EHR Usability — A Major Challenge

The final panel discussion today at the PDR Network sponsored PharmEHR conference was a debate among four physicians regarding their experiences using ePrescribing. In response to the question, “Has ePrescribing made your practice more efficient?”, positive responses outnumbered the negative three to one. Although ePrescribing was felt to be beneficial — particularly in relation to the renewal of multiple medications through an EHR — differences in implementation as well as practice or hospital policies reduced the overall value of the system. After a lively discussion regarding additional challenges such as the inconsistency of drug information from formularies, the conversation redirected to the most often discussed problem with EHRs: namely usability.

Released March 21, 2012: The NIST (National Institute of Standards and Technology) health IT Usability initiative is focused on establishing a framework that defines and assesses health IT usability. The goal of the research effort, being conducted in collaboration with the Office of the National Coordinator for Health Information Technology (ONC) and the Agency for Healthcare Research and Quality (AHRQ), is to create a detailed specification of an objective, repeatable procedure for measuring and evaluating the usability of health IT systems. The initiative will examine the human factors critical to designing usable EHRs and will guide industry in usability engineering practices. Click here to access the NIST resources.

Human factors and usability are significant barriers to optimized use of EHRs. A February 12 article in Health Data Management by Elizabeth Gardner began with the following paragraph:

“As long as there have been electronic health records, clinicians have complained that they’re difficult to use. These cries have often been dismissed as resistance to modern technology-ironic considering that the complainers are perfectly comfortable using robots to perform bypass surgery, zapping tumors with proton beams, or mapping brain activity with functional MRIs.”

In the article, Gardner goes on to highlight some of the usability challenges with EHRs, including the following:

  • Poor interface design
  • Multiple customizations creating non-standard solutions
  • Older legacy systems
  • Users not knowing what they need
  • Overcrowded screens packed with data
  • Alert and reminder fatigue causing users to switch off or ignore functions in the EHR
  • And more…

What is evident is that usability is a big barrier to the successful use of EHRs. With hundreds of certified EHRs in the market, not all are going to make the cut and be successful. However, you can be sure that in addition to meeting the data exchange requirements and other key Meaningful Use criteria, the best EHRs in the future are also going to be highly usable.

Have you had experience with usability issues in your EHR? Share your experiences.


6 responses to "EHR Usability — A Major Challenge"
  • March 22, 2012
    Carmen Brown

    This article is true. We implemented a certified system almost 2 years ago. For the most part, we have a very good system and I am overall pleased with the product. For office staff, the transition was fairly smooth and preferred, after having previously tracked data with paper records, which can be very tedious. On the other hand, our physicians care little for the alerts, the constant clicking, and the time consumed with the system. They dislike the face-time that has been lost in the exam room with patients because of their need to type in a computer. Lastly, physicians feel there are many more steps required to accomplish a task in EHR. To order or to write a prescription there is much more pointing and clicking, which takes more time than filling out a paper form or script pad. For a busy practice this can be very frustrating and unproductive. They claim this is the case in not just our office. This frustration is felt in the hospital settings, as well.

  • March 25, 2012
    Joseph J Muscato, MD

    I agree that ERx has made a large difference. However, for oncologists (as well as many others) the inability to e-prescribe scheduled drugs slows things down. Are we making any progress on this?

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  • March 29, 2012
    Barry Waters

    Great blog entry. With all EHR’s the physician time spent on notes, data review and orders is critical. Everyone I know has found physician time expenditure worse with EHR’s than paper charts. With such a low profit margin on E/M visits, decreased physician productivity is untenable. I’m skeptical “free enterprise” is going to improve usability, because once a practice signs on with a vendor, they are captive due to the financial burden of making a change. This reduces or eliminates the normal market pressures to improve speed of use. We need government funded research and product testing (free of industry bias) to improve usability. Even more importantly, we need a government mandate for a common file format for EHR/PM data. It would then be much easier for a practice to change products, market forces would become active, and more usable products would succeed and slow products would close.

  • March 29, 2012
    Alan Brookstone, MD

    The whole area of data transportability between EHR systems is challenging. Not that it should not be available, but the vendors are frequently built using proprietary data standards and not designed for true data transfer. A complicating factor is the meta data that is added to clinical notes e.g. a phone call from a patient that is logged or an attempt to bring a patient in for repeat follow up where that is unsuccessful. These types of data have medical legal implications, particularly if there is a negative outcome for which there is no longer any supporting data as the information was transferred from one EHR to another (but without the meta data).

  • April 2, 2012
    Barry Waters

    Many of the “EHRs” were developed to generate notes and to maximize coding. We need to move away from the concept of text medical notes to that of data capture, analysis and portability. In this transition a common file format must evolve. But I do agree with you that the above vision will never happen. Corporations are far too powerful.

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