Document Before Doing

We implement electronic health records in an effort to improve care. If we simply turn on a computer  instead of using a paper record, why would we expect care processes to improve? To achieve improvement, we have to redesign our care processes to take advantage of the EHR.

A common practice within medicine’s paper based world is to never document a procedure or administration of a medication prior to actually doing it.  EHRs give us an opportunity to utilize decision support to prevent errors, but they only work if a certain amount of document takes place prior to administration to a patient.

A workflow of vaccine administration typically has documentation following administration.  In a paper based world, this work flow may make sense since documentation does not in itself prevent administration errors.  In a smart EHR or vaccine registry, vaccine lot numbers are entered into a database as they are placed into inventory.  Lot numbers identify the specific type of immunization. If the lot number is documented prior to administration, decision support can provide alerts that the wrong immunization is being given, the immunization is being given too early or the immunization has already been provided.  Without recording the lot numbers first,  these errors are not prevented.

Changing of long established workflows is a difficult but necessary function if one is to achieve improvements in quality and patient safety.

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