Friday, August 18, 2017
Some Thoughts On How To Ease The Usability Crisis With Electronic Health Records.
This appeared last week
The veteran executive proposes a multi-pronged approach to ending the tyranny of wasted time and effort created by today’s technologies.
By John Glaser
August 09, 2017 11:09 AM
The HITECH Act resulted in near universal adoption of electronic health records (96 percent in hospitals and nine out of ten physician offices, according to the latest ONC tally) and having all that clinical information in electronic form is a remarkable advance.
It enables a wide range of possibilities for improving care, assessing its value, and managing populations in ways that might actually improve our collective health and reduce the overall healthcare bill. On the most basic level, caregivers should have an easier time getting up to speed on each patient's history and current condition than in the old days where they had to thumb through a paper chart trying to decipher other physicians' handwriting. Moreover, this advance means that patients can become more active and equal participants in their care; they can use their phones to discuss healthcare issues with their care team and see when they last had a tetanus shot.
But this significant progress in adoption also gave rise to concerns about the usability of EHRs.
Physicians are spending twice as much time with their EHRs as they do with patients, according to a time and motion study published last fall by the AMA. In the most recent Medscape Lifestyle Report, a survey of 14,000 physicians, EHRs were the fourth most common cause of burnout EHR complaints beat out insurance issues, threat of malpractice suits, concerns about salary, and patient volume.
EHR-induced patient safety problems related to usability are becoming a concern. A 2015 study published in the Journal of Patient Safety described almost 250 cases where EHR glitches or poor human factors were alleged to have caused patient incidents led.
Why have usability issues come to dominate so many discussions about EHRs?
First, change is hard, and EHRs are a big change, especially for clinicians who spent decades perfecting their use of paper charts. Any time you introduce new technology and new processes deep into the fabric of someone’s work routine, there will be significant struggles and bumpy transitions that might last years.
Second, if you're used to whipping off a prescription in five seconds, spending thirty seconds to enter the same information into the computer must seem like an absurd imposition, even if it does make the information exquisitely readable and simultaneously accessible to all authorized users. The same is true of many formerly paper-based tasks that now require clinicians to enter structured terms into fields. Those extra few seconds per task, multiplied by dozens of tasks, can add hours to the workday.
Third, the user interface design of EHRs can be sub-par. Compared with the smartphone tech we carry in our pockets, many EHR user interfaces feel like a throwback to the 1990s, and too many clinicians have tales of needing a dozen clicks to order a single drug, or being harassed by alerts to the point where they just ignore them all.
In fairness to EHR developers, automating healthcare tasks presents an exceptionally difficult design challenge. Medicine is based on a very complex body of knowledge, encompasses dozens of specialties, and tackles thousands of different diseases. Ideally it requires an application that can aggregate patient histories, lab values, medical images, monitor tracings, vital signs, progress notes, and miscellaneous other pieces of information, process them, analyze them, and send them back to the clinician with notes on best practices and relevant recent research. Compare that task to designing an application that supports the six transactions we might want to make at an ATM.
Fourth, in our collective efforts to improve care we have moved more and more work onto the shoulders of the clinician. Asking patients about the safety of their homes, engaging them in discussions about smoking cessation, counseling them about the importance of taking their medications, and documenting interactions using structured vocabularies – all of these actions could benefit patients. But their cumulative impact on a clinician can be overwhelming.
In some ways, beating up EHR vendors on usability is a form of shooting the messenger. Clearly the vendors have work to do, but others created the tyranny of large numbers of good ideas of work for the clinician.
What’s more, physicians often don't directly benefit from investing all this extra time. It's legitimate for them to ask, "What's in it for me and my patients?"
The benefits of EHRs seem to accrue to the healthcare system as a whole, or to payers--not to physicians, unless their compensation is adjusted.
Eventually, a value-based reimbursement model should reward their effort, but that prospect probably seems very far away to most.
So, what can we do to significantly improve the usability of electronic health records? There is no single strategy or tactic that will address all these factors.
See the suggestions that follow.
John Glaser, Ph.D., is Senior Vice President, Population Health, of Cerner Corporation. Prior to this position he served as the Chief Executive Officer of the Health Systems Business Unit at Siemens. He is the author of several books including “Glaser on Health Care IT” published by HIMSS Books.
The whole article is here:
Well worth careful read I reckon.
Posted by Dr David G More MB PhD at Friday, August 18, 2017