Can EHRs evolve from minimally usable to delightfully indispensable?

Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus on improving customer satisfaction.
By Matthew Douglass
10:41 AM
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Electronic health record platforms are among the most complex, interconnected, data-intensive software applications on the planet. Think about the seemingly endless fragments of patient information that an EHR is asked to store and maintain – basic demographics, diagnoses, chart notes, medications, allergies, upcoming appointments, previous surgeries and procedures, historical lab values, imaging studies, standing lab orders, e-prescription transmission transactions, claim submissions, and on and on.

Physicians and their staff also need to be able to review, transmit, reconcile, approve, and synthesize all of that clinical information to help make better, more informed decisions with their patients.

In 2008, fewer than 1 in 10 physicians were using an EHR, and the functionality that existed in those systems then would not qualify as a federally certified EHR product now. Over the last decade, to achieve federal certification, vendors worked at a feverish pace to add hundreds of features and change dozens more in order to achieve parity with the rest of the market. This transition from paper to digital happened so rapidly that usability suffered, innovation lagged, and real customer needs were under-prioritized.

Now that all certified EHRs share minimum functionality and can exchange information with each other, the time has come to refocus this entire industry on improving customer satisfaction.

The Office of the National Coordinator for Health IT has attempted to regulate the design of EHRs in a way that has not resulted in broad usability improvements to date. Approaching this immense problem from a more prescriptive regulatory perspective barely scratches the surface of what customers are demanding. While there should be required minimum standards for any software that is utilized by medical professionals to help them manage something as critical as patient health, no regulatory framework for usability will lead to more delightful user experiences for medical professionals or their patients.

What technology is needed in a modern medical practice?
Most complaints from EHR users stem from the feeling that the computer interferes with the ability of physicians to provide great, human-centered care for their patients. Many user interfaces look like they are 10 to 15 years old (because they are) and fail to meet customer expectations for how a modern application should function. Alert fatigue, infrequent software upgrades, and inefficient workflows contribute to this general dissatisfaction. In a recent study, researchers found that physicians spend 3 times the amount of time with computers as they do with their patients during a typical day. It's no wonder that EHR usability is consistently rated poorly across most software vendors.

Physicians and their staffs ultimately need software that supports their practice throughout the entire patient journey. Technology vendors must completely rethink their offerings by applying the essential components of user-centered design that have worked well in other industries.

Implementing an intentional approach to usable software
Usable software applications are intuitive, easy to learn, and memorable. They also must be efficient and prevent errors, all while deeply satisfying their users.

To achieve these six goals in health software, vendors must first gain a deep understanding of how a physician's office works – from the beginning of the day until the lights are turned off. A team of user researchers dedicated to this scientific task, investigating directly in doctors' offices, is crucial.

Tip: Merely dropping in for a few hours of office time is insufficient.  

Shifting to a user-centric approach in EHR design also requires gathering as much information as possible about how technology can assist customers with common tasks and data-intensive decisions.

Tip: It helps immensely to have a central place on the web where customers can request features. Often, the conversation that occurs in the comments section is crucial for software development teams to smartly refine feature requirements and improve usability.

Executives of EHR companies must embrace and encourage iterative software development within their product and engineering teams, with customer feedback directly informing each iteration.

Tip: Pair "minimum viable product" software development methodologies with user experience personas to turn users into happy evangelizers of products they love using every day.

Achieving indispensable EHR technology
For decades, physicians have pleaded with software makers to build functionality that helps them make better treatment decisions and provide better care for their patients. EHR vendors have instead delivered technology that is minimally usable and slows down the practice of medicine. Fortunately, this is not how it has to be.

As the entire healthcare industry transitions its business model from fee-for-service to value-based care, modern medical practices will find themselves relying even more on healthcare technology that efficiently collects, reports on, and synthesizes clinical data. To truly capitalize on this opportunity for smarter decision-making that leads to improved patient outcomes, current basic EHRs must evolve into mature, highly usable, indispensable tools that physicians and their staff enjoy using.

HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.


This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.