Physicians and other clinician users of electronic health record systems commonly rate the products low on a usability scale, in large part because non-clinicians do the bulk of the work designing them. Now, there is an industry effort to bring together stakeholders and build a better EHR.
The American College of Physicians and HIMSS Electronic Health Records Association recently held a usability workshop in Chicago, bringing together clinicians, software developers and usability experts.
At least a third of participants were clinicians, primarily physician champions, and that was by design, says Thom Kuhn, M.D., senior systems architect at ACP. “We wanted the folks who have drunk the Kool-Aid,” he explains. “The physician champions are the ones trying to deal with complaints and improve usability.”
A big complaint for primary care physicians, for instance, is documentation of evaluation and management (E&M) codes that describe the level of services given to a patient during an office visit, according to Kuhn. The problem is that doctors are forced to document irrelevant information not useful for patient care but is used for billing purposes. That forces the next doctor accessing those notes to wade through the E&M documentation to find what he or she is really looking for.
The value of the workshop, Kuhn says, was that when usability experts and physicians got together progress was made on both sides in the form of better understanding. “Find a usability expert to talk your way through solving a problem,” he advises.
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A particular issue that will take time to figure out is finding the optimum level of customization within EHR systems. They are so overly customized that it makes the EHR difficult to use. “But doctors want the screens they want when they want them,” Kuhn says.
Consequently, there is tension between physicians and vendors or internal IT personnel, as negotiations over customization bump up against usability, notes Leigh Burchell, chair of EHRA and vice president of policy and government affairs at software firm Allscripts.
There will always be tension between customization and usability, and the hope is that through this initiative and others, physicians will start to better understand the other side, Kuhn says.
One key importance of the workshop, Burchell notes, was the opportunity to walk regulators through how their rules impact usability. For example, physicians during an office visit need to capture a wide variety of vital signs and other Meaningful Use measures that don’t offer value because they are not appropriate for the reason for the visit, which interferes with the visit itself.
During the workshop, vendors also saw an opportunity to work together and create best practices for tackling such issues as implementation, training and making the right systems configuration choices, she adds.Workshop participants are planning at least one additional workshop during 2016.
