I love the never ending discussion of the number of mouseclicks and keystrokes that an EHR requires. I’ve heard this discussion for all 6+ years I’ve been blogging about EMR. While I don’t want to make an excuse for EHR companies to create crappy software, I think that there’s a few problems with just stating that an EHR software has too many clicks. Let’s take a deeper dive into the idea of too many clicks and keystrokes in an EHR software.
I once heard in a discussion the comparison of a piano player being able to quickly tap out a song on a piano with a doctor tapping and clicking out his medical notes in an EHR. They then posed the question, “Why can a piano player easily play so many notes so quickly?”
It’s an insightful question and comparison which I believe could help an EHR vendor deal with the issue of too many “EHR mouseclicks and keystrokes. As I think about why it’s not a burden for a piano player to play so many notes so quickly, I think it boils down to two areas: responsiveness and training.
One of the unique characteristics of a piano is that as soon as you tap the key, it makes a sound. Imagine trying to play the piano if when you tapped the key sometimes it would instantly make a sound and other times there’s a slight half a second or one second delay. It would be impossible to play a song and to get a rhythm that would allow you to play so many notes so quickly.
Unfortunately, the terrible situation I described above is what we experience with EHR software. Sometimes when you click you get an instant response and sometimes when you click you have to wait a little bit. The same goes with a keyboard on a computer. I recently had a bug on my computer that would basically tie up all the memory on my computer. When that happened I could type, but the letters would show up on the screen at varying intervals. I’m a pretty fast typer, but when this was happening it was terrible. I had to just stop until the problem was resolved.
While I’d love to just say that an EHR should always respond instantly to any request made, that’s not reasonable. The key for EHR vendors to think about is doing everything they can to ensure that their EHR responds in a consistent manner. The faster the better for sure, but don’t undervalue the benefit of a consistent response.
The second piece of this puzzle is training. We don’t assume that someone can step up to a piano and play all the right notes to a complicated piece of music with no training. Yet, for some reason we think that a doctor can step up to a complicated piece of software (EHR for those following at home) and quickly navigate all of the features of the software. Training matters and can make the world of difference in how you feel about the number of “clicks” you have to do in your EHR.
I’m sure that many EHR vendors love the above paragraph, but they also see the reality of many doctors not wanting to take the time or make the effort to train on an EHR properly. Doctors reasonably offer that they can’t just shut the doors on their clinic for a week of EHR training. While the politicians in DC can’t seem to do this, the solution to these two extremes is somewhere in the middle.
I’m not naive to the challenges that we face with click happy EHR systems. I’m certain that every EHR software could improve its software to decrease the number of clicks and make them more intuitive. I’m also certain that there are many doctors that don’t and won’t train themselves on the EHR software. Instead, they’ll sit back and blame their lack of training on “too many clicks.”
I have little doubt that both sides of the equation could and will get better. EHR software will become less click happy. Doctors will become better at clicking quickly. Although, until the software captures are thoughts automagically, we’re going to continue battling with these issues.