Why Electronic Health Records Aren't More Usable (cio.com)

itwbennett writes: There are plenty of things wrong with Electronic Health Records (EHRs), writes Ken Terry. Among them: 'The records are hard to read because they're full of irrelevant boilerplates..., [a]lerts frequently fire for inconsequential reasons..., and EHRs from different vendors are not interoperable with each other.' But those are all just symptoms of the underlying (and unsurprising) problem: '[T]hey are designed to support billing more than patient care.' A recent study (login required) found that, of 41 EHR vendors that released public reports, fewer than half used an industry-standard user-centered design process. This despite a requirement by The Office of the National Coordinator for Health IT that developers perform usability tests as part of a certification process that makes their EHRs eligible for the government's EHR incentive program.

Comments

No kidding!

[Anon-Admin]

I am my no means an expert on EHR. However I have dated a couple of RN's and have several in the family.

What I can say is that who ever develops this crap does not seem to ask the Doctors or RN's how they do there job.

There was a different 15digit code for every procedure, option, action and the RN had to key each in for every step and often had to click a "yes that is right" box or have a Dr come over and acknowledge that yes that is the correct prescription, etc. Im not talking about new prescriptions, Im talking about standard daily doses given in a care facility.

In every case it took 3x longer for them to do the computer entry than it did for them to do the job and add written notes to the charts. Every RN I know complains that it is cumbersome, time consuming, and takes away from their time caring for the patients.

It really reminded me of some of the time keeping systems I have used. Ones where Accounting laid out the system so you had to enter the time code for each task in no smaller than 15min increments and you had to make sure every min of your day was accounted for.

Re:No kidding!

[Anonymous Coward]

I've developed an EHR system for a small clinical company, and one of the biggest hurdles is preventing mistakes. The prompts for, "Yes, that's what I meant to do," are almost necessary because of industry standards like ICD9 (and, fuck, ICD10 now).

One digit wrong can mean a completely wrong diagnosis, which means completely wrong tests, and completely wrong results. The patient's life can depend on the right information getting in there.

So, when developing these systems, we have to balance usability vs preventing errors. Once a system becomes too easy to use, people just start whizzing right through it like it's nothing; second nature. That's when they overlook things, like the fact that they entered 129.4 instead of 128.4, which is prettin' similar at a glance.

It's this way for most applications, and not just EHRs.

Having worked for three different health organizations, I find that breaking the task apart is more accurate, but also requires more workers. So, now you have to consider privacy and security into the application design. Doctors require as much info about a patient as possible; RNs possibly less; data entry operators (medical translators, included), require far less. And those people at the front desk, the phlebotomist, who collect pee/oral swabs for testing... need far less.

There are so many factors to consider: reflexes on tests. What to do with positive STD tests (it's required by law in most states that an HIV positive patient is notified directly and almost immediately).

People think developers of these systems are the problem, but the real issue is two fold, and it has very little to do with accounting. What it has to do with is ensuring people don't fuck things up for a patient to the point that cancer is diagnosed as low cholesterol or something far less severe... and then the patient drops dead a year later... all because someone had the incorrect keystroke, of one-fucking-character.

Doctor's don't like to spend their time using EHRs because they already know their diagnosis, recorded it on paper, and need to move on to the next patient. They're already pressured, as there is indeed a shortage of doctors, not just other medical professionals / specialists.

If EHRs are truly going to be fixed, we need a lot more people, and a lot simpler standards and coding systems. The recent ICD-10 standard that was just switched to two months ago... has throw down the fucking gauntlet holding a monkey wrench.

Re:Uhm, greed?

[Anonymous Coward]

about my god damn 2 year old son

Did you try having him baptized?