Finding an EHR designed solely for improving patient care remains a source of simmering frustration, judging by the results of the Medical Economics 2017 EHR Report.
None of the doctors Medical Economics spoke with said an EHR vendor has ever responded to suggestions on how to improve their products.
“On several occasions I’ve tried to get in touch with [EHR manufacturer] Centricity [Practice Solution] about some easy corrections I’ve thought they could make and never heard back,” says Keith Aldinger, MD, a Houston internist in a two-physician practice and survey participant. “It’s a bit troubling that they don’t seem to want to work with the physicians, because it’s the end user who has to be satisfied. But if anything, it seems like it’s harder to navigate than it was when I started using it 10 years ago.”
Aldinger notes he started using Centricity around the time Apple introduced the iPhone. “If you look at the improvements in [the iPhone’s] usability versus the EHR, there’s no comparison,” he says. “I can’t think of any another product [than EHRs] that has performed so poorly, and not only survived but with abundant profitability. It’s just unbelievable.”
James Dunnick, MD, FACC, who provides EHR training to other doctors as head of The Dunnick Group, LLC, in New Orleans, sees a simple explanation for why EHR vendors rarely ask for doctors’ input regarding quality improvement: They don’t have to. Medicare payment reform and other government policies mean that most practices and healthcare institutions are virtually required to have an EHR, he points out, providing the EHR companies with a guaranteed market for their products. And the Meaningful Use program, during its existence, subsidized their purchase.
Regardless of any shortcomings in the technology, “they’re still going to make the sale, and then when you [the customer] don’t like it, it becomes your problem, not theirs,” says Dunning, a survey participant who still practices internal medicine part-time. “And then it’s so expensive to change systems, the customer just won’t do it, and would rather limp along with an unhappy staff.”
Cuthbert (MEDENT): This is excellent input that speaks to the core of what an EHR system should be taking into consideration at all times. As a vendor, it is easy to get caught up with the excuses that there are deadlines to meet to stay compliant with ongoing [federal] regulations. Since these are requirements that consume a lot of resources, it can be fairly easy to become unresponsive to the practicalities an EHR needs.
The vendor is in a test tube setting. The people creating the system's new features or work flow tend to be technical in their natures. This is why it is essential to have more laypersons looking at the simplicity, efficiency and common sense of the end result. During the development process you need to be intuitive, objective and mindful of each end user’s varying train of thought.
Once a project is ready for field use, it’s never really truly final. It is very important to listen carefully to early user feedback once it is put into real-world use. Furthermore, it is imperative that the necessary tweaks and adjustments are made to make sure the end result is very solid, efficient and logical.
The influence on programming usually comes from several sources including the practices, users, government, industry trends, insurance carriers and the vendors own vision for the future. We have the responsibility as a vendor to maneuver with a high level of integrity while still staying attentive to the physician's needs.
Mackie (athenahealth): Physicians and other healthcare professionals must absolutely drive the design process, and the responsibility lies with the developers and designers to make sure they are central to product planning.
At athenahealth, we partner with doctors and care teams as we build and reimagine the EHR. We are constantly tapping our physicians (both clients and athena staff) for feedback. We conduct thousands of user observations, on-site visits and interviews and maintain an online client forum-all of which inform our user experience and service roadmap.
The greater problem is that providers are so busy treating patients that it’s tough to engage them in product development. Or, they’ve had a prior experience where their suggestions went unaddressed and are now hesitant to become involved. We’ve recently formalized the process: We now have a research council, a group of end users who’ve agreed to be contacted to provide input, and we are strengthening our customer success team, which ensures that the pains of our clients and users are both heard and responded to.
One thing I’ve learned (Dr. Apostol speaks to elsewhere), is that physicians often want a system that’s customized to their specific specialty or way of working. Though hyper-customization is extremely attractive at face value, the stark truth is that in the long run most physicians realize it is a bad idea.
Customization silos systems, creates dead-end products that are unsustainable, and makes it infinitely more difficult to connect and share information across care settings. Whereas with a cloud-based platform model (like athena’s), providers are on an open, connected network and have access to personalized, niche services/applications for “plug and play.”
Frantz (NextGen): At NextGen Healthcare, our guiding principle is to ensure our clients can achieve the quadruple aim: improving community health, reducing costs, enhancing patient satisfaction and improving caregiver well-being. We consistently seek feedback via user group meetings and focus groups, held across the U.S. as well as through real-time polls and discussion boards.
The feedback received from our clients has influenced our solutions roadmap and our desire to implement holistic solutions that enable our clients to remain independent and successful. Earlier this summer, for example, we introduced key acquisitions to our portfolio-an analytics solution to enable true population health management and a mobile solution that improves clinical workflow.
Recently, we worked closely with an ophthalmology client on software customization that included the design of custom templates reflecting the provider’s preferences. Throughout the implementation and planning phases, we carefully listened to our client’s needs. Our project managers worked alongside the client to build the platform and format the software to fully integrate with the client’s workflows.