Making EHRs more user-friendly

HOUSTON – Many vendors give short shrift to the usability of their electronic medical records, says Jiajie Zhang, who is devoting the next three-plus years to addressing this usability factor.
It’s something he believes has been a barrier to physician adoption.   Zhang is overseeing one of the four federal research projects in the SHARP program. His is at the National Center for Cognitive Informatics and Decision Making in Healthcare at the University of Texas Health Science Center at Houston, where he serves as co-director.   “Only a small number of EHR vendors have their in-house team doing EHR usability,” Zhang said. “Most EHR vendors do not do that systematically.”   As Zhang sees it, it’s work that ought to be done by professionals specially trained to measure usability. It’s a science. The feature most lacking in EMRs, he said, is user-centered design. Many EMRs are in the age of DOS rather than Windows, he said.   Rosemarie Nelson, a principal at the MGMA Consulting Group, which provides help with EMR purchase and installation for physician practices, knows the technology frontwards and backwards because she once managed a medical practice.   Some EMRs on the market today are easy to use and some aren’t, she said. “Some are quick and easy to learn, and that creates a great first impression for the physician,” she said. “But some are clunky and cumbersome with day-to-day tasks between physicians and their support staff, and that makes them less easy to use, and unfortunately many physicians learn this the hard way – during implementation, post-purchase.”   What is most often missing, in her view, is a commonsense approach to workflow – how the typical physician’s day flows as he or she interacts with patients and the practice’s support staff.   “The EMRs could be better at taking advantage of the well choreographed dance between doctor and clinical support staff to accomplish seeing patients in the office and attending to the aftercare communications (results, calls) associated with taking care of patients,” Nelson said.   eClinicalWorks, which claims 55,000 providers across more than 8,000 practices using its solutions, views the usability factor as “huge,” said Heather Caouette, a spokeswoman for the company.   “In fact, many of our customers have told me that they selected eClinicalWorks because of the usability of our product,” she said. “Usability is key to get practices to use the technology and it is something that eClinicalWorks has taken seriously since the beginning.”   On the usability front, the company employs several avenues to work with clients on improving the product, and many of those approaches have been in place for years, she said. They include user roundtables, designed to learn more about clients’ unique requirements and how to address them.   Caouette also pointed to eClinicalWorks’ annual user conference and ecwusers.com, an open forum where customers gather to discuss the product, including what they like and don’t like about it. The site was started by customers, she said, “and while we are active participants, we have no admin privileges.”
 
eClinicalWorks has started an online place where customers can recommend new functionality and/or vote on existing suggestions.   That’s probably not exactly what Zhang has in mind, though he did not comment on specific products or vendors.   “What we do here is view usability as a science,” Zhang said. “It is a scientific field built on many years of research and practice in many other fields. The toughest task for us is to convince the vendors to do it.” He said the timing is good, though, because usability may be a required part of product certification for Stage 2 meaningful use.