AMA Wants EHR Designs Overhauled

In response to widespread physician discontent with electronic health records, the American Medical Association has announced a new framework for improving EHR usability designed to benefit both caregivers and patients.

With support from an external advisory committee comprised of physicians and health IT experts, AMA has developed eight usability priorities that the organization says will result in EHR improvements and greater physician satisfaction.

“Physicians face distinct challenges in effectively using an EHR. These challenges can typically be classified as usability issues,” said Steven Stack, M.D., president-elect of the AMA. “Today, the design and implementation of EHRs do not align with the cognitive and workflow requirements of physicians within and across specialties and practice settings.”

Last year, AMA and RAND Corp. conducted a study in which doctors identified EHRs as the leading cause of professional dissatisfaction, emotional fatigue, depersonalization and lost enthusiasm. In the study, doctors described poor EHR usability that did not match clinical workflows, time-consuming data entry, interference with face-to-face patient care, and overwhelming numbers of electronic messages and alerts.

As part of a new national initiative, the AMA’s framework outlines eight EHR usability priorities: 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; and expedite user input into product design and post-implementation feedback.

Christopher Ross, chief information officer of the Mayo Clinic, said these EHR usability priorities will enable physicians to focus on patients rather than technology and to “place the EHR in the proper role in the health IT ecosystem.” According to Ross, the priorities represent “consensus-driven” and “very practical” guidance to the healthcare industry on how to solve problems with EHRs.

“We do not want to go back to paper records but today’s current EHR products are immature, costly, and are not well designed to improve clinical care,” said Stack, who added that “there are a variety of market and regulatory drivers of this current lack of usability.” Specifically, he called the meaningful use program and the regulatory structure associated with it as “overly prescriptive, rigid, and unreasonable.”

AMA argues that despite numerous usability issues physicians are mandated to use certified EHR technology to participate in the Medicare and Medicaid incentive programs. “Unfortunately, the very incentives intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues,” according to a written statement. “The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting meaningful use standards. Moreover, federal certification criteria for EHRs need to allow vendors to better focus on the clinical needs of their physician customers.”

Stack said that the AMA intends to use its new EHR usability framework as a “tool to engage with vendors to incorporate the needed changes in future EHRs” and “we look forward to a vibrant collaboration with them going forward to advance these priorities.” He also revealed that the organization will distribute the eight priorities widely to physicians and that “practice improvement modules” on how to purchase, implement, and optimize an EHR will be made available to them in early 2015.

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