Electronic Health Records

Adoption & Implementation News

What Is Driving Claims in Healthcare about EHR Usability?

- Over the past several months, healthcare association and industry reports have highlighted the importance of EHR usability to the success of healthcare organizations and providers providing efficient, effective, and safe patient care.

In 2014, the American Medical Association (AMA) released a new framework comprising a multitude of priorities for creating more intuitive (i.e., usable) EHR technology. Shortly thereafter, Frost & Sullivan published a report detailing how limited EHR usability was impacting healthcare CIOs and their organizations. Other research even indicated that an emerging EHR monoculture — that is, the dominance of a single EHR technology — might benefit EHR usability, interoperability, and innovation.

A leading health IT subject-matter expert, however, contends that much of the criticism of a lack of EHR usability could be missing the point.

“I am always very cautious about the whole usability conversation,” says Micky Tripathi, PhD, MPP, President & CEO of the Massachusetts eHealth Collaborative. “When you look at the vendor market there are thousands of them and even hundreds of the certified EHR vendors, and there is nothing in meaningful use or any government regulation that force them to have their products architected or engineered in a particular way.”

Obviously, regulation requires that certified EHR technology can perform certain functions, but it does not prevent EHR developers from coming up with innovative ways of doing say.

“In a free market essentially with lots of technology options and no barriers to entry, how is it that no one is making usable products and that we could make general statements about every one of those vendors aren’t doing this or that?” he asks.

A better explanation, claims Tripathi, is the fundamental concept of economics — supply and demand. “Technology is always going to reflect the underlying businesses. Maybe I’m too much on the free market side, but the supply side is going to reflect what the demand side is asking for,” he says.


In the context of healthcare, Tripathi calls to mind two forces at work in driving EHR design and usability to this point. The first centers on purchasing power, which in healthcare has historically been controlled by large institutions.

“One might be that users of the systems for a long time were large enterprises rather than small enterprises,” he explains. “That tends to dictate how software was being designed because it was the large enterprises primarily providing feedback — an institutional mode focused on routinized practices.”

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Likely more important than the first is the immaturity of much of the EHR market. “There is a whole bunch of new vendors not tied to any of that legacy stuff. For me more than anything else, it is still early in our market cycle — that there is not enough market and user feedback yet to make the products better,” adds Tripathi.

And considering how long end-user feedback takes to become incorporate in new software, EHR adopters are more than likely playing a waiting game.

“If you don’t like your software either you can work with your vendor or it’s going to be a ten-year process to get that feedback back into the market,” Tripathi explains. “The only way to make EHR products more usable is to have more users using them. No one can architect a perfect system particularly for something as complex as this.”

What’s next in EHR design and usability

If current EHR technology is not meeting the needs of healthcare organizations and providers, then what does the future of EHR design and usability hold? According to Tripathi, three emergent trends are starting to gather momentum.

Given the growth of value-based care, EHR expansion to include population health and care management is the first:

We are already starting to see care management and population health types of applications that are considered bolt-ons to existing EHR systems if developed by a new or third-party vendor. Increasingly, you have Epic, Cerner, eClinicalWorks, and other vendors reaching up-market essentially to build their own kind of those abilities and functions and integrate them back into the standalone EHR experience so that users have one continuous experience even though it is spanning the spectrum of care.

Another entails a new but familiar approach at aggregating and displaying patient health data. “I imagine we would start to see is more of a Facebook-like experience to the extent that we will have different contributors to the patient record, including the patient ultimately, that will be seen more as an ongoing stream of those contributions that are both narrative and have the ability to be structured,” claims Tripathi.

The last and most promising is similarly a capability already in use in other information technologies, using metadata and tagging elements.

“Lastly, we’re starting to see some products that have more of that fluid experience similar to using a browser but also supporting more of a user-generated structure of data,” says Tripathi. “Rather than all your data being LOINC, coded, or pulled down from drop-down menus, you’re able to go through and tag different parts of the note that you define as a user. You can then perform searches, aggregations, or slicing and dicing — all of that — based on those tags.”

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