By Roy Hammar and Len Strickland, Jr, DSS, Inc.
Electronic health record (EHR) systems were introduced to the healthcare ecosystem to streamline document workflows and make sharing patient information easier. However, it’s no secret that EHR systems have fallen short of their promise—leading to clinician stress and burnout and less time for interaction with patients.
In a recent JAMA survey, more than half of the issues associated with clinician stress and burnout stemmed from inefficient EHR systems. EHR design and use issues – such as information overload, excessive data entry, note bloat, an inability to navigate the system quickly, and a fear of missing something – were listed as some of the primary reasons for “high clinician stress.”
Given the challenges EHRs present to physician well-being and better patient care, it’s time to reimagine the EHR. A new and improved EHR design and user interface can help:
- Reduce the documentation burden.
- Improve clinical effectiveness.
- Increase professional satisfaction and reduce clinician burnout.
EHRs are intended to improve access to healthcare data, and most do offer this advantage by making information digitally available and searchable. However, because EHRs historically have been designed with revenue capture as the primary purpose, provider usability and patient care has not been at the forefront of EHR design and development decisions. As a result, most EHRs lack an intuitive user interface or have usability issues that make documentation cumbersome – reducing clinicians’ available time for patient caregiving.
According to Stanford Medicine, primary care physicians (PCPs) reported spending a disproportionate amount of time per patient visit interacting with EHR systems, and many feel that EHRs compete with their patients for an already limited time and attention.
On average, during a 20-minute patient visit, PCPs reported spending 12 minutes interacting with the patient, 8 minutes interacting with the EHR system, and an additional 11 minutes of EHR interaction once the patient visit had concluded. Not surprisingly, only 11 percent of patients and 14 percent of PCPs report having an adequate amount of time together.
3 Areas of Improvement Needed
Usability. While having an EHR makes access to information easier, the process of documenting is often harder. The systems mold caregivers rather than letting users mold the system, increasing frustration and burnout. Many EHRs also make documenting more time-consuming than it needs to be, leaving providers looking for a better way.
Poorly designed user interfaces that aren’t intuitive also create issues that affect physicians’ stress levels and patient well-being. If the software isn’t intuitive, it can delay patient care because it takes the physician much longer to get the documentation done, and it’s often not as complete or thorough as it should be.
Clinical Decision Support (CDS). Having an intuitive CDS tool is another area where many EHRs fall short. While a CDS can improve patient care by prompting clinicians to think about clinical decisions in high-risk areas, this is only true if the tool is effective. If a CDS is constantly interrupting a clinician’s workflow in unhelpful ways, it can start to be like Charlie Brown’s teacher – “Blah, blah, blah –" and doctors just start to ignore it.
Interoperability Challenges. The proprietary architecture of many EHR systems has created an environment in which each vendor is using a different method to represent patient data, different coding formats, and different terminology, making sharing information between systems – or even among different versions of the same system.
The problem is further exacerbated when passing patient information from one health system to another. In a report by the Office of the National Coordinator for Health Information Technology, health systems indicated they rarely or never used patient health information received electronically from providers or sources outside their health system because of the following issues:
- 55 percent said it was too difficult to integrate the information into their EHR.
- 47 percent said the information was not always available when needed.
- 31 percent said the information wasn’t presented in a useful format.
Often because of interoperability issues, passing patient information from one EHR system to another must be done manually instead. Back to using paper – imagine that in the 21st century!
A Reimagined EHR
A reimagined EHR is designed and developed with an interface that is intuitive and user-friendly, reduces documentation burdens, and improves patient care and physician well-being. It must start with a design that is developed in consultation with healthcare professionals who have real-world expertise in the way clinicians and healthcare organizations work.
An intuitive, user-friendly EHR makes the screen more relevant to the end user by eliminating unnecessary information from the screen view and by streamlining workflow and navigation to reduce clicks. Next-generation EHRs also include a common patient framework. This means that no matter what department or role, the system maintains a consistent look and feel so that it’s easy for clinicians to use whether they’re working in another department or role within the organization. Such consistency reduces the implementation and training burden for providers, driving down costs, and improving speed to value.
To help relieve the documentation burden, an EHR should also provide flexibility to define and link fields to code sets to meet the unique needs of an organization’s workflows. An EHR should include a CDS tool that is intuitive to what clinicians need rather than interrupting their workflow. For example, a good CDS would trigger an alert if an important piece of information were missing when a physician clicked discharge, such as the interpretation of a CAT scan, rather than constantly issuing notifications as the clinician is actively documenting.
From a technical perspective, an EHR with a thoughtful architecture that includes open-technology, Fast Healthcare Interoperability Resources (FHIR) APIs and a cloud-based infrastructure can better address the interoperability challenges that current EHRs face. The use of open-technology and FHIR APIs also can allow organizations to keep best of breed systems such as their lab system or revenue cycle system, while still being able to switch to a new, more user-friendly EHR.
The current generation of EHR systems has failed to improve efficiencies in healthcare. They hinder patient care by creating a barrier between patient and provider, leading to physician burnout and reduced patient engagement.
But a reimagined EHR will deliver on the original promise. By combining advanced technology with an intimate understanding of healthcare workflows, next-generation EHRs should play a major role in the modernization of care delivery.
About The Authors
Roy Hammar is the Chief of Client Engagement at DSS, Inc. Roy is an experienced healthcare sales and consulting executive with a demonstrated history of success working with complex health systems. His experience includes Healthcare IT Sales and Consulting, Client Relationship Management, and Software Implementation.
Len Strickland is the Senior Product Line Manager at DSS, Inc. Spending the first half of his career in emergency departments and trauma centers as a staff nurse and director, Len is well-versed in the types of innovations that help to meet the needs of caregivers. For more information about DSS, please click here.