Would a physician use a stethoscope if it added six hours to his or her workday? Even though the stethoscope can be a valuable diagnostic tool, many clinicians would arguably forgo its use to save 30 hours a week.
In the earliest days of EHRs, many of us were optimistic that these systems would provide time-saving tools that enhanced the delivery of patient care. Unfortunately, most physicians today feel EHRs are less of a tool than a mandatory task to facilitate billing. Many question the EHR’s overall value to patients and resent having to use inefficient systems that add hours to the workday.
Consider a recent study in the Annals of Family Medicine, which estimated that primary care physicians spend nearly two hours on EHR tasks for every one hour of direct patient care. Instead of saving time, EHRs have created a world where doctors often work outside of normal office hours to complete all their EHR-related tasks, resulting in an average of six hours per day spent within the EHR. Many physicians would gladly forgo the use of EHRs to save time—yet it’s not an option for the vast majority of clinicians.
Given the inefficiencies of most EHRs, is it any wonder that a recent Medical Economics survey on the growing burnout crisis in medicine found they are a leading contributor?
Tool vs. Task
Physicians embraced the stethoscope because it was an efficient tool for improving patient care. If EHRs could be fixed so that they were less of a burdensome task and more of an efficient tool, could we minimize the widespread loathing of EHRs and perhaps spark a bit more EHR love?
To answer that question, we would need to commit to enhancing EHRs to make them more usable for physician end users.
Enhanced Usability Starts with the Physician
A recent perspective essay published in the Journal of the American Medical Informatics Association noted that “the user experience with an EHR is multidimensional with a variety of influences, some visible to and controllable by the end user, and others outside the end user’s control. Decisions made by vendors, healthcare organizations, payers, lawmakers, and regulatory bodies impact the EHR user experience.”
In short, the issue of EHR usability is complicated. However, to make EHRs more usable for physicians, we must start by seeking input from physician end users. EHR vendors need to involve physicians at the product development level to gain a better understanding of how a physician actually thinks and works in a clinical setting. We can no longer rely simply on computer programmers with minimal clinical experience—however brilliant they may be—to make critical decisions that impact physician workflows.
Vendors and health system administrators must also involve physicians when making key implementation decisions that impact how users interact with the EHR, especially at the point of care. Physicians—and not just well-intentioned C-suite executives and IT staff—must be included in discussions about template customization, documentation workflows, and other areas that impact patient care and the end-user experience.
Defining and Driving EHR Usability
Even with physician input, improving EHR usability isn’t a simple task, in part because usability is a subjective measure. In 2014, the American Medical Association (AMA) issued eight EHR usability standards in an effort to guide EHR vendors on development priorities. While AMA’s recommendations were solid, the industry has failed to make significant progress achieving these standards.
EHR vendors, of course, must balance an often overwhelming number of R&D priorities, including those mandated by the government and payers. While we might have a bit of fatigue with all the regulations and reporting requirements, many of these programs have effectively accelerated change: The HITECH Act and Meaningful Use, for example, helped drive EHR adoption by hospitals from 9 percent to 96 percent, and adoption by office-based physicians from 40 percent to 86 percent.
To fix EHR usability gaps, we should consider mandated standards. Medicare, as the country’s largest payer, is the likely choice to oversee such an initiative, and could include usability standards as part of the EHR certification process.
Alternatively, CMS could appoint an independent third-party organization to define standards and assess EHRs’ adherence to these standards by evaluating workflows and tracking the time required to perform certain routine tasks, such as creating a new prescription or accessing recent lab results. Because usability is largely in the eye of the beholder, the entity should also seek the opinions of physician users to create usability score cards for different EHR solutions.
EHR usability is a major source of physician frustration that continues to fuel physician stress and burnout, which impacts patient care. It’s time to prioritize fixes for EHRs to transform them from burdensome tasks to effective tools that help physicians deliver better patient care.
Jay Anders, MD, is chief medical officer of Medicomp Systems, a physician-driven provider of clinically contextual patient data solutions that fix problems with EHRs.