Improving Electronic Health Record (EHR) system must be part of the Solution; and not the Problem

Despite the National provisions Worldwide to facilitate a user-centered format and process to develop, adapt, Clinicians still strive with the Usability of their Electronic Health Record (EHR) Maintenance

Originally published by Technology Hits on Medium

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Despite all the workflows’ training and automation, clinicians are perpetually burning out by starting to keep up with the high regulatory burden, not to mention facility-specific configuration, customization, and training.

According to the American Medical Association, the rate of burnout in 2020 is more prevalent than anticipated in 2009. The survey details were performed at that year’s annual meeting to assess whether the organization’s predictions in 2009 on burnout impacted the HITECH Act as it was ordained. As expected, the conclusion was that burnout among physicians was particularly likened to the decrease in data quality due to the clinicians underestimating copy/paste behaviors. Furthermore, they seemed to have primarily overrated the impact that false positives from abuse and fraud detection algorithms would harm physicians and/or patients.

EHR Usability is associated with a significant Drawback for Clinicians upon Execution

Despite improvements being indicated, researchers still feel the “usability reality gap” is riddling with medical practices. To overcome that breach, some have begun to acknowledge the various socio-technical networks, including personnel, hardware, software, and culture of the organization, that can mold EHR usability. That will allow the process for customizing EHRs across communities that will include all stakeholders and not be designed according to a limited set of stakeholders’ preferences.

Because EHR usability directly impacts clinician and patient contentment and healthcare decisions, it is crucial to prioritize initiatives that underline the customization, hence improving the individual experience. In particular, along the road to customization, stakeholders should, too, contemplate EHR usability improvements in certain core areas that entail improving patient care, ensuring accurate compensation, boosting physician productivity, and reducing operational expenditures. But unfortunately, despite overwhelming attention made toward addressing said core elements, even the top five EHR technologies, including Athena health, advanced MD, and Kareo, have been unable to effectively achieve usability targets.

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Electronic Health Record usability issues increase after implementation and optimization. Individual physician’s stance toward the EHR has a significant impact on EHR adoption post-optimization. It requires a robust communication channel and coaching. Besides usability, other challenges hinder optimal EHR implementation.

Although usability is a significant factor in adopting electronic health record systems, medical practices are riddled with different challenges. For instance, the cost of implementing EHR can run somewhere from $15,000 to $70,000 per provider.

Staff resistance is another challenge, as not everyone in the medical staff would be open to the idea of technological undertaking in the establishment, especially amid overwhelming skepticism on the usefulness of EHR among physicians and the healthcare community in general.

Ensuring the medical staff sit through the EHR training process possesses the challenge of its own. Small and mid-sized groups, in particular, worry about the loss of business during the training stage.

Data privacy concerns are additional EHR implementation challenges; the stakeholders often voice concerns over data leakage risk due to a natural crisis or a cyber-attack. It is a logical yet financial agony for medical practices to transfer clinical data. It’s often a tedious and time-consuming task for the personnel.

Most clinics and medical practices have limited technical resources. Small ways hardly possess an in-house technical team. Moreover, they might lack mandatory hardware to equip the EHR solution. Therefore, it is a considerable expense to build an in-house technical team and buy hardware, which is why small and mid-sized healthcare providers delay EHR implementation.

Interoperability or ability of various EHR systems to swap information amongst themselves so that different providers can make use of it is necessary to ensure a complete image of the patient’s health. It relics an enormous task for healthcare providers to build an interoperable system that enables information transfer among multiple providers. That, in turn, is called for by the need for proper care coordination among various providers.

Today the majority of EHR solutions lack proper planning

Electronic Health Record implementation is not about the simple technical upgrade. Indeed, it carries a cultural change in the organization. Hence, EHR implementation’s change management aspects demand continuous hand-holding and hands-on support. Optimal usability requires advanced strategic planning and commitment from all stakeholders. Lack of communication between clinical and technical stakeholders is a must for Electronic Health Record implementation. It is essential to underline the fact that implementing EHR is not a one-time exercise. It is an ongoing process as it is needed to confirm that all parties' expectations are met.

Factors leading to lack of EHR Usability

Many factors influence EHR usability. Among that, one can name the frequent “system. Alerts”. While EHR warnings offer clinicians valuable updates and reminders, EHR alert exhaustion has been a problem for clinicians already struggling with EHR usability. Ironically, too many redundant Electronic Health Records alerts can undermine patient care and contribute to physician burnout. Physician burnout is gaining due to an increased number of EHR alerts from computerized physician order entry systems and clinical decision support tools.

Another factor affecting EHR usability is documenting clinical information. While the transition from paper to electronic documentation lets users take more accessible and legible notes, it is also the primary spur of clinician burden. Information plethora or having a lot of non-clinical or irrelevant text can be particularly tireless.

If clinicians can access a patient’s notes across their lifecycle, regardless of clinical benefits, it is difficult for the clinician to retrieve relevant data.

A sloppy user interface or a complex medication list results from an EHR yield that is not adequately technologically advanced or enhanced after implementation.

The Electronic health solutions being used by frontline clinicians are typically shaped by the billing or technology vendors. But they are also shaped by how those products are implemented at that provider site, with limited customization potential. Within that limit, the lack of data integrity is also a noteworthy agent behind the usability fiasco.

Physician Burnout is real and closely related to EHR Usability

Physician burnout has reached epidemic levels, parallelly negatively influencing unsafe patient care, unprofessional behaviors, low patient satisfaction, and higher physician attrition and depression levels. A meta-analysis of 47 studies among 42,473 physicians concluded the association of physician burnout and depersonalization with two-fold increased risks for unsafe patient care, unprofessional conduct, and low patient satisfaction.

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Suboptimal EHR usability contributes to physician burnout. It can lead to physicians leaving the medical profession. Furthermore, has negative physical and psychological implications.

Poor EHR usability can potentially, directly and indirectly, lead to patient harm not only through technical errors but also through physician burnout. That is a clear indication that we cannot underestimate the value of hands-on support in conjunction with the careful implementation of automated processes and EHR use cases. Electronic health records must be able to simulate the appropriate relative workflow and not just automation

Every medical practice is unique with an inimitable workflow. That is even more significant with patterns that have a diverse patient base. The workflow is not uniform for every clinician, even though tasks and some processes are comparable. Further, the workflow is changed based on regions, practices, and protocols adopted by the region’s laboratories and insurance companies. In all medical offices, the workflow pattern is different for different patients depending on their condition. Each patient may have various treatment protocols.

Based on a study, order sets often do not align with what clinicians need at the point of care. EHR usability affects and must be customizable to how order sets can be optimized to facilitate their service to the patients.

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