- The arduous process of integrating EHR technology into doctors’ offices has introduced clinicians to a new world of complex daily challenges, and the present lack of EHR usability only serves to exacerbate the problem.
Stakeholders are working to make headway toward enabling improvements: in March 2018, the Bipartisan Policy Center and Health IT Now joined forces to establish an oversight framework promoting health IT innovation and EHR usability.
ONC has also made efforts to spur progress in this area by subjecting EHR vendors to some degree of usability testing as part of the health IT certification program.
Still, most industry stakeholders agree EHR usability remains lackluster.
University of Illinois Chicago Assistant Professor of Biomedical and Health Information Sciences Andrew Boyd, MD, has experience both using and building EHR technology. While he sees the potential for EHR technology to significantly enhance patient care, he maintains that consumer-centered innovation in health IT is far behind that of other fields.
“The interfaces of EHRs are always referred to as clunky,” Boyd told EHRIntelligence.com. “People interact with well-designed and seamless tools like mobile phones and web browsers, but the problem with EHRs is the design aspect.”
This industry-wide shortfall may have serious consequences.
The Negative Effects of Poor EHR Usability
Last month, a JAMA study pointed to poor EHR usability as partially responsible for more than 557 patient safety events from 2013 to 2016. Industry experts have also blamed EHR usability problems for the sudden spike in reports of physician burnout in recent years.
According to Boyd, much of the problem stems from the lack of specialty-specific EHR interfaces currently on the market.
“The fact that we have everyone working on similar interfaces makes things cumbersome,” said Boyd.
“You go from a passive consumption of data to where you’re forcing clinicians to actively search out information,” he continued. “Clinicians have to go to the lab section or to the radiological section to find the information they need. Instead of a passive consumption of data, clinicians have to think about what they need and then search out the data, which takes time and mental effort.”
The trend among healthcare organizations to implement and utilize general EHR interfaces across a variety of specialties, care settings, and facilities may increase provider burden and reduce clinical efficiency.
“I saw one study that said doctors have to click 30 times to get all the individual data elements to do preventative testing for the average diabetic patient in an outpatient setting,” Boyd explained. “A modern EHR didn’t pull up whether the patient had the pneumonia vaccine, the eye exam, or the foot exam.”
For clinicians and hospital staff engaged in routine preventative maintenance, these extra clicks add up to consume a significant portion of the workday.
By designing EHR interfaces to prominently display the most relevant information based on provider specialty or care setting, Boyd stated healthcare organizations can significantly improve clinical efficiency and reduce provider frustrations related to EHR use.
Customizing EHR Interfaces for Provider Satisfaction
While numerous initiatives centered on reducing provider burden are already underway, few focus on fine-tuning EHR design. Providers benefit from new technologies that streamline clinical documentation and provider workflow, but confusing interfaces continue to muddle EHR use.
Boyd suggested optimizing EHR data visualization as one potential solution to the problem of cluttered EHR design.
EHR vendors and health IT innovators can help to reduce the number of clicks per day for providers by developing separate and unique EHR interfaces designed to highlight the health data most likely to be relevant to specific users.
This targeted form of EHR data visualization could help to boost clinical efficiency and cut down on the amount of time providers spend searching EHR systems for necessary clinical information.
The researchers analyzed existing literature to find use cases for EHR data visualization. Ultimately, Boyd and his team determined enabling different providers to utilize different data visualizations and EHR models could streamline usability for faster, better-informed patient care delivery.
“The models can be specific disease state models or hospital models,” Boyd stressed. “Because no two hospitals work the exact same way. A physician or pediatric dentist would need a different interface than a cardiothoracic trauma surgeon based on the needs and the disease state that they’re dealing with.”
These specific EHR interfaces display high-value information to clinicians in the same way a web browser predicts which website a user is most likely to visit based on user history.
“We’re not concealing — we’re highlighting the important information,” emphasized Boyd. “If a user wants to pursue other information, they would be able to pursue it.”
Highlighting clinically relevant information has proven to be an effective strategy for improving the usability of physician EHR notes. A November 2017 JABFM study found showing less data in physician EHR notes may improve productivity.
Physicians in the study preferred collapsible EHR notes that highlighted abnormal information with colored text and bold font. The EHR note design helped to reduce clutter and enabled physicians to quickly locate the most relevant and significant clinical information, contributing to a boost in overall efficiency.
“If you can figure out a design interface for a hospital where they only need to spend five minutes looking up the data on a patient instead of 15, you’re saving them time that they can spend with the patient,” said Boyd.
Recent market research also supports Boyd’s push for more specialized EHR interfaces. A Black Book survey released in April 2018 found specialty EHR products ranked highest for physician satisfaction among surveyed practices.
While specialized EHR interfaces hold promise, motivating EHR vendors and health IT innovators to develop separate and unique models for distinct hospitals, care settings, and disease states is a challenge of its own.
Driving EHR Interface Innovation
Boyd knows of the challenges inherent to streamlining EHR interface design — over the past 15 years, Boyd has designed interfaces for physicians, patients, and administrators.
“One of the challenges in healthcare is the data is more complex than a common smartphone,” explained Boyd. “The necessary knowledge to make clinical decisions as a provider is huge.”
Encouraging health IT developers to prioritize usability over other areas — such as interoperability or data analytics — is also a barrier to innovation.
“The market is a challenge,” said Boyd. “When you look at something that’s relatively complex, like an office photocopier — companies in the 80s and 90s lost marketshare for bad interfaces because people couldn’t figure out how to replace the ink cartridge.”
Comparatively, a bad EHR interface causes few immediate problems for healthcare organizations, which lessens the urgency for health IT developers to prioritize improvements.
“There are a number of competing needs when hospitals and clinics buy an EHR,” Boyd said. “Part is billing, part is healthcare practitioner buy-in, part is cost, part is training. Interface and visualization is one of hundreds of thousands of aspects of a purchasing decision.”
“From a market point of view, I have not heard that a beautiful interface is the sole decision criteria between two equal systems,” he added. “There’s dozens of other variables.”
Toward this end, Boyd urged providers to be more vocal about their demands related to EHR usability and design to increase pressure on vendors.
“Be engaged with the vendors,” Boyd recommended. “Be engaged with the decision-makers. When you have engaged clinicians who may not understand the IT but understand their domain, that’s when you see improvements.”