How to use an EHR? Depends whom you ask

'The EHR is not a black box where you plug in this software, and it's going to change everything for the better'
By Mike Miliard
10:50 AM

The data in electronic health records may be structured, but the usage patterns of the doctors who interact with them is anything but, according to research from Weill Cornell Medical College.

[See also: When EHR design is a 'what not to do']

After getting acclimated to EHRs, physicians tend to fall into their own personalized usage patterns, according to the research – leading to a huge variability to how the systems are put to work.

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The Weill Cornell study – performed in collaboration with the Institute for Family Health, a network of 18 New York City health centers – aims to better understand these unique dynamics between docs and health IT, offering perspective on which aspects of EHRs work well, and which need to be improved to standardize and optimize care.

[See also: Usability 101 workshoppers conduct research methods for improving EHRs]

"The variability really reinforces that the EHR is not a black box where you plug in this software and it's going to change everything for the better," said Jessica Ancker, a professor of healthcare policy at Weill Cornell, who led the research, in a press statement. "The patients and the doctors and the software are all interacting in a pretty complex and nuanced way."

First published in the Journal of the American Medical Informatics Association, the study analyzed 430,803 encounters of EHR use across 99,649 patients. The data showed how physicians varied widely in their approaches to different aspects of the EHR, such the frequency with which they responded to alerts and how often they updated patients' problem lists.

Working to reduce alert fatigue – and perhaps even scrapping some of the more burdensome but less efficacious elements of EHR design in favor of those that offer more value could help improve patient care, the research suggests.

Ancker has also published recent research examining consumer-facing personal health records, which have seen an increase in uptake from 11 percent in 2012 to 17 percent in 2013. As with clinical health records, patients' usage patterns will necessarily vary, but Ancker says any use of PHRs is better than none.

"The hope is that PHR breaks down a little bit of the barrier between specialized medical knowledge and the patient," she said in a statement. "EHR and PHR both have the potential to improve the way we deliver healthcare in this country, giving higher quality care and getting patients more engaged in their own healthcare, leading to downstream healthier people."

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