Optimizing the EHR user experience
July 16, 2019
By Dave Lareau
Who’s to blame for physicians’ discontent with EHRs? According to experts from the American Medical Association, developers and end users are not the only ones who have influenced the current EHR experience; the decisions and actions of regulators, policymakers, administrators and others have played a role as well.
In an article entitled, “The complex case of EHRs: examining the factors impacting the EHR user experience,” the authors review multiple factors that have led to physician dissatisfaction with EHRs. Rather than simply laying blame for the missteps of many, they rightly note that there are multiple opportunities for stakeholders to “collectively improve the use and efficacy of EHRs” — and suggest several solutions to improve EHR usability, user satisfaction, and patient care.
As a health IT “old-timer” who has witnessed physicians’ growing discontent with EHRs since the earliest systems hit the market a few decades ago, I have compiled a few of my own recommendations for fixing EHRs and optimizing the EHR user experience. But first, let’s take a quick look back at the evolution of these systems to better understand the complexities that have contributed to EHRs’ shortcomings.
ARRA and EHR adoption
The 2009 passage of the American Recovery and Reinvestment Act (ARRA) included incentives to accelerate EHR adoption and the digitization of medical records. Though clinical systems had been around since the 1960s, ARRA helped drive hospital EHR adoption from 9 percent in 2008 to 96 percent today, and office-based physician adoption from 40 percent to 86 percent. Thus far the government has paid providers $36 billion for their efforts.
While the EHR adoption rates are impressive, the hastily-crafted initiative was flawed and failed to include a detailed rollout plan to improve patient care, and set a pitifully low bar for EHR adoption. To qualify for funds, providers needed to adopt EHRs in a relatively short time frame. Traditionally, EHRs were designed to drive billing transactions and not to facilitate better patient care. As more providers adopted EHRs, vendors were forced to prioritize enhancements that helped clinicians qualify for incentives, rather than R&D updates to improve EHR functionality.
Given the lack of attention to usability, it’s not surprising that most physicians find their EHRs are cumbersome, inefficient, and a source of frustration. EHRs store massive amounts of clinical information — which is a plus — but much of the data is not easily accessed by clinicians at the “moment of need” for clinical decision-making.
Instead of empowering clinicians with tools that enhance patient care, we’ve forced users to accept workflows that fail to align with physician thought processes. Rather than providing point-of-care actionable information, we present clinicians with huge blobs of data that are not logically integrated, forcing users to waste precious “eyeball” time scrolling records to find the details relevant to an individual patient and the patient’s specific problem.
We have further diminished clinician productivity by requiring users to track and report specific metrics to be eligible for various quality incentive programs. These compliance activities, while designed to enhance patient care and outcomes, disrupt clinical workflows and add to physician frustration.
Fixing broken EHRs
Despite good intentions on the part of multiple stakeholders, today’s EHRs are broken — but also fixable, especially if we focus on these three areas:
1) Data usability. AI-based tools and other technologies can help transform the massive blobs of unorganized data that are hidden within EHRs and make information usable. Clinically-related data can then be logically linked so that all relevant information on an individual patient is easily assessable, at the moment of need, within a click or two. Ready-access to clean data within a patient’s complete record empowers clinicians and facilitates the delivery of safe and effective patient care, while also enhancing clinician productivity and eliminating many of the inefficiencies fueling clinician burnout.
2) Data interoperability. To advance patient safety and cost-effective care, the interoperability of clinical data must be a priority. Clinicians need easy, point-of-care access to patients’ complete records, including details originally created and stored in disparate systems. Health systems and vendors must fully participate in interoperability efforts and not engage in record blocking activities to preserve market share. If necessary, the government should implement inducements and/or penalties to promote full participation in interoperability efforts.
3) Third-party apps. The proliferation of third-party apps is giving providers the option to extend the functionality of their legacy EHRs without having to invest significant time and money for replacement platforms. Using established standards such as FHIR, organizations can now add solutions that create more efficient workflows, support data interoperability, and enable well-organized data that can be accessed on demand. Other apps are enhancing physician productivity and making it easier to produce complete and accurate documentation that facilitates the delivery of care and the tracking and reporting of quality measures. By taking advantage of app-based solutions, organizations are realizing better clinical and financial outcomes and increased physician satisfaction.
Finally, as we strive to optimize the EHR user experience, we must seek the ongoing input of physician users, and understand the factors inhibiting productivity and fueling burnout. We can no longer assume physicians will tolerate inefficient workflows, nor adhere to processes that negatively impact the physician-patient relationship.
If we want to positively impact the EHR user experience, we must make the needs and desires of users our top priority.
About the author: Dave Lareau is CEO of Medicomp Systems