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It’s often difficult to find specific explanations of what makes an EHR user friendly. Still, physician feedback is pointing to three important features.
What makes a usable EHR system? The answer seems to have eluded many EHR vendors, because repeated surveys report satisfaction with these systems has yet to reach a majority in the physician community. Medscape’s recent EHR report represents the latest round of statistics, and it reports that only around 42 percent of physicians are satisfied with their current vendor.
While it’s true that certain providers are opposed to converting their patient records into electronic form, there's a lot more that is driving physician dissatisfaction with EHRs.
One of the biggest problems is that many EHRs are designed like enterprise software, meaning users can accomplish tasks but only after hours of training and frustration. Fortunately, a new focus on usability could change that.
Defining usability in EHRs
The International Organization for Standardization defines usability as “the extent to which a product can be used by specific users to achieve specific goals with effectiveness, efficiency, and satisfaction.”
Usability isn’t about flashy design or features; it’s about accomplishing goals with simplicity.
A 2013 survey by IDC Health revealed the seven most common causes of EHR dissatisfaction among ambulatory providers. Four of them are directly related to usability:
• Electronic documentation that required more time than filling out paper charts
• A poor user experience
• Loss of productivity due to spending more time with the EHR
• Frustration from using a clunky user interface
It’s often difficult to find specific explanations of what makes an EHR usable. Many notable resources outline principles for usability, but principles don’t always accurately paint a picture of what features to be in a product.
Fortunately, physicians themselves have provided direction.
Data-backed usabilityMedscape’s aforementioned report also gathered feedback about EHR ease of use. The top three systems in descending order were:
VA – CPRS.
Yes, the VA health system placed in the top three, beating out EPIC, eClinicalWorks, and a host of other market leaders.
It even had the highest score for ease of data entry.
What unifying factors make these three systems so functional? It’s certainly not design. While Practice Fusion has a nice enough interface, Amazing Charts has definitely opted for a stripped down appearance, and the VA-CPRS system looks, well, underwhelming.
Let’s examine three prominent features that all three share.
1. Customization and free text options
A usable system helps its user achieve their goals without unnecessary complexity. Some providers still reminisce about the ease of paper charts because paper charts didn’t require five clicks to fill out one portion of a SOAP note. All three systems attempt to reduce the amount of clicks necessary to input information while still allowing users to create diagnosis templates that paste into the required fields.
These systems also allow physicians to enter free text if they need to. The assumption that point and click alone will result in increased efficiency simply isn’t true.
2. Reduction of steps
In describing the failure of enterprise software, Deloitte consultant Jaco Van Eeden says, “The goal should be to build an interface to all of these systems that, upon login, provides users with access to 50 percent of the functions they require to do their jobs. Within two clicks of the login screen, they should be able to access 80 to 90 percent of their job function.”
Again, all three of these systems outpace their competition by eliminating redundancy. The sheer monotony and repetitive nature of recording clinical information has become a familiar refrain for many EHR users. The VA’s system may look like a relic, but residents can use it with efficiency.
3. Mirroring expectation
In general, technology systems are only usable because they allow users to execute actions in a manner they’re accustomed to. While this is somewhat difficult for EHRs because no precedent exists from which to draw, providers do expect systems to fit into their work flow.
For example, the ease with which providers can send orders to nurses or administrative staff from within the interface of the EHR makes a huge difference. Clicking through a sea of pop ups to transmit a prescription isn’t the way these systems should work. Amazing Charts has even set up its patient profiles to mimic paper charts.
So while the well-established dissatisfaction of physicians with EHRs does have logical grounding due to a substantial number of poorly constructed systems, it is possible to find platforms that do prioritize usability. The key lies in simple functionality, rather than design or even comprehensive feature sets.