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Thoughts on Critical Thinking and EHRs

· Kim Tucker,

Several times in the last few months I have heard colleagues say that implementation of their EHR has negatively impacted critical thinking skills.  Actually, the language was a bit stronger, such as “destroyed critical thinking.” Unfortunately, the situations in which I heard these statements were not ones conducive to exploring the topic more fully.  So this week, I had the opportunity to have a one-on-one discussion with a nurse educator.  I asked her if she felt that the implementation of their EHR had a negative impact on critical thinking skills, to which she promptly replied with a resounding, ‘YES!’  So I asked her to give me an example, which she did.  At the end of her example, I asked her how the situation/outcome would have been different if they were still charting on paper.  Couldn’t the person in question still have checked the ‘Within normal limits’ box with a pen without really thinking about the situation?  Well, yes….so she provided a second example.  Again, couldn’t the same thing have happened in a paper documentation system?  Oops – yes it could.

While I am not trying to say that implementation of EHRs have not had unintended and even unfavorable consequences, I don’t believe that they are the sole cause in the decline of critical thinking either.  Critical thinking is a learned skill, and where are we learning it?  This question is beyond the scope of my thoughts at the moment.

In my experience, one of the biggest barriers to critical thinking is the lack of uninterrupted time.  In 2010, Kalisch and Aebersold found that nurses were interrupted every 4.5 to 6 minutes and multitasking 34% of the time.  I can’t imagine trying to write this blog if I were interrupted every 4.5 to 6 minutes as well as multitasking 1/3 of my time.  In my last stint as a direct care provider on a med-surg unit a few years back, I found myself running from thing to thing ceaselessly.  Given today’s levels of patient acuity, I am surprised anyone has time to think at all.

I am curious: What are your thoughts about EHRs and their impact on critical thinking?

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