![]() On the contrary, these requirements have led to increased pressure, frustration, cynicism and suffering due, among other things, to health care providers’ dissatisfaction and sense of under-accomplishment. ![]() Thus, to achieve the main objective of improving population health, patient experience and resource utilization, better work conditions and satisfaction of health care providers are also required.įor Bodenheimer and Sinsky, the obligation to meet patients’ legitimate expectations for high quality and empathic services are often not accompanied by conditions and means to achieve them. They point out that professional burnout is associated with patient dissatisfaction, resulting in poor health outcomes and increased costs. To the three established dimensions of the “triple aim” -improving the patient experience, improving population health, and reducing costs-, these authors add as a fourth dimension: the improvement of professional lives of health care providers. ![]() Rethinking the EHR through the quadruple aimīodenheimer and Sinsky (2014) proposed a set of essential core dimensions in order to optimize the performance of health systems. The time is therefore ripe to align the EHR value with the health system. Technology-focused consultation could also lead to failures or errors in the diagnosis and/or follow-up of patients (e.g., missing the contextual, psychosocial and emotional cues). This not only undermines the human dimension of clinical practice, but patients may feel neglected or abandoned, deteriorating their experience and therefore the quality of the care they receive. The research summarized above highlights the extent to which EHRs, and other IT-based tools and systems (e.g., teleconsultation, telemonitoring), could absorb much of health care providers’ attention and energy, to the detriment of interaction and communication with the patient. Other studies report that the use of the EHR takes about 30% of the consultation time with patients. In a medium-sized hospital, primary care physicians would spend 44% of their time on clerical work, and only 24% on communication and direct clinical contact with the patient. ![]() In the USA, a study on ambulatory care reports that physicians spend almost 50% of their time on EHRs and office work while only a third of their time is devoted to clinical work. These findings, which were observed across several IT-based tools and systems deployed in Quebec over several years (1994–2015) and also in other contexts, are in line with recent studies showing that EHRs have important consequences on clinical practice. Interoperability: the parallel utilisation of various non-integrated technological applications (e.g., doctor’s records, patient’s records, pharmacist’s records) may force health care providers to enter the same information several times (a form of “human interoperability”) or to search for information dispersed in different systems. In order to show how the quadruple aim can help to rethink how EHRs are designed and implemented, this paper clarifies the lessons that can be drawn from considering the unintended consequences of information technology-based tools and systems. These consequences enter in contradiction with the quadruple aim, which suggests that the well-being of health care providers is essential to any strategy that seeks to improve the quality of care, including patient experiences. These elements have been associated with increased frustration, dissatisfaction, stress, and exhaustion of health care providers. This situation is mainly attributed to the tedious and time-consuming workload imposed by data entry for administrative and billing purposes, constraints related to inappropriate interfaces and ergonomics, and EHR interoperability issues. Recent studies report that electronic health records (EHRs) have come to play an important role in the deterioration of work conditions for health care providers.
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