- In order to improve physician EHR use, health IT developers need to take into consideration the needs of end users and practice managers. New research shows that developers can improve EHR usability when they collect user feedback periodically.
According to a research team led by Anne Press, MD, this user feedback is important when integrating new specialty functions into an EHR. The team tested a substance abuse screening tool by integrating it into both the paper health record workflow and the EHR workflows at one hospital.
Press and colleagues surveyed medical office assistants (MOAs) and physicians about the integration for both the paper charts and the EHRs, assessing usability after two research phases.
The team hypothesized that both groups would prefer the EHRs for improved clinical workflow. However, after the first round of the study, the paper charts proved to be the preferred method of screening for both MOAs and physicians.
Following round one of the study, participants reported many complaints about the EHR system, saying that it complicated their workflows.
“Participants’ negative feedback on the electronic SBIRT tool was: a lack of interaction between the MOA and the patient, a lack of certainty in the hand-off of the tool to the health coach, and a decrease in general usability of the screening tool,” Press and colleagues reported.
Participants also found that the EHR made the appointment take longer and was difficult to complete, likely because the tool was not intuitive to use.
Despite these complaints, many participants explained that they may eventually prefer using the EHR.
“It was noted however, that if the items mentioned were adjusted, the electronic screen had the potential to impact the patient visit in a positive manner,” the research team wrote. “One participant noted ‘having all the clinical information for each patient in one place would make for a more efficient patient visit.’”
Going into round two of the study, EHR developers made adjustments to the screening tool, making screen navigation more intuitive and adding in alerts for hand-off between MOA and health coach.
These adjustments delivered the results the team had initially anticipated – the providers preferred the EHR as a screening tool. Participants reported that the screen was more intuitive and made the hand-off between MOAs and health coaches more seamless.
MOAs still had difficulty with the length of time it took to complete the screening tool, saying that it significantly slowed down clinical workflow. The researchers reported that a third round of testing will ideally alleviate that problem.
Ultimately, the importance of this research goes beyond substance abuse screening or EHR function integration.
“This study demonstrates the importance of usability testing during initial design,” the researchers explained.
“This study also demonstrates how clinical practice is dynamic, and therefore tools should also be flexible and easily edited,” they continued. “Usability testing a year later was able to identify new barriers and direct a new iteration of the tool. Using the SBIRT screening tool as a clinical case to constant usability testing highlights how other clinical decision support tools and electronic screening tools should consider periodic usability testing.”
Takes on EHR usability testing and clinical workflow are especially important as the EHR market shifts. Now that the market is nearly saturated and EHR adoption is ubiquitous, providers may be seeking solutions to make the technology more seamless with clinical workflows.
Understanding that thorough feedback assessments can be successful in improving physician EHR use and clinical workflow is useful for EHR developers. Going forward, they can implement targeted assessments as a means to improve these tools, making their use even more effective in improving patient care.