Laying EMR, Texting, Driving to Rest. Start Tomorrow

Guest post from Greg N Korneluk:

The government boogeyman is not forcing us to text, and drive at the same time.  We are the ones making the conscious choice to enter data into the EMR in the examination room while interacting with our patients. So why do so many of us do it?

On the surface it seems intuitive.  We are all good multitaskers. While listening to the same old story, why not update the record. No harm done. While we are at is, how about looking at our incoming messages and emails. It will get us home sooner.  Multi-tasking saves time – right? As it turns out many of us are mistaken about multitasking.

It turns out that we lose up to 40% of our productivity when we multi-task. I am privileged to be part of a team analyzing the EMR documentation habits of physicians. An interesting finding –  physicians who do no data entry in the exam room save up to 50% of their time documenting their visits. How is that possible? When they leave the room they enter or dictate  the pertinent positives and they use structured data for the rest. They leverage the EMR the way Michael Koriwchak does rather than creating original prose for every visit the way we learned in medical training.

The term multi-tasking is actually a misnomer. We can’t actually do more than one task at a time. Instead we switch tasks. So the term that is used in the research is “task switching”.

Task switching involves several parts of your brain: Brain scans during task switching show activity in four major areas: the pre-frontal cortex is involved in shifting and focusing our attention, and selecting which task to do when. The posterior parietal lobe activates rules for each task we switch to, the anterior cingulate gyrus monitors errors, and the pre-motor cortex is preparing for us to move in some way.

Here is a summary of the research:

  • It takes more time to get tasks completed if we switch between them than if we do them one at a time.
  • We make more errors when we switch than if we do one task at a time.
  • If the tasks are complex then these time and error penalties increase.
  • Each task switch might waste only 1/10th of a second, but if we do a lot of switching in a day it can add up to a loss of 40% of your productivity.

The research shows that people can attend to only one cognitive task at a time. We can only be thinking about one thing at a time. We can only be conducting one mental activity at a time. So we can be talking or we can be reading. We can be reading or we can be typing. We can be listening or we can be reading. One thing at a time.

So where do we go from here? Let’s make the conscious choice to go into the exam room with a pad of paper and only write down the pertinent positives. Then immediately after the visit finish the note. ?  Start tomorrow. Try it for an hour, a morning or a day.

If you want to make a quantum leap, dictate the note and pay your nurse to enter the data for you after hours. Your nurse will appreciate the money and you will appreciate your sanity.

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