Healthcare Providers Voice Gripes At EHR Usability Hearing

SOURCE:  InformationWeek

Clinicians want electronic health records (EHRs) of the future to be more user friendly than those of today when trying to enter orders and grasp subtle changes in a patient’s condition, according to experts testifying on a care provider perspective panel at the Health IT Policy Committee’s Adoption/Certification Workgroup hearing on EHR usability.

“All too often, we hear from providers that they look forward to the day when the technology works for them, instead of them feeling like they work for the technology,” said newly minted national coordinator for health IT Farzad Mostashari, MD, in his opening remarks at the April 21 meeting. “We hear from providers that they didn’t know what they were buying until they bought it, what it would be like to use, that there was not the transparency they hoped for. We hear about potential safety issues and about errors that can be attributed to the human-computer interface.”

Mostashari said he hoped the meeting would generate guidance around metrics and measures that could be used to define usability, but that there was potential to go too far.

“There’s a real risk that if this is done in a poorly thought-through way, if we take a too proscriptive approach, if the science isn’t there for how usability is to be measured or if we are too subjective, we could end up causing well-intentioned but severe unintended consequences,” he cautioned. “We could end up, in the extreme, mandating or regulating the design of software, and freeze in place the technology approaches of today. We could hinder the innovation that is so desperately needed–the disruptive and constructive innovation we need for tomorrow’s technology. That’s our critical challenge.”

Mostashari further cautioned that he did not intend for the government to create a pass/fail testing system, whereby poorly scoring EHRs couldn’t be marketed. “That’s not the purpose of what we’re trying to do,” he added.

Christine Sinsky, MD, a board-certified internist who practices at Medical Associates Clinic and Health Plans in Dubuque, Iowa, testified she has seen deep discouragement among physicians with their EHRs because of usability issues. Improvements were “urgently needed,” she said.

Sinsky, who speaks on practice redesign and the medical home, said EHR-associated administrative work had added two hours to the clinician workday. In addition, she said, many of the systems presented data in a “cluttered” way, leaving physicians struggling to identify meaningful information. This causes a “needle in a haystack” dynamic, she said, with “complex navigational pathways resulting in hard to see patterns.” Sinsky noted that just because a 15-page document has been imported into the electronic record, “doesn’t mean it’s easily available.”

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