EHR usability rises to the forefront

If you were able to peer beyond the horizon of current capabilities, you'd see EHR systems that work in ways no one has yet imagined. That's the prediction of Robert Tennant, senior policy advisor for the Medical Group Management Association.

[See also: EHR adoption rises at solo and two-physician practices]

In a recent interview with Healthcare IT News, sister publication of PhysBizTech, Tennant offered an analogy to the evolution of mobile phones in terms of design and user-friendliness.

“You’ve seen the movie Wall Street, where Michael Douglas is walking on the beach holding this 18-pound phone,” Tennant said. “I remember sitting in the movie theater watching this, and there was a gasp that he had a cordless phone that would work on the beach. Now we look at it, and we laugh. And, that’s not that long ago.”

Actually it was 25 years ago that Douglas played corporate raider Gordon Gekko in Oliver Stone's era-defining film.

[See also: EHR systems trending to mesh with physician work habits]

Still, Tennant’s point holds. "Things are changing," he observed. "Certainly, meaningful use is pushing the [EHR] industry."

Tennant also expects consolidation in the EHR market. There are about a thousand complete EHRs and EHR modules certified for meaningful use today, he noted.

"I suspect that number will decrease for Stage 2," he continued, "because the requirements are becoming more challenging. The better products, hopefully, will rise. But that takes communication between practices. Certainly what we try to do at MGMA is to provide a forum for folks to exchange ideas. It’s such a huge investment. Practices need to take their time and vet the products carefully and add usability to the top of the list when they’re doing their due diligence. Just because it can do something doesn’t mean it’s easily done."

Here's a recap of our further discussion about EHR usability.

Q. What concerns you the most with regard to usability?    
A. There’s unprecedented interest in EHRs by physician practice community in EHRs – driven by meaningful use – there’s no question about that. What we're concerned about is that the practice in its effort to try to get a system, install it and start getting the meaningful use dollars, that they select a product that isn’t very user-friendly. That can take a couple of forms. One would be if it’s a complete EHR, but it’s not very user-friendly. The interface is not very functional, and it can lead to a lot of frustration on the part of the clinicians.

The second issue is that the vendor doesn’t produce a complete EHR and relies on modules to fulfill the meaningful use requirement. It partners with one, two, three, four other vendors to provide the necessary functionality. In some cases, they can interact seamlessly, and it all works wonderfully. In other cases, they don’t interoperate particularly well. They can be cumbersome. The data may not move from one module to another very easily – and, again leads to frustration on the part of the users.

Q. What’s your best advice for physicians?

A. There’s some responsibility on the part of the practices to take the initiative to not just read the brochures and to listen to the sales pitch from the vendors, but actually do their due diligence and network with their colleagues – physician-to-physician, practice administrator-to-practice administrator – talk to their colleagues, find out what works and what doesn’t, and be prepared to work with the vendor, to customize the installation, work with the templates that will improve usability and to understand that in most cases, this is not a turnkey operation. There’s a lot of front work that needs to be done. And, some of the frustration with EHR installations on the part of practice staff is borne from the fact that they haven’t done the sufficient upfront work and training. So, once they go live, they are all comfortable with the interface and understand how to move from module to module. They understand how to enter patient data and utilize it.

So, I can’t over-emphasize the need for comprehensive staff training. I’ve talked to practices that have gone in both directions – some that sort of skimped on the training and struggled for a long time, and others that did the weekends, did the evenings, worked hard. And, once the transition occurred, it was very smooth and they were very, very pleased. But, there’s always a tradeoff. Who wants to work on the weekends? It takes commitment. It’s not good enough to have 40 percent of the staff engaged on it. There has to be a level of commitment, especially among the clinical staff. You can’t have recalcitrant physicians saying, "I don’t want to do it," or "I want to have a scribe follow me around." It’s a huge time and financial commitment that the entire staff needs to buy into.

Q. Is it a good idea to have usability as one of the measures for EHR certification?

A. I really think it’s a good step for ONC [the Office of the National Coordinator for Health IT] to start pushing the vendors toward more user-friendly systems, because if they’re not easy to use, it slows the clinician down, which we certainly don’t want to happen. It can frustrate them. It could lead to errors, and not taking full advantage of what these systems offer the clinician. User friendliness is especially important for what I would call the next wave of clinicians to adopt EHRs. The first wave, many of them had the systems in place, [and] a lot of them were technology-savvy. Now we’re trying to get at those physicians that aren’t necessarily technology-savvy. It’s absolutely critical that the interface be very friendly. Again, that’s going to increase the adoption rate among physician practices.

Q. Why has usability not been a consideration from the get-go?

A. We've been pushing the idea of usability for a long time. I was involved in the formation of CCHIT, the Certification Commission for Health Information Technology, which one of the six ATCBs now authorized to certify these products. I remember in the early days of CCHIT, I kept saying, "You know it’s not good enough just to test the functionality. If it takes a thousand keystrokes to get to something, well, it’s not very user friendly." The pushback came from two sides. One was from CCHIT, saying, "Well I don't know if we can test that. It’s difficult; it’s subjective." And the vendors themselves were leery about including usability in the testing criteria. We continued to harp on it over the years, and finally CCHIT added it to their test script. They have a whole protocol now in place to test it. My understanding is the product is assigned a rating from 1 to 5 in terms of its usability.
  [See also: Meaningful use Q&A with AAFP’s Steven Waldren, MD]

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