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On EHR Usability: An Apology (and a Path Forward)

Provider using a tablet

To my physician friends, nurses and clinicians of all kinds: 

I write to you today to offer a long-overdue acknowledgement: We can do better.

For decades, electronic health record (EHR) vendors have created software so complex, so convoluted and so click-ridden that more than half your working hours are now spent interacting with it. Software that forced you to pay more attention to it than to your patients. Software that turned you into data entry clerks and required you to connect from home to finish your work.

It’s a meager defense to observe that the regulatory burden for your profession has expanded dramatically over the past two decades, requiring that we force you to check off a multitude of boxes, repeatedly authenticate yourselves, and digitally sign scores of notes and documents.

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This observation notwithstanding, we can do better. We must do better. And I can say with confidence that we are starting to do better.

Last year, doctors Paul Dexter, MD, and Shaun Grannis, MD, MS, of the Regenstrief Institute wrote about the importance of Leveraging All Members of the Clinical Team to Improve EHR Usability. I’ll admit to holding my breath as I began to read it, hoping to learn that EHR vendors were doing at least some of the things they recommended.

Thankfully, vendors are now doing almost all of what was outlined and putting clinicians in the driver’s seat – not only in the initial EHR design process but at every stage of the product lifecycle. Many are now putting practicing physicians, nurses, and other clinical software users directly onto their development teams. This is a dramatic change from the way clinical software was developed just 10 years ago. 

The revolution in consumer electronic devices (particularly smartphones and apps) has made effective user interface design and general product usability baseline expectations for software in every other industry. Now it’s time for healthcare to catch up, and to positively answer the question posed by clinicians, “Why can’t my EHR be as easy and enjoyable to use as my favorites apps?” 

But just as Drs. Dexter and Grannis emphasize, EHR usability is not just about how an individual provider engages the software. It must include how it’s used by groups of providers. Today’s EHR must be designed to support team-based care, enabling physicians to focus on those tasks only they are qualified to perform, while efficiently delegating other tasks to other members of their team. Likewise, it’s not just about single patients, but “panels of patients” as these authors rightly note. 

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To meet all of these new challenges, EHR vendors must start fresh rather than continue to adapt existing software to a rapidly changing environment with mounting user expectations. We must prioritize usability, mobility, efficiency and integration – with data sources inside and outside of an organization. And we must design for care teams, with role-based workflows, tools for effectively communicating and coordinating care, and the ability to efficiently identify, monitor and take action on panels of patients (populations). On top of all of this, we need to enable greater personalization, since each clinician has her own unique workflows and practice patterns.

So, please know that the EHR industry has been listening. It’s not just products that are changing but the entire process used to develop them – and usability is now the top priority.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

Updated July 23, 2018