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EHR Usability Depends on Practice Culture, Provider Needs

A Scottsdale Institute report shows how experts at different healthcare organizations view priorities in EHR usability.

By Sara Heath

In recent years, EHR adoption has reached near ubiquitous levels, but have received scrutiny across the healthcare industry. Several of these critiques center on EHR usability and the way in which it improves clinical workflow.

What makes ensuring EHR usability so complicated, however, is the fact that usability is “in the eye of the beholder,” and is extremely individualized. In a June report released by the Scottsdale Institute, industry experts discuss the idea of EHR usability and the individual ways in which it can be improved.

First, the paper discusses the idea that EHR use should not disrupt clinical workflow in a negative way. For physicians practicing at Texas Health Resources in Arlington, Texas, seamless EHR integration is the core of EHR usability.

“Usability to me is our ability to insert the EHR into care-delivery workflows to make clinicians feel we are enhancing the ability to deliver care rather than impede it,” said THR CIO Joey Sudomir in the report.

As a result, technology developers need to make sure they are innovating at a similar pace to policymakers, and policymakers need to make sure they are keeping track with developers. Despite the perceived push for constant EHR improvement, there needs to be a stronger correlation between innovation and policy.

Of course, what works well in a certain practice depends upon who is using the EHR. For Joe Boyce, MD, CTO, CMIO at Mosaic Life Care in Missouri, EHR usability is about making the technology work for the kind of medicine a provider is practicing. An emergency department doctor is going to have different needs than a family medicine doctor, he says.

“The inherent problem for EHRs is the 80-20 rule: the kidney patient in the ICU on a ventilator for a nephrologist is not the same design as a family med doc looking at the usual outpatient URI. Those complex edge use cases drive the whole lot of EHR design,” Boyce said.

The solution may lay in provider and vendor collaboration.

“What we need is to design it from the ground up, making it web-based and platform independent, with lessons learned to date,” Boyce explained. “You need to have providers working with software engineers who are also experts in design. It gets very difficult to satisfy everyone, especially with the regulatory burden.”

Of course, when it comes to policymaking, industry leaders have a different point of view. At the Office of the National Coordinator for Health Information Technology, for instance, experts are careful not to confuse common EHR issues with usability issues.

“People sometimes conflate usability with other EHR issues,” said Andy Gettinger, MD, CMIO and executive director, Office of Clinical Quality & Safety at ONC.

“This isn’t about too many clicks. Many of those kinds of issues are not necessarily about usability, but reflect decisions made by the organization, such as every patient we see has to have their blood pressure, weight, pulse, pulse oximeter and height checked on every visit. In some medical settings that is good practice, in others many would argue that it is unnecessary and doesn’t improve quality or safety—especially if the patient is being seen daily.”

And taking a step forward, it is important to remember the age gap in EHR usability. According to ONC, younger users are more satisfied with the EHR, likely because they are more familiar with general technology use.

“The first digital divide is based on people’s chronological age and experience with technology,” Gettinger said. “Younger users are far more facile with EHRs, even the ones that have not been optimized. That’s about the times rather than the design.”

Going forward, the healthcare industry and EHR developers alike are going to need to ensure providers receive proper training in EHR use to facilitate better understanding of the technology.

Likewise, it will be critical to understand the nuances of EHR usability. While the report shows that there needs to be a clear distinction between EHR usability and other EHR burdens, developers will also need to acknowledge the individualized aspect of usability.

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