I’ve been a practicing hospitalist for over 20 years. When I trained back in the days of paper records, if I was writing a progress note and wanted to see the patient’s labs I would grab the little tab, turn the page to see my labs, then flip right back and keep writing my note. Now most EHRs force me to navigate through multiple screens to accomplish the same thing. Imagine if, in the paper days, I had to sit at my desk and click my pen 25 times before I could write down the labs data in my note; it would have driven me crazy. But that's effectively what EHRs have done to physicians.
Today we live in a mobile-centric world, in which the use of apps, with their intuitive swipe-and-tap interfaces, is second nature to most people. That surely was not the case when medical records first migrated from paper to EHR systems; nor would anyone have called the typical EHR 1.0 interface “intuitive”. Rather, most EHRs simply replicated the paper-based workflow and page design on a computer screen. EHRs recreated the paper chart digitally right down to the fish bones that physicians used as a form of shorthand to document certain lab results.
Still, the move to mobile represents an adjustment for EHR 1.0 users, if only because change brings at least some measure of the unfamiliar. But this change promises to solve at least one major problem: We’ll finally put the computer to its best use, as a tool that makes physicians better and more efficient clinicians, rather than treating it as an electronic piece of paper.
For example, we can now envision intelligent systems that effectively put patients with a known disease and treatment plan on a care “glide path” that helps the provider track the patient’s progress to discharge. Orthopedics already does this very well. A provider knows that following surgery on post-operative day one PT is going to initiate a standard process designed to effectively move the patient to discharge by post-op day three. We’re not far from adapting such a computerized “glide path” model for patients with congestive heart failure or diabetes.
Forcing physicians to wait their turn for one of too-few hospital workstations is not making them better. The inexplicable persistence of UIs that fail to effectively parse information in a manner consistent with a physician’s workflow or thought process isn’t helping. Obtrusive, non-emergent automated queries that foster alarm fatigue aren’t helping. System design predicated on a one-size-fits-all user experience strategy hinders delivery of care. These are some of the shortcomings of “EHR 1.0” systems that must be remedied going forward.
