AMA Calls For Design Overhaul Of Electronic Health Records To Improve Usability

Champions reboot of technology to help physicians take better care of patients

Building on its landmark study with RAND Corp. confirming that discontent with electronic health records (EHRs) is taking a significant toll on physicians, the American Medical Association (AMA) recently called for solutions to EHR systems that have neglected usability as a necessary feature. Responding to the urgent physician need for better designed EHR systems, the AMA today released a new framework outlining eight priorities for improving EHR usability to benefit caregivers and patients.

“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said AMA President-elect Steven J. Stack, M.D. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

While AMA/RAND findings show physicians generally expressed no desire to return to paper record keeping, physicians are justly concerned that cumbersome EHR technology requires too much time-consuming data entry, leaving less time for patients. Numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology, “most office-based providers find themselves at lower productivity levels than before the implementation of their EHR” and that “workflow, usability, productivity, and vendor quality issues continue to drive dissatisfaction.”

“Now is the time to recognize that requiring electronic health records to be all things to all people - regulators, payers, auditors and lawyers - diminishes the ability of the technology to perform the most critical function - helping physicians care for their patients,” said Dr. Stack. “Physicians believe it is a national imperative to reframe policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus.”

To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs, the AMA framework outlines the following usability priorities along with related challenges:

• 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

These priorities were developed with the support of an external advisory committee comprised of practicing physicians, as well as noted experts, researchers and executives in the field of health information technology.

Despite numerous usability issues, physicians are mandated to use certified EHR technology to participate in the federal government’s EHR incentive programs. Unfortunately, the very incentives intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues. The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting meaningful use standards. Moreover, federal certification criteria for EHRs need to allow vendors to better focus on the clinical needs of their physician customers.

The AMA recognizes that not all EHR usability issues are directly related to software design itself. Some issues are a result of institutional policies, regulations, and sub-optimal implementation and training. The AMA will continue to move aggressively on these fronts, including empowering physicians to work with vendors and other to develop and implement more usable products.

To advance these goals, the AMA plans to utilize the eight usability priorities to lead EHR improvements for physicians, vendors, federal and state policymakers, institutions and health care systems and researchers, which could ultimately lead to greater professional satisfaction for physicians. Through these efforts, the AMA hopes to advance the delivery of high-quality and affordable health care to improve the health of the nation.

AMA/RAND Research Report
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy

“Electronic health record usability, however, represents a unique and vexing challenge to physician professional satisfaction. Few other service industries are exposed to universal and substantial incentives to adopt such a specific, highly regulated form of technology, one that our findings suggest has not yet matured.”

Gary Bostein, M.D.
AMA Advisory Committee on EHR Physician Usability
Decatur, Georgia

"The ultimate measure of a well-designed electronic health record is how it helps physicians take better care of patients. It is critical that enhancing quality patient care is the first priority of an electronic health record and data collection is second. Particularly for physicians in solo and small practices, digital data collection has become overwhelming and interferes with and detracts from time with patients."

John Mattison, M.D.
AMA Advisory Committee on EHR Physician Usability
Southern California

"Data liquidity is critical to optimal patient safety and quality outcomes, especially as it supports a complete health record, and is essential for safe transitions between different care providers."

Christine Sinsky, M.D.
AMA Advisory Committee on EHR Physician Usability
Dubuque, Iowa

"The designs of many electronic health records do not meet the needs of physicians and too often detract from valuable time with patients. As a practicing physician, my desire is that EHRs will help me focus on patient care. They can do this by providing concise, context sensitive and real time data that is uncluttered by extraneous information. This will help in eliminating the current information overload and unnecessary administrative data entry that is overwhelming today's physicians and interfering with patient care."

Steven Steinhubl, M.D.
AMA Advisory Committee on EHR Physician Usability
La Jolla, California

"Given the rapid growth of digital technology in health care, whether for health and wellness, or the management of chronic illness, a comprehensive health information technology strategy must include interoperability between a patient's mobile technology, telehealth technology, and the electronic health record."

Raj Ratwani, Ph.D.
AMA Advisory Committee on EHR Physician Usability
Washington, DC

"User-Centered Design (UCD) is critical to advancing electronic health record usability to meet the cognitive and workflow needs of physicians. While some electronic health record vendors have implemented UCD, their results have been inconsistent and many others do not utilize UCD.”

About the AMA
The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America.