Since they first began to be adopted in force, far too many physicians have found EHRs to be difficult to use.
In fact, when researching this item, I noted with little surprise that I first began writing EHR/EMR workarounds back in 2013, when a JAMIA article noted that doctors were using a combination of paper- and computer-based workarounds to address usability problems with their systems.
The workarounds documented in the article included not only shortcuts intended to increase efficiency, but also clever hacks allowing doctors to do things the system didn’t provide a way to accomplish. The researchers also found that some physicians were creating paper records then entering them into the EHR.
In theory, a single workaround might not be a problem, but the more often physicians have to improvise, the more likely it is that their non-standard practices will introduce unwelcome variability into whatever processes they touch, as the above-described study illustrates.
Now we look up in 2019, after many years of attempts to make EHRs more usable, to find that (brace yourself!) usability is so still an issue. A widely-shared study on EHR use during hospital morning rounds has concluded that these systems were fostering workarounds that undercut overall clinical workflows.
The study, which appears in journal PLoS ONE, looked at how care teams functioned during morning rounds at a major teaching hospital in New England.
The researchers found that there was a “pervasive” use of workarounds at key points of the rounding process, which seems to have introduced a high degree of variance in how teams used the EHRs overall. This was happening, in part, because system design and hospital room settings didn’t support care team workflow adequately.
The research team also determined that the care team wasn’t using EHRs for information sharing, and that these systems often impeded intra-care team communications.
Such usability problems, and resulting lack of workflow standardization, could ultimately be harmful to patients, the researchers said. “These issues pose a threat to patient safety and quality of care,” the authors wrote.
They identify a few possible solutions to these problems, including improvements in EHR design, care team training and changes to the hospital setting. And these seem like reasonable suggestions, but they won’t accomplish much on their own.
Unfortunately, and I hate to be a downer, too often the key focus of EHR design decisions still isn’t improving usability — it’s supporting documentation and billing. While vendors have made some improvements in the UI and UX for EHRs, they haven’t improved nearly as much as they should have done. I mean, if rocket technology had remained this far behind the times, we certainly wouldn’t be looking at live pictures of the Martian landscape.
The truth is, we still need to keep hammering home the point that until EHRs are designed primarily for clinicians, they’re going to introduce their own hazards. Can we really afford to let this keep happening?