Will Electronic Health Records Ever Be Usable? - InformationWeek

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9/26/2014
09:06 AM
Stephanie Kreml
Stephanie Kreml
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Will Electronic Health Records Ever Be Usable?

AMA attempts to address the frustration EHRs create, especially for doctors and other healthcare workers.

"It's easy to use, once you know where everything is," the instructor said during an EHR training session I recently attended. Most EHR companies seem to believe this is an acceptable way to design software.

EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue. This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians' professional satisfaction.

The issue of usability is has reached a critical point, with many doctors hiring scribes to enter information into EHRs while they perform their duties in an effort to save time. In fact, a recent survey by the American College of Physicians found that EHRs cause physicians to lose on average 48 minutes per clinic day, or five hours per clinic week.

[For advice on adoption and effective use of EHRs, read EHR Success: 4 Change Management Process Tips.]

Personally, I've felt the brunt of EHR adoption on both the physician side and the patient side. While trying to make an appointment for my son recently, a recorded message told me that the office was switching over to a new EHR and to expect delays, as fewer patient appointments would be available. It took days of playing phone tag with the practice's office staff to make an appointment booked six weeks out, and three months later, the recording is still playing.

As a physician, the EHR I use in clinic is really quite cumbersome. The software does offer a lot of functionality (most of which I'll never use) and incorporates all CMS requirements, HHS health information policies, HL7 standards, the HIE framework, CPT codes, HCPCS codes, ICD-9 codes (which will soon move to ICD-10 after multiple delays), etc.

The alphabet soup is quite dizzying, no doubt, and keeping up with all the changing requirements eats up resources for EHR companies. But by trying to be everything to everyone via endless menus, EHRs have left users behind. I often feel more like a data entry clerk than a doctor. More sophisticated algorithms are available, allowing interfaces to be smarter about how information is presented and collected. We see this every day in the consumer world, where software systems anticipate our needs before we even realize them.

So now the AMA is speaking up to affect change. The AMA priorities state that EHRs should:

  • Enhance physician's ability to provide high-quality patient care
  • Support team-based care
  • Promote care coordination
  • Offer product modularity and configurability
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient education
  • Expedite user input into product design and post-implementation feedback

These are all valid goals, and the AMA does suggest solutions to achieve them. However, many of these issues have been discussed for quite some time, and the approach for solving them has been fragmented while vendors vie for position to gain market share.

In the end, implementing these priorities should be transparent to the users -- the physicians and the patients -- and should run seamlessly in the background with a more intuitive user interface. Over the next few weeks, I'll go into greater depth on how each priority should be considered in more practical terms.

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.

Stephanie Kreml, M.D., is a Principal at Popper and Company. In her current role, she develops and implements business strategy for start-up companies and new business units in existing companies; consults in areas of clinical need, commercialization, and technology ... View Full Bio
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David F. Carr
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David F. Carr,
User Rank: Author
10/1/2014 | 2:28:42 PM
My doctor: Epic EHR enthusiast
While going for a physical, I asked my doctor about his EHR, fully expecting to hear a litany of complaints. Instead, he turned out to be one of the power users of Epic who coaches others in his organization. He's invested the time to come up with macros/templates that help him flesh out a patient record quickly. At the same time, he was aware of the dangers of "copy and paste" medical records and said doctors are trained not to fall into that trap.

He told me he did know some older docs who got one look at the computer system and decided they needed to either practice somewhere else or retire. But he personally doesn't know how he would get by without the technology. If the system is ever offline for some reason, he feels a little lost.

So the technology needs to improve, yes (and some systems need to improve more than others), but there is also a generational change at work. Some doctors have figured out how to make the technology work for them rather than the other way around.
Gary_EL
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Gary_EL,
User Rank: Ninja
9/27/2014 | 9:10:13 PM
Re: Look what you Gain
It may not be totally useless, because the information will still useful locally. And, since many patients nowadays receive all their care in one network, that's all that matters to them. It will hinder researchers, because they will have a harder time aggregating information from different sources. Again, there was an expression back in the 1980's - islands of automation - which is what we have here.

 
shamika
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shamika,
User Rank: Ninja
9/27/2014 | 8:56:03 PM
Re: Look what you Gain
@ Gary_EL, I agree with you. Even though you have the most sophisticated systems and if you can't communicate the information, it will be a waste of time and money.
shamika
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shamika,
User Rank: Ninja
9/27/2014 | 8:52:16 PM
Re: looking forward to your series on the AMA framework
This is interesting. However what about confidentiality of these data? With all these new systems its always better to look in to the data protection as well.
Stephanie Kreml
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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 9:11:27 PM
Re: Those aren't goals
Exactly right - they are somewhat nebulous. Which is why I'm going to dissect them over the next few weeks to make them more concrete and actionable. Stay tuned!
kstaron
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kstaron,
User Rank: Ninja
9/26/2014 | 6:51:11 PM
Those aren't goals
Those are wishes. Not a one of them had any concrete how's invovled or a time frame for that matter.  Saying you want to decrease the doctor's cognitive workload (I hope only in the respect to dealing with EHR software) is a great first step, but leaves no interpretation on how that should be done. I imagine the people making EHR software right now are ripping out their hair trying to mesh those wishes into something concrete.

For any of you who use EHR's what are your top pet peeves to help out those poor guys developing it to make it better?
Stephanie Kreml
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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:42:44 PM
Re: looking forward to your series on the AMA framework
Thanks, Amy, and great analogy. We will get there, and the more emphasis we place on usability, the faster we can achieve a better state for EHRs (and the healthcare system in general). Ultimately, we should see benefits by way of decreased costs and better outcomes.
Stephanie Kreml
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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:34:30 PM
Re: looking forward to your series on the AMA framework
Very good point - most clinicians are really not that tech savvy. I consider myself to be a techie, being an engineer before a doctor, and even I struggle with using some of the software that's thrust upon us.

As the AMA directive points out, there needs to be a shift toward user-centered design, so that there is more focus on how users do their job, and how the software can facilitate this instead of just what the software can do.
Stephanie Kreml
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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:26:11 PM
Re: Look what you Gain
That's great, Gary - your experience is how it should be, and some healthcare systems have done a better job implementing EHRs than others. We are in a transition period with quite a few growing pains, and once we make our way through it, the system will be better for everyone.
Gary_EL
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Gary_EL,
User Rank: Ninja
9/26/2014 | 3:07:55 PM
Look what you Gain
Last weekend, I had to make a trip to the emergency room. It could be that the system they use in the hospital system that I use for my health care is a very good one, but even the super-stressed, super-busy ER docs had no trouble using the system and entering the complex results of my visit into it. I was scheduled for a follow-up with a specialist the next day. Instead of the specialists having to listen to my unprofessional explanations, they had instant access to what the ER docs observed, without being filtered through me. My Primary Care doc also has instant, unfettered access to both the specialist's and the ER's notes. The system also maintains a patient's center, where I got a virtual reading assignment of articles about my condition, suitable for non-medical people.

The biggest downside is that the system cannot communicate with the systems maintained by other doc's or medical organizations. We should all look forward to the day when these systems are far enough along for standardizations to be first agreed on and then enforced.
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