We are slowly but surely seeing a shift away from the standard Windows motif for electronic health records user interfaces. Not all, but many, doctors find using dialog boxes, screen forms, and drop-down navigation menus tedious, time consuming, and counter-intuitive. 

In fact, our primary—yet somewhat anecdotal--research finds that busy primary care doctors tend to have the most issues with EHRs, while doctors who perform high-end procedures are less impacted. 

The difference is the number of encounters seen per work week, the availability of medical transcriptionists doing the actual data input, the complexity and number of complaints during the encounter, and the reimbursement rate of the encounter.

Primary care docs--the infantry of the medical profession--see the most patients per week.  Their encounters are scheduled at 15 or 30 minute intervals and rarely, if ever, are dedicated medical transcriptionists available.  During each encounter the patient tends to have multiple complaints or issues, and revenue-per-encounter tends to be the lowest. 

Consequently, a few minutes extra per encounter has a relatively large impact on productivity, so anything that adds time and labor to the workflow adds frustration and dissatisfaction for these docs. It is not uncommon for primary care docs to work an extra hour or two per day clicking around in the EHR.  This is typically uncompensated time, which probably accounts for “studies” showing EHR reduces costs--it’s easy to save money by replacing a $15/hour file clerk with an uncompensated $200,000 per year internist, but is it smart?

For anybody that says Tholemeier, you’re over-generalizing, I agree to some extent.  The degree to which doctors, particularly primary care doctors, are negatively impacted by EHR varies.  Some EHRs are better than others at mimicking or improving workflow and making the doctors productive.  In many cases, implementing any EHR is a way to improve pathetically designed, paper-centric workflows.  And, of course, the long-term benefits of getting all this info into computers are unassailable.

But, and it is an enormous but, can anybody truly say that a Windows, mouse, and keyboard EHR is final destination for EHR user-interface design?  Of course not, and we are seeing some reasonably innovative solutions oriented around Apple’s iPad -- not the device so as much the user interface. 

But if you take a few minutes to watch this amazing Sixth Sense presentation you can see just how far we could go to improve how doctors and patients and the “computers” interact.

Amazing.  Is this exactly it?  Probably not.  But will it make EHR designers think? Hopefully.

Rob Tholemeier is a research analyst for Crosstree Capital Management in Tampa, Fla., covering the heath I.T. industry. He has over 25 years experience as an information technology investor, research analyst, investment banker and consultant, after beginning his career as a hardware engineer and designer.

 

 

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