Will Electronic Health Records Ever Be Usable?

"It's easy to use, once you know where everything is," the instructor said during an EHR training session I recently attended. Most EHR companies seem to believe this is an acceptable way to design software.

EHR usability has been greatly ignored by vendors, and last week the American Medical Association issued eight usability priorities in an attempt to address the issue. This directive comes as a result of a joint study by the RAND Corporation and the AMA highlighting EHRs as a significant detractor from physicians' professional satisfaction.

The issue of usability is has reached a critical point, with many doctors hiring scribes to enter information into EHRs while they perform their duties in an effort to save time. In fact, a recent survey by the American College of Physicians found that EHRs cause physicians to lose on average 48 minutes per clinic day, or five hours per clinic week.

[For advice on adoption and effective use of EHRs, read EHR Success: 4 Change Management Process Tips.]

Personally, I've felt the brunt of EHR adoption on both the physician side and the patient side. While trying to make an appointment for my son recently, a recorded message told me that the office was switching over to a new EHR and to expect delays, as fewer patient appointments would be available. It took days of playing phone tag with the practice's office staff to make an appointment booked six weeks out, and three months later, the recording is still playing.

As a physician, the EHR I use in clinic is really quite cumbersome. The software does offer a lot of functionality (most of which I'll never use) and incorporates all CMS requirements, HHS health information policies, HL7 standards, the HIE framework, CPT codes, HCPCS codes, ICD-9 codes (which will soon move to ICD-10 after multiple delays), etc.

The alphabet soup is quite dizzying, no doubt, and keeping up with all the changing requirements eats up resources for EHR companies. But by trying to be everything to everyone via endless menus, EHRs have left users behind. I often feel more like a data entry clerk than a doctor. More sophisticated algorithms are available, allowing interfaces to be smarter about how information is presented and collected. We see this every day in the consumer world, where software systems anticipate our needs before we even realize them.

So now the AMA is speaking up to affect change. The AMA priorities state that EHRs should:

These are all valid goals, and the AMA does suggest solutions to achieve them. However, many of these issues have been discussed for quite some time, and the approach for solving them has been fragmented while vendors vie for position to gain market share.

In the end, implementing these priorities should be transparent to the users -- the physicians and the patients -- and should run seamlessly in the background with a more intuitive user interface. Over the next few weeks, I'll go into greater depth on how each priority should be considered in more practical terms.

The owners of electronic health records aren't necessarily the patients. How much control should they have? Get the new Who Owns Patient Data? issue of InformationWeek Healthcare today.