Health systems have invested billions on electronic health records, and EHR vendors have kept pace in improving and enhancing their platforms. Yet, with all that, many in the healthcare field still hate them, especially physicians.
So the question we placed to readers was simple: How can they be fixed?
Healthcare IT News received nearly 100 answers from insiders at provider organizations, technology vendors and consulting shops and many of them came back to one word: usability.
“Focus more on provider workflow and less on the tool,” wrote one health systems vice president. “Better user interface and workflow to reduce data entry clicks,” wrote a consultant who answered the survey.
As part of our survey, we asked readers to pick their top EHR concerns and the results were mixed. About 21 percent said confusing user interface was the top EHR issue, 21 percent cited “too many clicks,” 20 percent pointed to interoperability issues and 18 percent picked workflow clashes with other clinical tasks.
The following gallery highlights some of the more detailed responses we got.
(Advance the slides to see each response)
"Develop bullet-proof NLP and a massively flexible workflow routing/decision support system. Bypass discrete form filling with hyper accurate NLP. Bypass rigid workflows with hyper flexible, adaptive NLP. Develop context-aware sessions so that relevant information is parsed and displayed at relevant context(s). Chain up workflows backend, and not do it front-end - cause Drs and Clinicians don't agree with admin/finance/regulatory/quality driven workflows."
- Deputy CMIO, Hospital/Health System
"Reduce the amount of data that is required by government regulations. The natural course of maturity of EHR applications will take care of the rest."
- Manager of EHR Applications, Hospital/Health System
"Incorporate AI and cognitive computing tools. The data is already in the system. Use it to anticipate the provider's next move."
- CMIO, Hospital/Health System
"Creating a more simple, easy to use user interface that follows the workflow of the individual role using it. Too many options can be too confusing."
- Nursing Informaticist, Hospital/Health System
"Talk to clinical people that have had experience with multiple systems. There should be designers that have actually done the patient work and are part of a technical team that understands the blending of the two worlds. It is not easy, but is critical to a design that can provide clinicians with the tools to care for the patient. It is ALL about the patient. Simplicity is what is needed. Just because you can create a fancy system does not mean that is the way to go."
- RN, Clinical IT Consultant
"Adapts to physicians workflow and has complete picture of patient no matter where or how to provide best clinical outcome."
- President, Vendor
"Easy. End Cert for EHR. We need innovation. We do NOT need a US gov nanny state and policy market that has left us with a few very large, could care less vendors. We need new players. I'll say it again. We need innovation. Anyone with an ounce of EHR experience PRIOR to HITECH can tell you what needs to be done. Every time someone says MDs need to "document" that, they are removed from the team, fined and possibly fired. Every nonsensical data entry burden must be removed from EHRs. We want home health care, we know when we want it, don't ask us to document face time, why, etc. We are the doctors, listen to us. Stop getting in the way of our care. When I want an MRI of a knee on someone, there should be no question as I am a board certified, ortho surgeon, with 20 yrs experience. I know. So all preauth is now automatic for board certified MDs that want ANY test. Period. Stop all nonsensical note coding requirements. We do not want to read the same blah blah blah, normal prostate on female patients, etc. We want to know what the other MD is thinking and planning in 2 sentences. Decouple EHRs from billing. Encourage customization/workflow efficiency. Significantly improve usability by removing all US gov mandates. End ALL quality measuring, attesting, reporting, done by MDs. There is NO evidence it improves anything. Once we get a basic functioning EHR then look for interop. Not before. Stop listening to NON-front line, non-clinical MDs and ANYONE that does not have to work on a certEHR every day all day. Get real MDs on these committees. Stop penalizing MDs for anything related to EHR, measures, attesting, etc."
- CMIO, Physician Practice
"Better workflow design for quickly accessing and recording patient information. Paper was more physician workflow friendly - replicate that and leave the data gathering to the computer system. Highlight fields which are regulatory/legal in nature. Have multiple submission/completion states - one for patient care and another for regulatory/legal compliance - they are not the same and a patient being treated expediently and with quality should outweigh the "cover-my-butt" mentality that the forms are being built with...so there needs to be a way for hospitals to separate the two - treatment documentation needs to be done during the critical times (time-sensitive) and legal follow-up can be done later in the office. Make them easy to do and separate...happy nurses and doctors."
- Senior Programmer Analyst, Hospital/Health System
"Hello, I am not a practicing healthcare provider but work for a vendor for developing EHR's for my client. I am a doctor but left my practice 7 years back when I moved to Healthcare IT as an analyst. Based on my last 7 years of work experience in developing IT solutions for our clients, I feel that the biggest challenge has been of Interoperability between systems as we are aware that none of the hospitals/healthcare centers have a full fledged system from one vendor. I think that the one way in which EHR's can be improved is by increasing interoperability across various systems. I am not telling this because of the option mentioned below in the questions, but as my experience with clients this is a big factor that needs to be addressed. An open platform is the need of the hour that allows systems from various vendors to bring about the possible integration between these."
- Senior Business Analyst, Vendor
"Stop letting the same CTOs / Product Managers / developers who continue to bring unusable, frustrating technology, mind numbing platforms to market to continue develop bad technology.
Stop thinking that a single platform can solve all problems which results in massive platforms that can do lots of things but none well.
Stop with the "interoperability" talk until you can convince the top vendors to truly be interoperable. Having EPIC sign the top 3 hospitals in our area and now they can "share data" is not what the heart and soul / goal of "interoperability" is about.
Remember that ultimately, while it is ALWAYS about the patient, the very nature of healthcare is the PERSON WHO DELIVERS CARE to the patient. Every vendor, CTO, product manager, developer should have to use, in a real-life setting, the crap they develop to develop empathy for the end-user and other stakeholders.
Great tech cannot be developed in a vacuum. To truly transform the platforms that document and monitor the care delivered, to disrupt this market, vendors, providers, hospital systems have to look beyond the top 5 badly functional but unusable "but we will make due with it" platforms. There are a lot of great user and patient centric design people in lots of different industries and we desperately need those in health IT.
Give those trying to disrupt and make a positive impact on both the end-user and the patient a fighting chance. The big vendors should be working with smaller startup ventures with both support, mentoring, challenging the status quo, and working towards creating usable tech to improve patient outcomes.
Design is not a nice to have. Great design is critical to great software, great user experience, and great EHRs."
- CEO, Vendor
"Too much data is spread across too many screens. It's not a click count issue, it's a problem with data not being presented in a meaningful manner to users whether clinical or administrative. Patient demographics and vitals should always be visible to clinical staff and telemetry should be integrated (interoperability with IoMT) for all, not just anesthesiologists and ICU staff.
Physicians should have the patient's information and their documentation available in an at-hand manner to be edited in a format that matches their form and prose.
Administrative staff like coders should always have demographics and diagnoses visible. Billers should always have demographics, insurance and monetization factors visible.
CQM staff should always see census and trend information important to their facilities. Whether in a clinical setting or administrative the patients should always be the focus and the presentation of the patient's reason for visit pertinent to the role in question should immediately follow.
We need to move the focus away from role based security as a methodology only for securing a system and make it control the functionality available to users. Users who receive access denial messages shouldn't see them with the frequency they do. If an area of the software isn't intended to be used by someone in a specific role that data, that sub-application, shouldn't be available for access. This has the added benefit of respecting PHI by segregating and limiting information visible to various parties. Role management, role based security, needs to move beyond thinking of security as approving or denying access to information and start respecting information management as part of it's general function."
- Junior Systems Admin, Hospital/Health System
"Minimize or eliminate need for 3rd party and create one system that works throughout."
- Clinical Informatics Architect, Hospital/Health System
"EHRs increase the burden on physicians. They don't make our jobs easier. They were built for billing, not clinical tasks. They don't accommodate our needs with patients at the point of care."
- Physician, Hospital/Health System
"Reducing clicks and organizing user interfaces is elementary. The true crux of the issue is optimizing the EHR workflow to support and enhance clinical tasks and medical decision making as opposed to clashing and hindering it."
- Senior Director, Vendor
"Focus on shared data elements, to avoid duplicating data entry. Automate as much as safely possible. Establish processes to involve user feedback and implement efficiently."
- Applications Coordinator II, Hospital/Health System
"User training could be smoother. Software needs to be made in mind that not every user is tech savvy."
- Systems Analyst, Consultant
"It can be greatly improved by making Healthcare Record Standards, like the one we have for Real Estate (www.reso.org). Then we should have all EHR Software adhere to this new standard."
- Owner, Physician Practice
"Clinicians should be driving the design of EHRs, not technology professionals. CIOs in healthcare facilities should have clinical backgrounds."
- Nurse, Vendor