AMA Decries Poor EHR Usability

September 17, 2014

Announcing a new initiative to address problems with EHR, the AMA wants to encourage patient engagement and less time spent documenting data.

The American Medical Association has announced a new initiative to address physician dissatisfaction with current EHR technology and usability: the "Professional Satisfaction and Practice Sustainability" initiative.

Steven J. Stack, MD, president-elect for the AMA, and Christopher J. Ross, chief information officer for the Mayo Clinic, jointly spoke Sept. 16 about the imperative to improve current EHR design and usability to provide better quality patient care and increased provider satisfaction. To this end, the AMA, in concert with an advisory committee of physicians, health IT experts, and researchers, released a road map for addressing poor EHR usability and design issues.

The AMA outlined these goals for EHR improvement:

1. Enhance physician ability to provide high-quality patient care

2. Support team-based care

3. Promote care coordination

4. Offer [EHR] modularity and configurability

5. Reduce cognitive workload

6. Promote interoperability and data exchange

7. Facilitate digital patient engagement

8. Expedite user input into product design

Part of the impetus for this initiative, said Stack, was the current disconnect between the cognitive demand (the number of screens, scrolling, and clicks) required to document a note into the patient's EHR and physicians' clinical work flow requirements. He added that the goal of the new initiative was to change medical practice priorities by shifting the focus to patients; improving population health; and increasing physician satisfaction.

It is no surprise that physicians are unhappy with spending inordinate amounts of time documenting patient visits in the EHR; many say they feel like data entry clerks. Patients too complain that they no longer receive their physicians' full attention.

In a 2013 study conducted by the AMA and RAND Corporation, "physicians identified electronic health records as obstacles to quality patient care and the leading cause of physician dissatisfaction, emotional fatigue, depersonalization, and lost enthusiasm," according to the AMA. Stack pointed out that EHRs were originally designed for health information transactions and billing, not to promote ease of clinical care.

In order to address these issues, Stack said the AMA has developed an action plan to promote greater EHR usability by:

Engaging vendors to develop solutions;

• Assisting physicians with purchasing and implementing EHR systems;

• Developing ongoing research into better EHR products;

• Continuing to provide physician-generated feedback on the meaningful use program; and

• Addressing physicians' EHR usability concerns.

When asked what he thought would be required to improve current EHR work flow Stack said that, as an emergency room physician, his technology needs were not the same as a primary-care physician's. In trying "to be all things, to all people," he thinks that EHR vendors are missing the mark. They should develop products that are more specialty specific. He went on to say that the AMA's goal for EHRs is to produce a "useable, readable narrative" rather than a discrete set of unrelated data.

Stack said that one way to achieve this is to have adaptable design tools within the EHR that will allow team members to produce data that is easily accessible and meaningful, without undue clicking and scrolling.

Ross concurred with Stack, adding that the AMA's new goals for EHR were ultimately created to promote better engagement between physicians and patients, through strategies like redesigning EHR software to lessen the number of clicks required for navigation, and encouraging use of mobile EHRs such as tablets - so that physicians can hold the tablet in their lap while looking at the patient directly.

At the Mayo Clinic, Ross has been intimately involved with health IT, and said that his organization is committed to advancing the health IT industry, and finding a better way to do the job through "consensus driven ideas to drive results." He added, "The best EHRs can optimize care, while the worst EHRs can impede care."