Thursday, March 06, 2014

The Answer To This Question Would Seem To Be Pretty Obvious. The EHR Needs To Be Optimised For Clinician Use!

This appeared a little while ago.

Should doctors bend to EHRs, or EHRs meet doctors needs?

By Diana Manos, Senior Editor
The ultimate question comes down to: are EHRs made to help physicians or are physicians being made to work with their EHRs? That's the question asked yesterday in a HIMSS14 session aimed at getting rid of some of the frustrating bugs that can lead to discomfort, if not out-right catastrophe in medical care.
Imagine the unwelcome surprise a patient receives when they needed Tylenol at the hospital, the doctor ordered it electronically, and in walks a nurse with a Tylenol suppository.
This happens all the time, said Zach Hettinger, MD, director of Informatics Research for MedStar Health's National Center for Human Factors Engineering in Healthcare.
The reason is easy to explain, Hettinger said. This particular system’s electronic health record has 18 choices for Tylenol. The way it is designed sets up a hazard for doctors to accidently order the wrong one.
When it happens to Hettinger, a practicing physician, of course the nurse calls to verify. Then Hettinger replaces the order for one with oral tablets. But, this is just one more step to an already overloaded day, and an annoyance for both him and the nurse.
Raj Ratwani, a researcher at MedStar’s National Center for Human Factors in Healthcare, said these are the kinds of usability problems providers and health systems face every day. Ratwani and Hettinger were part of a panel at the HIMSS14 pre-conference workshop on patient safety on Sunday.
Doctors should not be “trained” by a system; the system should be “trained” initially by doctors’ needs, Hettinger said.
Location of the computer and other factors need to be taken into account. In emergency rooms, every time a physician is interrupted from entering information into an EHR, it increases the numbers of errors that the physician could make, and some of them could be “catastrophic,” Ratwani warned. That's why some hospitals provide laptops or computers on wheels to help the doctor move from the center of it all, closer to the patient, when entering data.
More here:
The answer to the question is a real no-brainer. To me this applies both at the development phase as well as the implementation phase of the introduction of EHR systems and the important thing to understand is that user acceptance can be critical to the success or failure of a product or implementation.
At least part of the reason we have seen such limited success in the PCEHR program was related to the failure to actually figure out in advance who the PCEHR was for and then consult those users properly. Hence the mess we now see!
David.

5 comments:

Grahame Grieve said...

"The answer to the question is a real no-brainer"

David, I don't think the answer is quite so simple. Some doctors - even most doctors - are locked into some particular ways of working that don't make sense and that prevent any sensible benefits of putting an information system in. In these cases, they need to be retrained to *use the system*.

This doesn't mean that poor implementations are ok - and there's always examples of poorly designed or poorly implemented systems for people to poke a stick at - but it does mean that the answer is not automatically that you bend the system to the users.

Bernard Robertson-Dunn said...

IMHO, an new information system should support a transformation in the way the whole system (i.e. the healthcare workers and the enabling systems) works.

This probably means that a new information system should support existing practices as well as new practices. Different healthcare workers could adopt and adapt at different rates. Others could discover new and better ways, either individually or as guided by institutional innovation.

Unfortunately, the PCEHR is a point solution that neither reflects current practices nor enables better, high value, future practices.

Rather than a bridge from the old to a new world, it is likely to be a road block to any sort of new world.

Terry Hannan said...

As documented elsewhere in a system that continues to become a world-wide evolution. The final point being the most important.
DESIGN GOALS FOR COMPLEX E-HEALTH SYSTEMS
COLLABORATION:
SCALABILITY:
FLEXIBILITY:
RAPID FROM DESIGN:
USE OF STANDARDS:
SUPPORT HIGH QUALITY RESEARCH:
WEB-BASED AND SUPPORT INTERMITTENT CONNECTIVITY:
LOW COST: preferably free/open source
CLINICALLY USEFUL: feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used.
AMPATH Medical Record System (AMRS): Collaborating Toward An EMR for Developing Countries Burke W. Mamlin, M.D. and Paul G. Biondich, M.D., M.S. Regenstrief Institute, Inc. and Indiana University School of Medicine, Indianapolis, I

Bernard Robertson-Dunn said...

@Terry,

Totally agree, with, IMHO, the most important goal being

"CLINICALLY USEFUL: feedback to providers and caregivers is critical. If the system is NOT CLINICALLY USEFUL it will not be used."

The measure of success or failure of the PCEHR shouldn't be number of registrations or even summaries uploaded, but its usefulness.

Does NEHTA/DOH have a plan to measure that? Is it documented?

It also suggests that the real "consumer" is not the patient but the clinician.

InformaticsMD said...

The question is not a no-brainer; the question is a question that should not even be a question.