Aaron Berdofe, MHI – Health Informatics

A fundamental factor in understanding Information Theory is that a signal, regardless of noise, will degrade over time and distance.  Those of us in healthcare are starting to feel that a person’s mental capacity also degrades the more time and clicks they spend on an EHR.   There are people who really hate working with EHRs.  Not just the practitioners mind you, but the people who have to put them together and support them too.   It turns out that there may be a reason behind this frustration and it is called Decision-Fatigue, or the fancier version: Ego-Depletion.   For a richer synopsis, I’d recommend reading this particular overview, but the basic premise behind the concept is that we have a finite number of decision “points” at the start of every day.  As we encounter decisions throughout the day we give up a point each time we decide between a Mocha Chai Frappuccino and an Iced Latte or whether we really do want undo all the work we put into documenting on the wrong patient.  Two in the bucket.  If you’ve ever reached the end of the day completely exhausted from all of your desk jockey mental prowess, just know that your decision points are approaching zero and it will be best not to think much the rest of the night.

The last thing we want in our day is to run into a larger number of decisions that need to be made.  Yet, here we are implementing very decision-intensive EHRs in the healthcare setting.  A setting which can only be described as decision-intensive itself.  Is it strange that there are complaints?  The multi-functional and über-flexible products require a multitude of decisions to be made spanning months, sometimes years before they even get used.  I know that process is where most of my decision points go during the day.  So was it strange when a recent HISTalk poll found that readers felt the ultra-flexible, built-it-your-own-way, decisions-galore product producer, Meditech is losing market share, while the our-way-or-the-highway products from Epic are constantly gaining ground?  Can it be thought strange when an EHR implementation team throws it hands up in the air after weeks of decisions when a doctor looks at the screen and says, “Why do I have to decide this? Can’t it just do it for me?”  I’ll save you the decision points: No, it all is perfectly understandable.  We are exhausted.

I even write this at the tail-end of a decision-laden day, my mental construct nearly defeated and my only saviors being proper nutrition and an impending sleep.  Therefore, I ask of us; nay, implore all of us in the healthcare industry to work towards reducing the amount of decisions we have to make during the day.  Let us create tools that simplify and make successful processes into habits so we barely have to think about them at all.  In other words, let’s make sure we put our decision points towards what really matters.  For now, my signal is entirely degraded.