Electronic health records systems should be the springboard from which clinicians perform an elegant forward dive, with 3 1/2 somersaults in the pike position, enabling a classy entry into the pool of data.
EHRs should not inspire fear and loathing, in Las Vegas, or anywhere else for that matter. Yet, six years into the rush to install caused by the Meaningful Use EHR Incentive Program, there’s mixed reviews on the applications that have been put in place.
Perhaps we all understood, to a degree, that EHRs were a foundational first step if we were ever to get off paper and make use of the potential efficiencies of the computer. Yet, as the Mayo-American Medical Association study found this summer, most physicians don’t believe that EHRs add to their efficiency and thus interfere with quality patient care.
So with EHRs widely installed at almost all hospitals and the vast majority of physician practices, pressure will continue to mount to obtain benefits from, not complaints about, EHRs. And provider organizations need EHRs to start delivering on their promise, as providers will come under intense pressure to improve quality/value, and not just up the volume of services they provide.
So here are four ways EHRs need to improve to regain positive momentum for their organizations.
Improve user interfaces. Ease of use—or, rather, the lack of it—is one of the chief complaints for clinicians. And it’s understandable—many times, EHRs were designed to offer a reflection of the paper chart, in the belief that such familiarity would assuage clinicians’ fears that they were completely moving away from that form factor. Sadly, the user experience was not completely researched, and some inefficiencies were designed into interfaces.
Now, it may make sense for EHR vendors to redouble efforts to research the user interface to increase ease of use, navigation and data entry options. And here’s a crazy idea—since vendors now appear willing to cooperate on various fronts, maybe it might make sense for them to jointly research and develop a common user interface that all could use, so that clinicians could move between systems easily, without the struggle of learning new conventions.
Reduce documentation, highlight key findings. Much of this was recently discussed by Barry Chaiken, MD, in his illuminating blog on documentation. But to summarize it, much of the benefit of EHRs has been lost by facilitating the inclusion of massive amounts of documentation. It’s work for clinicians to create it (unfortunately, made easy only through the highly risky practice of copying and pasting) and double work to wade through needless verbiage to get to the nuggets that really suggest what’s wrong with a patient, and what course of action could fix it.
The challenge is twofold. First, clinicians must be relieved of entering data that’s unnecessary or could be better entered through interfaces with medical devices. And whatever the reason for entering copious notes—whether it’s the ease of doing so through the use of pull-down menus and copy-paste, or medicolegal fears of not fully documenting everything—documentation for documentation’s sake must be de-emphasized and unlearned. And the true power of computing, to use artificial intelligence and natural language processing, must be incorporated into records to unlock key findings that can help clinicians zero in on patients’ key issues.
Redesign EHRs for the future. Records systems need a redesign so that they are looking forward to future demands, not backward into history. Many of the systems in use today are built on a framework that was optimal for capturing activities, supply usage and other bits of information that supported fee-for-service billing and charge capture. But that won’t be important in the future; rather, EHRs will need to support provider organizations in providing the best possible care, and that will entail drawing in information from other sources, mapping in population health, analytics, artificial intelligence and more.
Rather than paving over the cowpaths, vendors need to accelerate work to revamp their offerings to increase their flexibility and reflect the needs that providers will be facing over the next 10 years.
Information exchange and sharing. I discussed part of the challenge in yesterday’s blog on interoperability, but the concept needs to be expanded beyond just improving the ability to easily exchange data between vendors’ systems. Clinicians must be able to find information on patients and where they were treated easily, in the course of their workflow. Access needs to be focused on crucial information, and not just a dump of a text file. And if we ever hope to engage patients in their care, they need access to their medical information in a unified fashion, not by searching through multiple portals.
Achieving these four goals represents a massive challenge to the industry, but progress is essential if the industry hopes to truly gain clinician enthusiasm and achieve benefits from its EHR investments.
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