Don’t Blame Providers For Variations In EMR Use

Posted on June 20, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study published in the Journal of the American Medical Informatics Association has documented what we all already know  — that providers have idiosyncracies in how they use EMRs. The question that remains unanswered is whether this is a bad thing.

According to iHealthBeat, researchers dug into a massive amount of data which painted a picture of how 112 physicians and nurse practitioners working in federally qualified health care centers in New York City used their EMRs. To conduct the study, the researchers looked at 430,803 visits by 99,649 patients who came to the centers.

After analyzing the data, the study found that providers varied in several key habits when using their EMRs, including how often the updated patient problem lists, when they would respond to clinical decision support alerts, whether the appointment was with a new patient or an established one, and the use of the meaningful use objective metrics, iHealthBeat reported.

Why were providers vary so widely and how they conducted these tasks? Researchers said that there are several reasons for this variation, including the providers overall familiarity with the EMR system, the familiarity with the patient’s medical problems, and workflow differences due to staffing differences at the health centers.

According to the researchers, significant variance among providers’ EMR use suggests that it’s a good idea to measure individual level measures of usage, as such studies might improve research on quality and cost outcomes of EMR use. In other words, the study suggests that variance in EMR usage might lead to positive or negative outcomes, and that standardization — once best practices are determined — might improve outcomes.

The problem with this logic, though it sounds  good on the surface, is that providers are struggling hard enough already to develop routines which make EMRs work for them. And as with any other technology, those workarounds are going to vary depending on who you’re talking about and what they’re trying to accomplish.

I’d argue that while tracking sources of variance in EMR use might have some value in improving outcomes, it’s no excuse to force standardization in professionals’ EMR habits, as long as their overall outcomes are appropriate. What’s more, a push to standardize how providers use EMRs puts the struggle to make them workable on providers, not the vendors whose product quirks are almost certainly responsible for this dilemma.

The bottom line, as I see it, is that while this research is useful, it should raise a red flag on vendors, whose usability levels are still far from where they should be. When you give providers a highly usable, well-thought-out interface to use which suits their daily routines, then it might be time to streamline their work habits. Until then, give  them a break if you don’t want to spark a revolution.

P.S. If you’re curious about what the best thinking on EMR usability is out there, check out this list.