Recently I came across yet another article – complete with an attention-grabbing headline – that highlighted the inefficiencies of EHRs.
It offered recommendations for “finally” fixing this long-term problem. Unfortunately, the author – who is a health IT exec – didn’t offer much that’s new or insightful, nor anything that would lead me to believe that EHRs are poised for a sudden transformation and will soon be more user-friendly and increase physician productivity.
Personally, I am exhausted by the endless stream of studies that reveal ever-climbing levels of physician fatigue and discontent with EHRs – but I am ever more exhausted by all of the suggestions and ideas that don’t address the real reason most EHRs have usability issues: developers failed to include physicians in their design efforts, their targeted end-users, in the system design process.
In my opinion, that’s a travesty.
EHRs and smartphones; apples and peaches
We often hear people remark that EHRs should be as easy to use as a smartphone. I personally love my smartphone and agree that EHRs need cleaner, more user-friendly designs that allow physicians to spend more time with patients. I am also pretty confident that when Steve Jobs was designing the first iPhone, he relied heavily on the input from his targeted end-users; that is, cell phone users.
EHRs and smartphones may both be technology tools, but they are as different as apples and peaches. The practice of medicine is obviously much more complicated than placing a phone call or pulling up a website on a smartphone. If you dial the wrong number, no one is going to die. However, if a physician enters the wrong dosing instructions when ordering medication, the result could be tragic. EHRs require more functionality and precision than smartphones – and no one understands that better than a physician.
The forgotten physician and the clinical gap
Many EHR companies have lost sight of who they’re building their systems for. Most of today’s EHRs were originally designed to facilitate billing and reimbursement activities, and not to support clinical thought processes or physician workflows. User-friendly clinical interfaces have long been an after-thought for vendors who have focused more on addressing regulatory requirements than designing systems that are pleasurable and efficient for physician end-users.
And truth be told, healthcare providers continue to buy these systems - despite usability concerns - because the systems are needed to automate financial processes and keep revenues flowing.
Why physician input is critical
EHR companies that want to create clinical systems that doctors love and want to use must include their end users in the design process. After all, the physicians are the ones who know the required workflows, understand existing bottlenecks, and can identify which processes are critical to patient safety. Physicians can identify common clinician thought processes and understand why one workflow may be preferred over another. They understand what tasks are traditionally performed by a medical assistant, how long a particular procedure might take, and when and why a clinician cannot be looking at a computer screen. In short, a physician understands how other physicians see patients and practice medicine.
Many vendors include physicians on their advisory boards to provide strategic input. While I applaud such programs, they’re not the same as having physicians work hand-in-hand with software developers to create clinical applications. Physicians need to be included in every step of the process, including the design, building, and testing. Furthermore, developers need a broad spectrum of opinions from multiple physicians across a variety of specialties.
What’s next – or what should be
EHR companies have a choice to make as they explore new technologies and consider next-generation products. One option is to incorporate emerging technologies that leverage natural language processing (NLP), artificial intelligence (AI), and other innovations which have great potential for transforming healthcare – though not necessarily enhance the physician experience.
Alternatively – or perhaps in addition - vendors could seek more physician input and work to create highly usable solutions that give physicians what they need to practice medicine. By leveraging physicians’ knowledge and experience, developers would have the expertise required to create highly usable clinical solutions that think and work the way clinicians do; that deliver physicians the actionable information they need for clinical decision-making at the point of care; that create more efficient workflows that enhance physician productivity.
If more EHR vendors involve physicians in the design process, we might end up reading fewer doom and gloom stories about inefficient clinical systems and physician dissatisfaction. Perhaps we’ll then see a surge in catchy headlines highlighting happy physicians who are delivering better patient care, thanks to their highly-usable EHRs.
About the author: Jay Anders, MD is the Chief Medical Officer of Medicomp Systems. Dr. Anders supports product development, serving as a representative and voice for the physician and healthcare community that Medicomp's products serve. Dr. Anders spearheads Medicomp's clinical advisory board, working closely with doctors and nurses to ensure that all Medicomp products are developed based on user needs and preferences to enhance usability.