Usability of Electronic Medical Records

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This is a review for a peer review article by John B. Smelcer, Hal Miller-Jacobs, Lyle Kantrovich which helps summarize usability and work flow issues related to the implementation of an EHR in current organization. [1]

Research question

What are some disadvantages which cause variances in task flow, work styles, and needed functionality which need solutions to improve the usability of EMRs?

Methods

Design

A literature review was conducted and the following prominent usability articles were summed up to find consistent points which may hinder physician usability:

  • 1. American Medical Association (AMA), (2006 October 24). Benefits of an EMR. Retrieved on May

2007 from www.ama-assn.org

  • 2. Brown, N. (2005, May). Driving EMR Adoption: Making EMRs a Sustainable, Profitable

Investment. Health Management Technology, 25(5), 47-48. Retrieved on May 2007 from www.healthmgttech.com

  • 3. Connolly, C. (2005, March 21). Cedars-Sinai Doctors Cling to Pen and Paper. The Washington

Post, p. A01. Retrieved on May 2007 from http://www.washingtonpost.com/wp-dyn/articles/A52384-2005Mar20.html

  • 4. Eisenberg, D. (2001, April 23). To the Rescue!, Time, 157(16), 34-36.

Health and Human Services, Centers for Medicare and Medicaid Services (2009). National Health Expenditures 2007 Highlights, Retrieved on January 2009 from http://www.cms.hhs.gov/NationalHealthExpendData/downloads/highlights.pdf

  • 5. Organisation for Economic Co-operation and Development (2006, October 10). Health Data

2006, subscription database, Retrieved on May 2007 from http://www.oecd.org/health/healthdata

  • 6. Rogoski, R. (2005, May). Look Before You Leap, Health Management Technology, 26(5), 10-15

Retrieved on May 2007 from www.healthmgttech.com

  • 7. Rosencrance, L. (2006 November 16). Problems abound for Kaiser e-health records management system, Computerworld, 40(46), 1-3 Retrieved on May 2007 from

http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=90 05004

  • 8. Saporito, B. (2005, June 20). The e-Health Revolution, Time, 165(26), 55-57.

4 Journal of Usability Studies Vol. 4, Issue 2, February 2009

  • 9. Schoen, C., Osborn, R., Huynk, P. T., Doty, M., Peugh, J. & Zapert, K. (2006). On the Front

Lines of Care: Primary Care Doctors’ Office Systems, Experiences, and Views in Seven Countries, Health Affairs, 25, pp. 555-571.

  • 10. Scott, J. T., Rundall, T. G., Vogt, T. M., Hsu, J. (2005 November 3). Kaiser Permanente's

experience of implementing an electronic medical record: a qualitative study, British Medical Journal, 331:1313-6, Retrieved on May 2007 from http://www.bmj.com/cgi/content/abstract/331/7528/1313

Results

Findings from the various studies had found some consistent trends in issues with usability. The following is a summary of the most prominent issues:


Long Training Times

EMRs provide an enormous range of functionality. This complexity can be bewildering for beginning users, and it simply takes time for them to understand what can be done and how to do it. This is typically a problem with the navigational structure of the EMR system. A typical EMR system contains hundreds and hundreds of screens that need to be accessed through the system’s navigational scheme using tabs, buttons, and hyperlinks. Learning the right paths takes time.


Loss of Productivity

Even after a physician has learned to use the EMR, it often causes him or her to be less productive. The causes are many:

  • Difficulty finding important information
  • Typing the note is slower than writing it out.
  • Some tasks are tedious to complete with the EMR, e.g., reordering chronic medications.
  • The system response time can be long.
  • Changing exam rooms requires logging off one workstation and enduring a lengthylogin to a new one.
  • Lack of integration places information needed for one task on multiple screens
  • Searching for a procedure or diagnosis can produce useless results. Physicians speak one language, but the procedures and diagnoses are sometimes based on a different set of codes.
  • Some screens contain information that is not needed, but missing information that is.

Conclusion

Obvious problems with EMRs, such as loss of productivity and long training times, have deeper causes. These stem from the complex interaction of highly skilled physicians trying to complete complex tasks in a challenging work environment with a complex and not always usable medical information system. Yet, by applying user-centered design in this complex environment, usability professionals can contribute significantly to improving EMR usability. Greater productivity and lower costs with better health care is our ultimate goal and can be reached with improved implementation and usability of EMRs.

Commentary

The following list summarized take-aways that practioners can get from this article:

  1. Electronic medical records (EMR) have not penetrated the medical field in spite of the benefits that all agree are possible.
  2. One of the primary reasons for this failure is the lack of usability in the implementation of many systems.
  3. While incorporating usability in EMR systems presents many unique challenges, these can be addressed and handled by usability professionals.
  4. These challenges are the result of the difficulty of crafting a system that involves skilled users, complex functionality, and critical tasks.
  5. Designers of EMR systems should consider the following:


  • Employ a flexible navigation scheme to accommodate the variety of specialists, environments, personnel, and individual practices.
  • Use appropriate defaults to reduce non-productive work load.
  • Enable the rapid switching between patients that is consistent with the way many physicians operate.
  • Allow for the delegation of appropriate responsibility to other members of the medical team.
  • Provide various methods of data entry that conforms with the way many physicians work.

References

  1. . Creating Usability of Electronic Medical Records. Journal of Usability Studies Vol. 4, Issue 2, February 2009, pp. 70-84. http://uxpajournal.org/wp-content/uploads/pdf/JUS_smelcer_Feb2009.pdf