade EHR technology to increase efficiency, improve health outcomes, and deliver more value for patients, caregivers, clinicians, and staff involved in healthcare. These priorities and strategies provide some solutions to the inadequacies of EHRs as outlined by Melton et al.2