Federal government incentives worth about $30 billion have persuaded the majority of physicians and hospitals to adopt electronic health record (EHR) systems over the past few years. However, most physicians do not find EHRs easy to use.
Physicians often have difficulty entering structured data in EHRs, especially during patient encounters. The records are hard to read because they're full of irrelevant boilerplates generated by the software and lack individualized information about the patient.
Alerts frequently fire for inconsequential reasons, leading to alert fatigue. EHRs from different vendors are not interoperable with each other, making it impossible to exchange information without expensive interfaces or the use of secure messaging systems.
EHRs are designed to support billing more than patient care, experts say. They add to, rather than reduce, the workload of doctors. And they don't follow the principles of user-centered design (UCD), which puts the needs of the user at the forefront of the design and development of products and systems.
The American Medical Association in 2014 issued an eight-point framework for improving EHR usability. According to this framework, EHRs should:
- enhance physicians' ability to provide high-quality patient care
- support team-based care
- promote care coordination
- offer product modularity and configurability
- reduce cognitive workload
- promote data liquidity
- facilitate digital and mobile patient engagement
- expedite user input into product design and post-implementation feedback.
Nevertheless, it does not appear that EHR vendors are placing more emphasis on UCD. The Office of the National Coordinator for Health IT requires developers to perform usability tests as part of a certification process that makes their EHRs eligible for the government's EHR incentive program. Yet a recent study found that, of 41 EHR vendors that released public reports, fewer than half used an industry-standard UCD process. Only nine developers tested their products with at least 15 participants who had clinical backgrounds, such as physicians.
Government regulations are a key barrier to improving the usability of EHRs, says Peter Basch, MD, medical director for ambulatory EHR and health IT policy at MedStar Health, a Washington, D.C., healthcare system. For example, he notes, EHRs were easier to use before developers were required to design them in a way that enables them to collect quality data for the government's EHR incentive program. (Physician practices and hospitals must gather this data on health care processes for a certain percentage of Medicare or Medicaid patients to show "meaningful use" of EHRs so they can qualify for incentives and/or avoid financial penalties.)
Another downside of the meaningful use program, says Basch, who advises the American College of Physicians on health IT, is that vendors have had to focus on rewriting their software to meet the changing EHR certification criteria. As a result, they have had little bandwidth left over to meet the needs of their customers by building more user-centered products.
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