The AMDIS Connection: EHR Usability Is in the Eye of the Beholder
One fundamental reason why EHR usability isn't where it needs to be yet is because of lack of use. There are organizations and individuals that have absorbed applied information technology in healthcare, and have had it in place for decades. But as of a year ago or so, the percentage of the medical population in this county that had implemented a full EHR was only between 15 and 20 percent.
Since the vast majority of the healthcare establishment hasn't gotten and effectively applied these tools, it shouldn't surprise anybody that they are not ready for easy introduction.
Another factor dragging on EHR usability is the transition of U.S. healthcare to regional and subspecialty care, rather than primary care. So much of the diversity and specialization in practice has not yet been incorporated into information instruments we're being asked to now disseminate. No one should be surprised if an EHR that works in cardiology doesn't work in oncology.
The major vendors of these products (because of market forces) have had to make compromise decisions about how much diversity they were going to put into their product lines. They had to homogenize some aspects of their products so they could introduce them into more markets, and so the implementation plans wouldn't last for years.
Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy. These systems are designed not to delight a particular user group, but rather to capture the key information which acted as the model for their development. Most major vendors' EHR products have been developed over an extended period of time. This means different modules within the same product may have different ways of doing the same thing.
In addition, usability in the eyes of a sophisticated beholder will be very different from the perceptions of a novice. Whether you're on the clinical side or the business side, the practice of medicine is very complicated, data-intensive work, and there are a number of variables. You'll see this if you talk to different facilities using the same product. At one implementation site, everybody is delighted with the EHR, but you go to another hospital and they're ready to rip it out. The variables involved are the skills and attention devoted to the necessary details of implementation. High usability is much more likely if there is a concerted, dedicated evidence-based commitment to workflow redesign, to process redesign, to teamwork.
The usability conundrum that we have, the diversity of opinions with regard to the era that we are in—from joy to horror—is totally predictable. There is no simple answer in terms of technology. I am sure the best and brightest will have their detractors and the ones that are considered the worst will still have their boosters. The interplay of the people and the technology is what determines usability in the last analysis.
The number of real-life implementations is rising now, which is exactly what the market needed. We shouldn't be too impatient on one hand, and on the other hand, we should embrace clinicians' kicking of the tires. Vendors need to be open to rapid prototyping and not try to coerce adoption. They also need to keep track of their own data: If usability reports from users are unsatisfactory, there should be serious efforts made on R&D and continued product refinement. That's how every industry improves.
Since the vast majority of the healthcare establishment hasn't gotten and effectively applied these tools, it shouldn't surprise anybody that they are not ready for easy introduction.
Another factor dragging on EHR usability is the transition of U.S. healthcare to regional and subspecialty care, rather than primary care. So much of the diversity and specialization in practice has not yet been incorporated into information instruments we're being asked to now disseminate. No one should be surprised if an EHR that works in cardiology doesn't work in oncology.
The major vendors of these products (because of market forces) have had to make compromise decisions about how much diversity they were going to put into their product lines. They had to homogenize some aspects of their products so they could introduce them into more markets, and so the implementation plans wouldn't last for years.
Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy. These systems are designed not to delight a particular user group, but rather to capture the key information which acted as the model for their development. Most major vendors' EHR products have been developed over an extended period of time. This means different modules within the same product may have different ways of doing the same thing.
In addition, usability in the eyes of a sophisticated beholder will be very different from the perceptions of a novice. Whether you're on the clinical side or the business side, the practice of medicine is very complicated, data-intensive work, and there are a number of variables. You'll see this if you talk to different facilities using the same product. At one implementation site, everybody is delighted with the EHR, but you go to another hospital and they're ready to rip it out. The variables involved are the skills and attention devoted to the necessary details of implementation. High usability is much more likely if there is a concerted, dedicated evidence-based commitment to workflow redesign, to process redesign, to teamwork.
The usability conundrum that we have, the diversity of opinions with regard to the era that we are in—from joy to horror—is totally predictable. There is no simple answer in terms of technology. I am sure the best and brightest will have their detractors and the ones that are considered the worst will still have their boosters. The interplay of the people and the technology is what determines usability in the last analysis.
The number of real-life implementations is rising now, which is exactly what the market needed. We shouldn't be too impatient on one hand, and on the other hand, we should embrace clinicians' kicking of the tires. Vendors need to be open to rapid prototyping and not try to coerce adoption. They also need to keep track of their own data: If usability reports from users are unsatisfactory, there should be serious efforts made on R&D and continued product refinement. That's how every industry improves.