Keep your government hands off my EHR

Consider this scenario. Your clunker is on its last legs, and it’s time to get a new car. Most likely, you’ll search product reviews to help you decide which make and model is best — best according to people who’ve driven them and kicked the tires a bit, not based on company accolades. You’ll want to know what drivers think. Amazon.com does the same thing for books (and every other product under the sun) with readers giving books their reviews and ranking.

The healthcare space should be no different. It’s human end-users — doctors and nurses — who need to define the usability of electronic health record (EHR) products by their acceptance and use of the products. The government-proposed approaches to enforcing usability for healthcare IT aren’t focused on the opinions of clinicians but on vendor compliance with self-defined testing processes performed in focused areas of their products. In fact, the stamp of approval for usability is based on the vendor’s adherence to the process, regardless of the outcome of the testing.  The applicability of the product to the healthcare environment where it’s deployed — and the opinions of end-users — has been left out of the equation.

Some EHR vendors get it, others don’t; most clinicians aren’t interested in whether a manufacturer or designer jumped through regulatory hoops to bring the product to market. Neither are they interested in how well they jumped through these hoops. Consumers care about whether the product fits their needs and wants.

Usability, after all, is defined as the ease of use and learnability of a human-made object. A car that is easy to drive, gets good gas mileage and carries everything you need, is well received. The level of “usability” for most consumer products is reflected in how well the market accepts designs, which is determined by user reviews and product purchases. With top-down usability being defined for us, we may as well have a committee decide which vehicle we’re going to buy, regardless if it fits in our garage.

Healthcare IT users can, and should, rightly decide which system is best for them and their facility. For instance, just look at the 2013 KLAS EDIS study results. Emergency medicine is not served well by an all-purpose, one-size-fits-all enterprise system. It’s a unique specialty with many competing demands in a complex, constantly changing environment. Emergency departments (EDs) have their own needs, unique patient volumes and a staggering breadth of presenting complaints. The differences of the ED from the inpatient or ambulatory outpatient environment require a specialized system fitting its processes. You wouldn’t take an office-based system and put it in your hospital environment. Why would you put an enterprise system in your ED?

The idea that usability can be influenced by simply putting standard processes in place is a flawed approach, especially in a market that requires products with true usability — the ability to deliver high-quality healthcare efficiently and effectively. There are benefits to honoring the human element over arbitrary standards: clinician performance and patient outcomes, to name two.

Robert Hitchcock is vice-president and chief medical informatics officer, T-System.

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