Why Electronic Health Records Aren't More Usable
Chet Van Wert | Apr 13, 2016
Topic category: Healthcare/Wellness

Less than half of electronic health records (EHR) vendors that reported on their development processes employed standard user-centered design (UCD) methods in developing their systems. An even smaller number tested the usability of their systems with physicians - a key segment of the target market.

As a result, doctors spend up 9 times longer completing an EHR, much of it entering required but irrelevant data, as compared with an old-fashioned hand-written record. Doesn’t sound like a formula for reducing costs, does it? Add to this sorry situation a lack of format and process standards that make EHRs from different vendors incompatible, and you have a sense of the mess that EHRs represent today.

Ken Terry, writing for CIO.com, sees the cause of this mess in a development process that prioritized billing issues over clinical usability. Another source of conflicting priorities is government regulations:

"EHRs were easier to use before developers were required to design them in a way that enables them to collect quality data for the government's EHR incentive program. (Physician practices and hospitals must gather this data on health care processes for a certain percentage of Medicare or Medicaid patients to show "meaningful use" of EHRs so they can qualify for incentives and/or avoid financial penalties.)

"Another downside of the meaningful use program, says Basch, who advises the American College of Physicians on health IT, is that vendors have had to focus on rewriting their software to meet the changing EHR certification criteria. As a result, they have had little bandwidth left over to meet the needs of their customers by building more user-centered products."

EHRs in use today are essentially a first-generation product, with all the problems that implies. Records designed with primary care physicians in mind are cumbersome for specialists to use, and many of the smart functions one could imagine an EHR performing have yet to be developed. Of course, changing regulations don't help, either, as they monopolize developers' time that might otherwise be spent improving the product's usability

In 2014, the American Medical Association published a framework for an improving EHR usability, which state that EHRs should meet the following criteria:

  1. enhance physicians' ability to provide high-quality patient care
  2. support team-based care
  3. promote care coordination
  4. offer product modularity and configurability
  5. reduce cognitive workload
  6. promote data liquidity
  7. facilitate digital and mobile patient engagement
  8. expedite user input into product design and post-implementation feedback
Ken Terry |Dec 3, 2015
Tags: TK
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Avaya's SDN Fx: How to Implement the Internet of Things for Healthcare

The Internet of Things holds great promise to improve our health and wellbeing, from connected medical devices to instant and automatic data sharing, to more complete record keeping.

Hackers continue to dominate the headlines. Healthcare providers hold some of the world’s most sensitive information, making them a particularly high-value target.

Reporters at Computerworld recently demonstrated the risk of “medjacking,” where hackers were able to exploit Internet-connected medical devices, such as infusion pumps, to administer deadly levels of an otherwise helpful drug into an unsuspecting patient, without triggering an alarm to medical professionals.

The network represents one of the largest avenues of attack, and every possible effort should be made to secure it.

Software-defined networking represents a crucial layer in a multi-layered security plan. The network can be easily segmented into areas that remain invisible to devices on the edge. One physical network can create numerous virtual networks on the fly. Network connections open as approved devices connect, and dynamically close as those devices are disconnected. Getting a complete picture of every device on the network at that moment is a single click away.

In a healthcare setting, does the network that transports data from the MRI machine to the electronic health record system need to share the same path options as the payment card system? No. By segmenting the network and isolating various systems, you create additional protections against a single intrusion infecting multiple systems.

To quote the lead hacker at the NSA, who recently gave a presentation on how companies can protect themselves from the NSA: “Segment networks and important data to make it harder for hackers to reach your jewels.”

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Sydney Adventist Hospital is a busy hospital, admitting 20,000 patients annually.

With that level of activity, doctors and staff need to access patient records, on every kind of device, at any time of day or night. How do they do it? With Avaya’s strong, stable network. Here are Sydney Adventist Hospital’s own words:

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Bedside Software-Defined Networking and the Evolution of Healthcare IT

Today, IT departments in healthcare organizations are under tremendous pressure to become the enablers of a digital strategy. The network will play a key role in the shift to digital healthcare, as most of the enabling technologies—such as mobility and the cloud—are network centric. It’s time for the networks in healthcare institutions to evolve away from legacy architectures to a software-defined network.

The networks currently found in most healthcare organizations were designed for an era when application and compute resources were static and “best effort” service delivery was the norm. The networks were built on multiple tiers, were highly complicated and had long troubleshooting and repair times.

Building performance and reliability into the network often required overbuilding the network, which is why traditional networks have an average utilization rate of less than 30%, according to ZK Research. Additionally, the traditional networks were multi-tier in nature and were combined with older, inefficient protocols, such as the Spanning Tree Protocol (STP). These networks were designed when almost all traffic flowed from the client to the server in a North–South direction. Again, this was sufficient in the past—but East–West directional traffic is growing 10 times faster than North–South traffic, and traditional architectures add far too much latency to the transactions. In the healthcare vertical, this latency can be the difference between a doctor having the right information to make a critical patient care decision or not. Clearly, a new architecture is required for healthcare institutions to meet today’s challenges.

A software-defined network (SDN) is a next-generation network that is simpler to build, easier to manage and highly agile, and it can scale as rapidly as the business requires. An SDN will perform better and have higher availability and scalability than traditional networks with improved utilization. SDNs in hospitals, clinics and other healthcare organizations will deliver many benefits to healthcare IT, including the following:

Network segmentation: This feature of SDNs, which is known as clinical segmentation, isolates specific departments and/or devices in their own virtual, private networks. The primary benefit to the IT department is that it is much easier to secure connected endpoints because each group of devices will be completely isolated from other devices. If there is a breach on a network segment, it will not impact devices on other segments.

Flow control: A software-defined network allows IT to monitor and control flows between devices with a high degree of granularity and apply them either by group or according to specific device policies. This enables IT to optimize the performance of specific flows, ensuring the performance of mission-critical systems—such as MRI and electronic records—aren’t affected by other applications.

Edge automation: As mentioned previously, the complexity of healthcare IT has increased over the past decade. The fact that the infrastructure now must support a large number of mobile devices only adds to the complexity. Many IT services require the network to be provisioned at the edge, often on a port-by-port basis. This was a challenge with static endpoints, but when the devices are mobile, network managers face the constant reconfiguration of every point in the network between the edge and the core. An SDN enables edge automation to ensure that each Ethernet port at every location can provide any service to authorized devices. In this scenario, all the intelligence is at the edge, and the network services are transparent to the core (Exhibit 2). This arrangement obviates the need for edge port provisioning, which can be costly and time consuming for the IT department. With an SDN, policies dictate which devices can be automatically added to the network, providing an additional level of security while allowing the medical staff to perform their required activities without IT support. This removes all human latency and speeds up processes, which can be the difference between patients receiving the medical attention required and being put at risk.

Inventory management: Healthcare IT must support thousands of mobile devices in addition to all of the traditional fixed devices, making inventory management difficult, if not impossible. An SDN provides detailed information on the types of devices, the location of the devices as well as the number of them. This removes from IT the burden of having to track the devices using spreadsheets or homegrown databases, which can be error prone and highly inaccurate.

Ease of management: SDNs offer northbound interfaces so the network can easily integrate with network management tools, which provides the IT department with a “single pane of glass” to manage the network. This shifts the management responsibilities from being complex, command line–driven tasks to being simple, task-based and policy-controlled operations in a rich, web-based interface. This change simplifies management but enables faster time to service with reduced complexity and less downtime from human errors.

Single, end-to-end architecture: The various points in legacy healthcare networks—such as the core, edge and campus—were deployed and managed independently. SDNs change this paradigm by providing a single, unified architecture across the network, which can be located within a building or across a campus, or can even span the globe. SDNs provide a single architecture, offering the benefit of having one set of processes for one system.

SDN makes network operations simpler, easier to manage, highly agile, and scalable