Thursday, May 30, 2013
The Slow Crawl Toward Improved EHR Usability and Interoperability
by Steven J. Stack, M.D.
Well-developed electronic health records hold the promise of helping health care professionals improve patient care and deliver it more efficiently, and the American Medical Association recognizes that enhancing EHR usability and interoperability will further ensure our nation's goal of a high-performing health care system. Physicians are generally prolific users of technology: new patient monitoring devices, diagnostic imaging, equipment and advanced surgical tools, to name a few. In each case, physicians have adopted these tools quickly and became proficient users -- and they have done so without the need for a national incentive program. Why is it, then, that so many physicians are still trying to incorporate EHRs into their practices?
While the Medicare/Medicaid EHR incentive program can be credited with sparking a rapid adoption of health IT, it has also created negative consequences. Swift implementation of certified EHRs, needed to obtain incentives under the meaningful use program, has compelled physicians to purchase tools not yet optimized to the individual user's needs. These tools often impede, rather than enable, efficient clinical care. EHRs can also pose challenges as a physician attempts to meet documentation, coding and billing requirements. AMA has been an outspoken advocate for health IT improvements and continues to work with the federal government and other stakeholders to advance usability and interoperability.
EHR Usability
According to the Healthcare Information and Management Systems Society, "usability is one of the major factors -- possibly the most important factor -- hindering widespread adoption of [EHRs]." Surprisingly, the Office of the National Coordinator for Health IT does not provide physicians any information about the usability of EHRs that it certifies. Usability standards should be included in ONC's certification criteria to ensure that physicians are able to invest in the EHR system that fits the needs of their practice.
Many physicians report they are unhappy with the EHR products available to them, likely due to the fact that EHRs are still in an immature stage of development. They find them clunky, confusing and complex, and they are struggling to successfully incorporate EHRs into their workflow. According to a recent survey of physicians by American EHR Partners, approximately one-third of all surveyed physicians said that they were very dissatisfied with their EHR and that it is becoming more difficult to return to pre-EHR productivity levels.
Given this decrease in productivity, it is no surprise that since the start of the meaningful use program, we've seen continued escalation in physician dissatisfaction with their EHRs. According to the same American EHR Partners survey, the percentage of physicians who would not recommend their EHRs to a colleague increased from 24% to 39% between 2010 and 2012.
AMA also is concerned about the viability of the thousands of certified EHR products. We've heard from many physicians who have invested in EHRs that have gone out of business. These physicians, who were doing their best to adopt EHRs, are now faced with the financial hardship of purchasing an entirely new system. The uncertain future of an EHR extends beyond the product's business model to the security of the product's certification status. In fact, ONC recently revoked the certification of two EHR systems so providers cannot use those EHRs to satisfy meaningful use requirements. Physicians who have already invested in these now-uncertified systems will need to spend even more money on a new, certified EHR to replace their non-certified EHR or face a penalty.
Lots more here:
This is a very worthwhile discussion of what remain two of the major barriers to real clinical use of EHR systems.
David.
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