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"Usability Failures" of EMRs Frustate Physician Users

Posted May 25 2011 12:00am

The fact that EMRs have been failure prone is no secret (see: The Causes of EMR System Implementation Failure ). The cause of such failures is multifactorial. Lab Soft News has also covered this topic in the past (see: EMR Failures and a Recipe for Their Avoidance in the Future ; Modeling the Costs of IT System Failures Globall y). However, I firmly believe that physicians, like most professionals, will avidly embrace any type of information technology that will improve their productivity. This is particularly true these days when healthcare reform requires physicians to work more efficiently. It follows that a large part of the rejection of EMRs by clinicians is based on the fact that they are not well designed. A recent article discusses this issue (see: Complexity of EMRs discourages new users, doctors tell HHS panel ),. Below is an excerpt from it:

Physicians say they want electronic medical records to be fast, accurate and easily customized, but they are reporting that usability of EMRs doesn't appear to be the focus of the federal government when establishing meaningful use standards and certifying products. Physicians are frustrated with newly purchased EMRs, doctors told a Dept. of Health and Human Services panel that makes recommendations on health information technology policy. They said physicians might not be as tech-savvy as other professionals and are encountering problems with the technology while trying to earn potentially tens of thousands of dollars in Medicare and Medicaid EMR bonuses. Physicians discussed the usability issue during an April 21 hearing of the Certification/Adoption Workgroup, part of the HHS Health Information Technology Policy Committee . Some physicians using the technology have become deeply discouraged, said [a physician at the hearing]. For instance, one primary care physician told her it takes 10 minutes to navigate drop-down menus to order a routine mammogram. The same task should take no more than a few seconds of a clinician's time....At the hearing, the American Medical Association recommended that future certification of EMR systems by HHS-approved groups include testing and tracking usability. Excessive click-through screens, design limitations and alert overload are factors discouraging doctors from using EMRs. Failing to take usability into consideration can lead to unintended patient safety issues, the Association said. Examples include computer screens with too much information, nonintuitive steps to gain key data, small font sizes and the potential for selecting the wrong patient when multiple records are open at one time.

The question of EMR "usability" is understood by anyone who has worked with computers. The key question if how efficiently a particular task can be performed using the system. The particular task can be ordering a lab test or reviewing the details of the last hospital admission. It's no surprise to me that the "usability of EMRs doesn't appear to be the focus of the federal government when establishing meaningful use standards and certifying products." I am sure that such standards were largely developed by government officials, vendors, EMR consultants, and organizations such as HIMSS with hardly an end-user physician in sight. As I have noted before, HIMSS is joined at the hip with vendors and CIOs whose primary concerns will be distant from system usability (see: HIMSS Describes Itself as a "Trade Association" in a Press Release ; Multiple Privileges Extended to Hospital CIOs at HIMSS ).

What I find most interesting about this article is the focus it places on how EMRs affect patient safety. My guess is that the issue of "usability" from a physician efficiency perspective would elicit only a yawn from regulators. Therefore, the only way to get their attention is to link usability to patient safety. Here's where the irony comes into play. Computer-alert-overload is cited above as one of the factors that can dull the senses of physicians and potentially harm patients. Why were EMRs originally designed with multiple patient alerts in the first place? This was a feature offered to ensure patient safety. All of this underscores the fact that most of today's leading EMRs were designed with insufficient, effective input from the physicians who are now being asked to use them as one of their primary work tools in hospitals.

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