What can be done to fix EHRs?
Key Takeaways
EHRs began with good intentions, but their implementation has been challenging.
From a user experience (UX) standpoint, EHRs are difficult and time consuming for a doctor to navigate. Improving the UX requires simplification, making EHRs more user-friendly and less time-consuming.
Experts believe that regulators need to implement rules from the top: particularly safety and usability testing of EHRs.
EHRs can make or break a physician’s efficiency, as well as their longevity in medical practice. The proof is in the research. For example, one 2020 Journal of Medical Internet Research study found that 74.5% of queried physicians said EHRs contributed to their burnout.[]
It was never supposed to be this way.
In 2009, President Barack Obama delivered a speech at an AMA conference saying EHRs “will not only mean less paper-pushing and lower administrative costs, saving taxpayers billions of dollars; it will also mean all of you physicians will have an easier time doing your jobs.”[]
Along these perceived benefits, however, comes the clerical burden of EHR data entry, which takes an undeniable toll on doctors. What would solve the problem? We spoke with a few experts. The answer, it seems, must incorporate physician input, user experience (UX) design, and healthcare policymakers.
Assessing the problems
Gaurav Sharma is the EMR manager at GoHealth Urgent Care. EHRs, he said, are a daily confounding issue for him and his team.
"EHRs are like an advanced physics college class that had no prereq requirement."
— Gaurav Sharma
Mastering just one requires time and effort.
Another EHR specialist, Katelyn O’Brien, MBA, works at The Queen’s Medical Center in Honolulu, Hawaii as a senior project manager, and has been working on EHR implementations for 10 years. She said the myriad EHR systems scatter patient information, often turning an assessment of medical history into a digital Easter egg hunt.
“If there was one source of truth when it came to a patient’s health information, patient care would definitely be improved,” she said.
Sharma believes the issue can be broken down into three subsections.
Pre-registration/registration. Physician employers could ease the clerical burden on doctors, and allow physicians to focus more on the patient encounter, if they captured as much patient information as possible during pre-registration and registration.
Clinical documentation. While this needs to be a detailed record for the patient, the interface still needs to be as simple as possible for the doctor to use. All EHRs should be integrated with speech recognition software or scribes to support providers.
Billing/coding should be simplified. Answering a few questions in the EHR should produce an accurate, suggested EM code.
Sharma feels–and many physicians would agree–that a doctor’s sole focus should be caring for patients.
“When providers spend more time thinking about coding than clinical care–we should all be alarmed,” he said.
UX issues
Better UX design will improve physician interaction with EHRs, say experts consulted for this story.
The UX design flaws of EHRs consist of two main issues: The basic design and interface (how patient information is displayed and used), and information support problems (how doctors access patient information).
“The name of the game should be ‘click reducers,’” Sharma said. “EHRs need to be developed with accuracy and speed in mind. Click fatigue is a real thing and it opens providers up to incorrect data input.”
O’Brien added that existing systems need to be updated and simplified.
“I think (doctors) expect the system to be more intuitive and drive decision-making for them,” she said. “This is difficult to do, because patient care can vary so drastically from one patient to the next, even if they are being seen for the same thing, based on past medical history, labs and a plethora of other things.”
Role of healthcare policymakers
In many ways, the push for EHRs originated at the top, among healthcare policymakers. Reform must originate there as well, the experts told us.
Raj Ratwani, PhD, is an EHR usability expert with MedStar’s National Center for Human Factors in Healthcare. He worked with two collaborators, Michael Hodgkins, M.D., of the American Medical Association, Chicago, and David W. Bates, M.D., of Brigham and Women’s Hospital, Boston, to curate ideas they felt necessary to improve EHRs through legislation.
They workshopped three main points:
Policies should require vendors to test EHRs for usability.
Healthcare organizations must be allowed to participate in all usability and safety testing alongside vendors.
Policies should require vendors to report any safety or usability issues in a timely manner. This will allow healthcare organizations to do pro-con analysis of each EHR system.
Sharma had his own insights, regarding EHR reform originating from policymakers.
“I feel healthcare policy is useful, necessary and helps us compile data for future use/need,” he said. “However, it’s not created with a provider in mind. In an ideal world, policies that require EHR change should be on their own timeline. Provider/healthcare organizations should have an implementation date of their own. This would allow providers to adopt changes, perfect workflows, and educate the end users.”
Ultimately, according to O’Brien, reform begins with putting the physician-patient relationship back at the center of the EHR conversation. Doctors are becoming more frustrated with the system because there are more and more distractions taking the eyes off of the patient.
“I think there are too many healthcare requirements that end up hindering patient care instead of helping,” O’Brien said. “Especially with promoting interoperability, there were so many documentation requirements that slowed down patient visits but didn’t actually add value to the delivery of patient care.”