AMA offers framework for EHR design overhaul

The American Medical Association (AMA) is calling for solutions to EHR systems that have neglected usability as a necessary feature, releasing a framework that outlines eight priorities for improving EHR usability.

"Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work," said AMA President-elect Steven J. Stack, MD, in a release. "This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients."

AMA's framework stems from RAND Corp.'s study that confirmed the toll EHR dissatisfaction is taking on physicians. While AMA/RAND findings show physicians generally don't want to return to paper-record keeping, physicians are justly concerned that cumbersome EHR technology requires too much time-consuming data entry, leaving less time for patients. Numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology, that "most office-based providers find themselves at lower productivity levels than before the implementation of their EHR" and that "workflow, usability, productivity, and vendor quality issues continue to drive dissatisfaction."

"Now is the time to recognize that requiring electronic health records to be all things to all people--regulators, payers, auditors and lawyers--diminishes the ability of the technology to perform the most critical function--helping physicians care for their patients," said Stack. "Physicians believe it is a national imperative to reframe policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus."

To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs, the AMA framework outlines the following usability priorities along with related challenges:

• Enhance physicians' ability to provide high-quality patient care
• Support team-based care
• Promote care coordination
• Offer product modularity and configurability
• Reduce cognitive workload
• Promote data liquidity
• Facilitate digital and mobile patient engagement
• Expedite user input into product design and post-implementation feedback

AMA developed these priorities with the support of an external advisory committee comprised of practicing physicians, as well as noted health IT experts, researchers and executives.

"The ultimate measure of a well-designed electronic health record is how it helps physicians take better care of patients," said John Mattison, MD, of the AMA Advisory Committee on EHR Physician Usability, who works in southern California. "It is critical that enhancing quality patient care is the first priority of an electronic health record and data collection is second. Particularly for physicians in solo and small practices, digital data collection has become overwhelming and interferes with and detracts from time with patients."

"The designs of many electronic health records do not meet the needs of physicians and too often detract from valuable time with patients," Steven Steinhubl, MD, AMA Advisory Committee on EHR Physician Usability, who works in La Jolla, Calif. As a practicing physician, my desire is that EHRs will help me focus on patient care.  They can do this by providing concise, context sensitive and real time data that is uncluttered by extraneous information. This will help in eliminating the current information overload and unnecessary administrative data entry that is overwhelming today's physicians and interfering with patient care."

Providers must abide by numerous requirements in order to participate in the EHR incentive program but the very incentives intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues, according to the organization. The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting Meaningful Use standards.

Access the AMA's framework.