EMRs require better user-centered design

Healthcare IT News recently asked, “Do doctors have to be typists to get MU incentives?”

That question reminded me that given the many hours of unreimbursed labor performing EMR data entry at end of day, a significant chunk of a clinician’s workday is spent performing medical secretary services. Let me set the record straight, I am a good typist.  But EMR data entry interfaces are often unnecessarily cumbersome, so clinicians put off the majority of data entry until end of day to avoid falling utterly behind schedule.

Even the sign on process can be painfully slow, which discourages contemporaneous use of the system, especially when visits get repeatedly interrupted to speak with outside physicians by phone or to deal with patient complaints at the front desk, requiring securing and signing on multiple times in one visit.

The lack of user-centered design combined with cash infusions to encourage the purchase of systems that need further refining and that will be expensive to fix given that they are sunk costs is alluded to in the Healthcare IT News article’s discussion.  Specifically it discussed “whether or not current certified EHR systems allowed for decision support to appear again after the order is entered. Most of the physicians in the group said it was not possible. At least one said it was. Tang said to make Calman’s idea possible, it would probably require most physicians to have their EHR systems reprogrammed. Not a feasible idea, he said.”

That discussion brings to mind those pesky modal windows that fire alerts when a patient record first opens, freezing the system, forcing the user to deal with the alert in a definitive way at that moment, hence the reminder is not available when it actually is needed. Along that line, vendors and consultants often encourage clinicians to redesign their clinical workflows, not necessarily in a manner that makes clinical sense – i.e. not akin to the workflow changes one may enact when e.g. performing Lean improvement, but in a manner that will match how programmers wrote the EMR code.

In March, the Human Factors and Ergonomics Society held its first Symposium on Human Factors and Ergonomics in Health Care: Bridging the Gap. Despite all the vendors in the EMR space and the current lack of incorporation of basic user-centered design and human factors principles in many products, only Athena Health, to which I have no connection, participated in the Healthcare Information Technology track of that symposium.

Rather than relying on lobbying power to maintain market share, it would be refreshing to see vendors embrace human factors and user-centered design principles, along with modern languages and architectures, to create better systems that enable clinical quality, safety, efficiency and effectiveness.  Hopefully, EMR vendors will see value in participating in next year’s HFES Health Care Symposium and in incorporating such principles in their products.

Barbara J. Moore is a pediatric pulmonologist and medical informaticist. She is a clinical adjunct faculty member of Northeastern University’s Masters Program in Health Informatics and consults for healthcare information technology companies and healthcare providers.

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