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7/1/2011
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EMR Problems Hurt Doctor Efficiency, AMA Says

Inconsistent user interfaces, password fatigue, and the rapid pace of change continue to trip up doctors who are using electronic medical records.

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Responding to physicians' concerns that electronic medical record (EMR) products are difficult to navigate and use for retrieving important patient information, the American Medical Association has voted to advocate for the standardization of key elements of EMR interface design.

According to AMA board member Steven Stack, MD, many physicians must often work with one system in their practice, then two or three others during the day as they attend to patients in different hospitals. With no consistency among those user interfaces, physicians are "slowed down and made inefficient," he said.

EMR user interfaces are comprised of icons, screen menus, keyboard shortcuts, and control sequences that allow physicians to interact with the software or operating system. "Studies have documented physicians' difficulty in efficiently locating critical patient information in EMR systems due to poor user interface design," the AMA stated.

While pushing for some standardization, Stack said the AMA was sensitive to the concern that EMR competitors must be able to differentiate their products. "We are not suggesting that physicians need to have a homogeneous experience, and we certainly don't want to stifle innovation--that's why the policy only calls for the standardization of key elements."

Stack illustrated his point by recounting how vendors were persuaded to present images in a consistent manner, reducing the likelihood they would be misread.

The AMA will also advocate that medical facilities and health systems work toward standardized login procedures. Stack explained, "Physicians are suffering from relentless password fatigue--every organization has its own security policies requiring ever more complex passwords with a combination of numbers and characters, upper case, and lower case. Often, physicians are forced to change those passwords every 60 or 90 days, so it becomes almost impossible to access information."

While ameliorating password fatigue will definitely make system access easier, Stack said the key to physician (and overall clinician) adoption lies in instituting the proper system selection process. "Please, please listen to and work with the physicians and nurses delivering care--invite their participation into the process when it can have meaning, not after the vendor has been selected and the contract has been signed."

When asked about the feasibility of achieving Meaningful Use of health IT, Stack said the program's breakneck speed was problematic.

"The hospital and physician community have expressed concern that the pace of change is faster than the industry can successfully deliver. Unfortunately, we have not yet had an opportunity to study the full impact of Stage 1 so we can assess the good and bad, then make adjustments for the next stage. We would welcome the chance to have a reflective pause to increase the likelihood of success," he said. "We agree with the direction, but you cannot move one-fifth of the U.S. economy on a dime."

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at aguerra@healthsystemCIO.com.

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