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Say It One More Time: EHRs Are Hard To Use

Posted on September 19, 2017 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.

I don’t know about you, but I was totes surprised to hear about another study pointing out that doctors have good reasons to hate their EHR. OK, not really surprised – just a bit sadder on their account – but I admit I’m awed that any single software system can be (often deservedly) hated this much and in this many ways.

This time around, the parties calling out EHR flaws were the American Medical Association and the University of Wisconsin, which just published a paper in the Annals of Family Medicine looking at how primary care physicians use their EHR.

To conduct their study, researchers focused on how 142 family physicians in southeastern Wisconsin used their Epic system. The team dug into Epic event logging records covering a three-year period, sorting out whether the activities in question involved direct patient care or administrative functions.

When they analyzed the data, the researchers found that clinicians spent 5.9 hours of an 11.4-hour workday interacting with the EHR. Clerical and administrative tasks such as documentation, order entry, billing and coding and system security accounted about 44% of EHR time and inbox management roughly another 24% percent.

As the U of W article authors see it, this analysis can help practices make better use of clinicians’ time. “EHR event logs can identify areas of EHR-related work that could be delegated,” they conclude, “thus reducing workload, improving professional satisfaction, and decreasing burnout.”

The AMA, for its part, was not as detached. In a related press release, the trade group argued that the long hours clinicians spend interacting with EHRs are due to poor system design. Honestly, I think it’s a bit of a stretch to connect the study results directly to this conclusion, but of course, the group isn’t wrong about the low levels of usability most EHRs foist on doctors.

To address EHR design flaws, the AMA says, there are eight priorities vendors should consider, including that the systems should:

  • Enhance physicians’ ability to provide high-quality care
  • Support team-based care
  • Promote care coordination
  • Offer modular, configurable products
  • Reduce cognitive workload
  • Promote data liquidity
  • Facilitate digital and mobile patient engagement
  • Integrate user input into EHR product design and post-implementation feedback

I’m not sure all of these points are as helpful as they could be. For example, there are approximately a zillion ways in which an EHR could enhance the ability to provide high-quality care, so without details, it’s a bit of a wash. I’d say the same thing about the digital/mobile patient engagement goal.

On the other hand, I like the idea of reducing cognitive workload (which, in cognitive psychology, refers to the total amount of mental effort being used in working memory). There’s certainly evidence, both within and outside medicine, which underscores the problems that can occur if professionals have too much to process. I’m confident vendors can afford design experts who can address this issue directly.

Ultimately, though, it’s not important that the AMA churns out a perfect list of usability testing criteria. In fact, they shouldn’t have to be telling vendors what they need at this point. It’s a shame EHR vendors still haven’t gotten the usability job done.

Collaborating With Patients On Visit Agendas Improves Communication

Posted on April 26, 2017 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.

Maybe it’s because I spent many years as a reporter, but when I meet with a doctor I get all of my questions out, even if I don’t plan things out in advance. I realize that this barrage may be unnerving for some doctors, but if I need to fire off a bunch of questions to understand my care, I’m going to do it.

That being said, I realize most people are more like my family members. Both my husband and my mother feel overwhelmed at medical visits, and often fail to ask the questions they want answered. I don’t know if they feel pressured by the rapid pace of your typical medical visit, afraid to offend their doctor or have trouble figuring out what information will help them most effectively, but clearly, they don’t feel in control of the situation.

Given their concerns, I wasn’t surprised to learn that letting patients create and share an agenda for their medical visit – before they see their provider – seems to improve physician-patient communication substantially. New research suggests that when patients set the agenda for their visit, both the patient and their doctor like the results.

Study details

The paper, which appeared in the Annals of Family Medicine, said that researchers conducted their study at Harborview Medical Center, a safety-net county hospital in Seattle. The researchers recruited patients and clinicians for the study between June 9 and July 22, 2015 at the HMC Adult Medicine Clinic. The 67-clinician primary care clinic serves about 5,000 patients per year.

When participating patients came in for a visit, a researcher assistant met them in the waiting room and gave them a laptop computer with the EMR interface displayed. The participating patients then typed their agenda for the visit in the progress notes section of their medical record. Clinicians then reviewed that agenda, either before entering the exam room or upon entering.

After the visit, patients were given a survey asking them for demographic information, self-reported health status and perceptions of the agenda-driven visit. Meanwhile, clinicians filled out a separate survey asking them for their gender, age, role in the clinic and their own perceptions of the patient agenda.

After reviewing the survey data, researchers concluded that using a collaborative visit agenda is probably a good idea. Seventy nine percent of patients and 74 percent of clinicians felt the agendas improved patient-clinician communication, and both types of participants wanted to use visit agendas agenda (73 percent of patients and 82 percent of clinicians).

Flawed but still valuable

In closing, the authors admitted that the study had its technical limits, including the use of a small convenient sample at a single clinic with no comparison group, It’s also worth noting that the study drew from a vulnerable population which might not be representative of most healthcare consumers.

Nonetheless, researchers feel these data points to a broader trend, in which patients have become increasingly comfortable with electronic health data. “The patient cogeneration of visit notes, facilitated by new EMR functionality, reflects a shift in the authorship and “ownership” of [their data],” the study points out. (I can’t help but agree that this is the case, and moreover, that patients’ response to programs  like Open Notes support their conclusion.)

I’m not sure if my mom or hubby would buy into this approach, but I imagine that if they did, they might find it helpful. Let’s hope the idea catches fire, and helps ordinary consumers take more control of their clinical relationships.