October 3, 2017 Owen Carey

How to Improve EHR Usability During the Implementation Process

Throughout 2017, healthcare industry leaders have pressed health IT companies and developers to innovate technologies that prioritize EHR usability and streamline the provider workday.

The American Medical Association (AMA) in particular has made efforts to encourage EHR system design that allows for more efficient, painless EHR use. Earlier this month, the association teamed up with the University of Wisconsin in a study that found primary care physicians spend nearly six hours on EHR data entry during a typical 11.4 hour workday.

In response to these findings, AMA published a list of eight priorities for health IT companies to keep in mind during development to improve usability. Recommendations ranged from promoting data liquidity to reducing cognitive workload.

However, health IT companies are not the only entities capable of improving system usability. AMA recently turned the lens on physicians to explore how healthcare organizations can play a hand in enhancing EHR usability themselves.

While past examinations of usability focused mostly on system design, the association’s online roundtable discussion gathered feedback from physicians on how healthcare organizations can enable usability improvements during the EHR implementation process.

“Because physician practices and even large health systems often don’t have much experience with EHR configuration (especially with installations that are new to them), third-party consultants are frequently engaged to help with configuration and training,” wrote Senior Natural Scientist at Rand Corporation Mark Friedberg, MD during the discussion.

“The quality of the services provided by these consultants is likely to vary—meaning that even for the same underlying EHR vendor product, the configured tool that physicians actually use could be quite different across installations,” Friedberg continued.

Well-executed EHR implementations can lead to more usable systems tailored to the specific needs of physicians at an individual practice. For this reason, University of Colorado Health System (UCHealth) CMIO Chentan Lin, MD stated his health system invested in a 24-member informatics team to spearhead implementation decisions.

“We focus on relationship-building and understanding our front-line clinicians and solving their problems,” wrote Lin. “This means taking the vanilla EHR system, keeping the best standard processes, and then creating a best-practice workflow for each specialty. This is a ton of configuration that we are starting to tackle.”

While the onus remains on health IT companies to improve system usability, some physicians told AMA they have taken matters into their own hands after becoming impatient with the time vendors have taken to generate advancements.

“Like many front-line docs, we are deeply skeptical that this can be done in a time frame that will allow for meaningful relief of the burnout docs are experiencing, to a large extent due to the EHR burden,” wrote Bellin Health Family Physician James Jerzak, MD. “Our solution at Bellin Health was to institute an advanced team-based care model, one that up-trains staff (CMAs and LPNs) to do the majority of the EHR work and to redesign in-basket flow to more of a team approach[.]”

Stakeholders across the industry have emphasized the need to improve the standard-issue EHR system. In an article published in The Joint Commission Journal on Quality and Patient Safety, Health Informatics and Digital Strategy Consultant Linda Harrington, PhD stated usability is one problem responsible for widespread physician dissatisfaction and productivity losses.

“For example, in a survey involving 13,650 licensed RNs in the United States, 92% of the respondents were dissatisfied with inpatient EHRs,” wrote Harrington. “Disruption in productivity, communication, and work flow, which all reflected problems in usability, were cited as three top dissatisfiers. Usability, then, was a big miss, reflecting the dependence on complex software in the unique business of health care”

Until health IT companies adjust EHR technology to better suit the provider workday, involving experienced IT teams to guide implementation decisions and instituting team-based care models could mitigate usability problems for frustrated physicians.

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