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:
- enhance physicians' ability to provide high-quality patient care
- support team-based care
- promote care coordination
- offer product modularity and configurability
- reduce cognitive workload
- promote data liquidity
- facilitate digital and mobile patient engagement
- expedite user input into product design and post-implementation feedback