Researchers from the Baylor College of Medicine in Houston and their collaborators have come up with a five-point plan to improve the usability of EHRs in a paper published in JAMA.
"People expected information technology in healthcare to work similar wonders as elsewhere, such as on our phones, so expectations were naturally high when electronic health records were implemented nationally. But healthcare is much more complex, and usability and safety challenges have emerged," said senior author Hardeep Singh, MD.
The paper is based on lessons from 10 years of initiatives to make EHRs easier to use.
The five-point plan:
1. Develop a national database of usability and safety issues. A national reporting system should be created to monitor and improve EHR usability and safety, the researchers said. If clinicians and patients can easily report issues in a database, there will be more transparency in patient records. Additionally, database analysis could identify common unsafe conditions at a national level and inform recommendations to avoid these issues.
2. Create basic design standards. Previous work by Dr. Singh and his colleagues revealed a lack of standards on how to display graphs of diagnostic test results in several EHRs. Healthcare should have design standards for how information is displayed within EHRs, similar to the standards the transportation and aviation industries use, the researchers said.
3. Address unintended harms. Since EHR usability issues could come from vendor design and how healthcare organizations implement this design, multiple parties need to collaborate to fix issues through shared responsibility, the researchers said. For example, some vendors may have a clause in their contracts that shields them from liability from software design problems. Policymakers should assess vendor clauses to determine whether they prevent accountability and remove them.
4. Simplify mandated documentation requirements affecting usability. The researchers said some federal documentation requirements have increased clinician workloads and may not be clinically relevant. Policymakers should simplify documentation requirements, and EHR display should be modified to let clinicians focus on patient care.
5. Establish standard usability and safety measures so progress can be tracked. EHRs cannot be compared directly on their usability since there are no standard measures of usability. The researchers suggested these measures be developed and tested to track how different EHRs would work in clinical practice.