Will Electronic Health Records Ever Be Usable?

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David F. Carr,
User Rank: Author
10/1/2014 | 2:28:42 PM

My doctor: Epic EHR enthusiast

While going for a physical, I asked my doctor about his EHR, fully expecting to hear a litany of complaints. Instead, he turned out to be one of the power users of Epic who coaches others in his organization. He's invested the time to come up with macros/templates that help him flesh out a patient record quickly. At the same time, he was aware of the dangers of "copy and paste" medical records and said doctors are trained not to fall into that trap.

He told me he did know some older docs who got one look at the computer system and decided they needed to either practice somewhere else or retire. But he personally doesn't know how he would get by without the technology. If the system is ever offline for some reason, he feels a little lost.

So the technology needs to improve, yes (and some systems need to improve more than others), but there is also a generational change at work. Some doctors have figured out how to make the technology work for them rather than the other way around.

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Gary_EL,
User Rank: Ninja
9/27/2014 | 9:10:13 PM

Re: Look what you Gain

It may not be totally useless, because the information will still useful locally. And, since many patients nowadays receive all their care in one network, that's all that matters to them. It will hinder researchers, because they will have a harder time aggregating information from different sources. Again, there was an expression back in the 1980's - islands of automation - which is what we have here.

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shamika,
User Rank: Ninja
9/27/2014 | 8:56:03 PM

Re: Look what you Gain

@ Gary_EL, I agree with you. Even though you have the most sophisticated systems and if you can't communicate the information, it will be a waste of time and money.

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shamika,
User Rank: Ninja
9/27/2014 | 8:52:16 PM

Re: looking forward to your series on the AMA framework

This is interesting. However what about confidentiality of these data? With all these new systems its always better to look in to the data protection as well.

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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 9:11:27 PM

Re: Those aren't goals

Exactly right - they are somewhat nebulous. Which is why I'm going to dissect them over the next few weeks to make them more concrete and actionable. Stay tuned!

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kstaron,
User Rank: Ninja
9/26/2014 | 6:51:11 PM

Those aren't goals

Those are wishes. Not a one of them had any concrete how's invovled or a time frame for that matter. Saying you want to decrease the doctor's cognitive workload (I hope only in the respect to dealing with EHR software) is a great first step, but leaves no interpretation on how that should be done. I imagine the people making EHR software right now are ripping out their hair trying to mesh those wishes into something concrete.

For any of you who use EHR's what are your top pet peeves to help out those poor guys developing it to make it better?

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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:42:44 PM

Re: looking forward to your series on the AMA framework

Thanks, Amy, and great analogy. We will get there, and the more emphasis we place on usability, the faster we can achieve a better state for EHRs (and the healthcare system in general). Ultimately, we should see benefits by way of decreased costs and better outcomes.

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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:34:30 PM

Re: looking forward to your series on the AMA framework

Very good point - most clinicians are really not that tech savvy. I consider myself to be a techie, being an engineer before a doctor, and even I struggle with using some of the software that's thrust upon us.

As the AMA directive points out, there needs to be a shift toward user-centered design, so that there is more focus on how users do their job, and how the software can facilitate this instead of just what the software can do.

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Stephanie Kreml,
User Rank: Apprentice
9/26/2014 | 3:26:11 PM

Re: Look what you Gain

That's great, Gary - your experience is how it should be, and some healthcare systems have done a better job implementing EHRs than others. We are in a transition period with quite a few growing pains, and once we make our way through it, the system will be better for everyone.

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Gary_EL,
User Rank: Ninja
9/26/2014 | 3:07:55 PM

Look what you Gain

Last weekend, I had to make a trip to the emergency room. It could be that the system they use in the hospital system that I use for my health care is a very good one, but even the super-stressed, super-busy ER docs had no trouble using the system and entering the complex results of my visit into it. I was scheduled for a follow-up with a specialist the next day. Instead of the specialists having to listen to my unprofessional explanations, they had instant access to what the ER docs observed, without being filtered through me. My Primary Care doc also has instant, unfettered access to both the specialist's and the ER's notes. The system also maintains a patient's center, where I got a virtual reading assignment of articles about my condition, suitable for non-medical people.

The biggest downside is that the system cannot communicate with the systems maintained by other doc's or medical organizations. We should all look forward to the day when these systems are far enough along for standardizations to be first agreed on and then enforced.

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