Friday, February 24, 2017

This Is A Very Useful And Thoughtful Article On Clinical EHR Useability. Worth A Browse.

This appeared last week.

Can EHRs evolve from minimally usable to delightfully indispensable?

Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus on improving customer satisfaction.
February 16, 2017 10:41 AM

Electronic health record platforms are among the most complex, interconnected, data-intensive software applications on the planet. Think about the seemingly endless fragments of patient information that an EHR is asked to store and maintain – basic demographics, diagnoses, chart notes, medications, allergies, upcoming appointments, previous surgeries and procedures, historical lab values, imaging studies, standing lab orders, e-prescription transmission transactions, claim submissions, and on and on.
Physicians and their staff also need to be able to review, transmit, reconcile, approve, and synthesize all of that clinical information to help make better, more informed decisions with their patients.
In 2008, fewer than 1 in 10 physicians were using an EHR, and the functionality that existed in those systems then would not qualify as a federally certified EHR product now. Over the last decade, to achieve federal certification, vendors worked at a feverish pace to add hundreds of features and change dozens more in order to achieve parity with the rest of the market. This transition from paper to digital happened so rapidly that usability suffered, innovation lagged, and real customer needs were under-prioritized.
Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus this entire industry on improving customer satisfaction.
The Office of the National Coordinator for Health IT has attempted to regulate the design of EHRs in a way that has not resulted in broad usability improvements to date. Approaching this immense problem from a more prescriptive regulatory perspective barely scratches the surface of what customers are demanding. While there should be required minimum standards for any software that is utilized by medical professionals to help them manage something as critical as patient health, no regulatory framework for usability will lead to more delightful user experiences for medical professionals or their patients.
What technology is needed in a modern medical practice?
Most complaints from EHR users stem from the feeling that the computer interferes with the ability of physicians to provide great, human-centered care for their patients. Many user interfaces look like they are 10 to 15 years old (because they are) and fail to meet customer expectations for how a modern application should function. Alert fatigue, infrequent software upgrades, and inefficient workflows contribute to this general dissatisfaction. In a recent study, researchers found that physicians spend 3 times the amount of time with computers as they do with their patients during a typical day. It's no wonder that EHR usability is consistently rated poorly across most software vendors.
Physicians and their staffs ultimately need software that supports their practice throughout the entire patient journey. Technology vendors must completely rethink their offerings by applying the essential components of user-centered design that have worked well in other industries.
Implementing an intentional approach to usable software
Usable software applications are intuitive, easy to learn, and memorable. They also must be efficient and prevent errors, all while deeply satisfying their users.
To achieve these six goals in health software, vendors must first gain a deep understanding of how a physician's office works – from the beginning of the day until the lights are turned off. A team of user researchers dedicated to this scientific task, investigating directly in doctors' offices, is crucial.
Tip: Merely dropping in for a few hours of office time is insufficient.  
Shifting to a user-centric approach in EHR design also requires gathering as much information as possible about how technology can assist customers with common tasks and data-intensive decisions.
More tips and other information here:
I thought this was a really interesting article, expressing very clearly what we would all like to see in clinical EHRs. Meeting what is asked for here will be a real challenge for the myHR!
David.

6 comments:

Anonymous said...

https://www.youtube.com/watch?v=xB_tSFJsjsw

Anonymous said...

Read the comments after watching the video

Anonymous said...

Based on my personal observations that Tim Ke lest is on a crusade and seems more interested in proving his UK critics wrong about paperless vision, Minister Hunt might wish to speak with the U.K. Minister Hunt

http://www.theregister.co.uk/2017/02/17/should_the_nhs_be_less_prescriptive_about_digital/

The links within the article are worth reading. With only a few months until Secure Messaging is solved and faxes replaced just what is the solution? I can find nothing on this public ally and we were promised transparency.

I am also concerned we are heading down this path when we are far from ready http://www.theregister.co.uk/2016/10/14/more_oversight_needed_digital_economy_bill/

Anonymous said...

10:19 am. Invite you to read this http://techscience.org/a/2015081103/

I would not worry to much, the CEO is there for a purpose, as a sort of shoulder to cry on, make people feel loved, he is not a delivery program manger I am sure someone will replace him next year. However I might be wrong and SMD will be the test, after all SMD is not a technology problem (unless they make a hash of it) it is a business model issue.

Bernard Robertson-Dunn said...

From http://techscience.org/a/2015081103/

Results summary, edited for clarity and reference

"Our findings suggest that this balance may be able to be achieved if:
1. communication with the public is prioritized,
2. the mechanisms to express consent are specific and easy to understand,
3. control of data is decentralized or centralized only on a small scale, and
4. regulations on purchasers of patient data are clearly outlined and subject to strong government oversight.

Our study ultimately finds that the current care.data program is highly problematic in:
5. its flawed protection of patient anonymity,
6. an unsuitable opt-out system,
7. unclear criteria for accessing the collected health data, and
8. the risk it poses to the trust between patients and general practitioners."

All these points already apply to MyHR. Re point 2. not many people know that the legislation that enables opt-out removes the need for consent.

If you keep doing the same thing, you'll get the same result. If you expect different results, its called insanity.

Bernard Robertson-Dunn said...

Of course, care.data is nothing like MyHR. Care.data extracted current patient data from GP systems automatically. It was never intended to be a patient system, it was all about big data.

MyHR is an optional system; not in the opt-in/out sense, but patients choose to get their GP to upload shared health summaries, or not. GPs can upload without patient knowledge or permission, but I suspect this is unlikely/uncommon, so there's probably not a lot of up-to-date data in it.

In fact, of the 4,606,435 registrations (5 Feb data) I estimate that about 94% have no Shared Health Summaries. This is based upon the reported statistic that since the MyHR was implemented 611,977 SHSs have been uploaded. Assuming om average each one has been updated once, there are 305,989 records with a SHS. That's 6.6% of all registrations.

So, MyHR isn't designed to be a clinical system, it isn't a big data system (it's pretty empty), so (as David keeps asking) what is the MyHR for? Or, more importantly, what value have we taxpayers got for our $1.5billion?

Even a politician should be able to understand that question and, with a bit of luck, the answer - whatever that may be.