In the increased adoption of Electronic Health Records (EHR), usability is a key concern, according to a recent survey by the Scottsdale Institute.

“We had such a quick EHR adoption rate that most implementations defaulted to merely replicating paper record,” Rebecca Freeman, CNO at the Office of the National Coordinator (ONC), said in the survey. “So, when people talk ‘usability,’ it’s more about poorly defined workflows and documentation. They’ve replicated a process that doesn’t fit well in the automated sphere.”

The survey, titled “EHR Usability: In the Eyes of the Beholder,” was released in June and asked health CIOs, CTOs, and other experts what EHR usability means and how it can be improved. The implementation of Meaningful Use in 2011, which sets EHR objectives that eligible professionals and hospitals must achieve to qualify for the Centers for Medicare and Medicaid Services Incentive Programs, has vastly increased the adoption of electronic records and made usability a central issue.

Freeman said that training is a major problem with EHR. “Nurses get two to three days of EHR training, doctors one day,” said Freeman. “You can’t learn to use an incredibly complex system in that short a time period. And it’s very rare to get follow-up training.”

Others surveyed likened the complexity of EHR to that of aviation systems, with a complex interplay of variables combining into one display.

“Commercial aviation has two pilots land at familiar airports in the same model with lots of support and even full automation, but in medicine every patient has many more considerations and handoffs,” said Joe Boyce, CTO and CMIO at Mosaic Life Care. “Also, the plane’s complexity is addressed by hundreds of hours of training and simulations—a luxury rarely available in medicine. It’s more often: ‘This doc is starting next week, get ’em trained.’ ”

Some of those surveyed found that age and generational divides were a major determinant of whether a physician would more readily adopt EHRs and related applications.

“The first digital divide is based on people’s chronological age and experience with technology. Younger users are far more facile with EHRs, even the ones that have not been optimized. That’s about the times rather than the design,” said Andy Gettinger, CMIO at ONC. “Medicine as a discipline doesn’t change easily or rapidly. The conversion to EHRs has been very dramatic and it’s difficult for people to get used to a new norm.”

Some, however, have noticed that this resistance is changing as EHRs become more prevalent.

“I’ve spent more than 20 years working with physicians who were fighting the EHR. In the last three years they now ask, ‘Hey, can you do this for me on our EHR?’ Our doctors are happy with the EHR overall compared to paper,” said Boyce.

One proposed improvement to usability in EHR is to allow patients to contribute information to their own records.

“I see many benefits in having a patient as a member of their treatment team,” said Boyce. Another solution he proposed would be to break down the records into specialized categories, to more easily find information. Others see a solution that focuses on bridging the gap between physicians and IT professionals.

“One key to a well-designed, highly usable EHR system,” said Freeman, “is a really seasoned informatics staff. Informaticists with knowledge of evidence-based medicine and clinical workflow serve as important translators between the clinical staff and IT-system builders.”

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