EHR Design and Usability Challenges

Abstract

In the 1950s the clinical data in medical records of patients in the United States were mostly recorded in a natural, English-language, textual form. … Such patients' data were generally recorded by health-care professionals as handwritten notes, or as dictated reports that were then transcribed and typed on paper sheets, that were all collated in paper-based charts; and these patients' medical charts were then stored on shelves in the medical record room. The process of manually retrieving data from patients' paper-based medical charts was always cumbersome and time consuming. An additional frequent problem was when a patient was seeing more than one physician on the same day in the same medical facility; then that patient's paper-based chart was often left in the first doctor's office, and therefore was not available to the other physicians who then had to see the patient without having access to any recorded prior patient's information.-Morris F. Collen, MD, Computer Medical Databases 2012 1 This section provides what I feel are key insights into the current issues in using electronic health records as well as common limitations of those systems. In part, the intent is to inform readers considering the selection of an EHR about factors that I feel are commonly ignored or not given sufficient weight in the selection process by the typical practice. Physician Attitudes about EHRs: Despite the significant EHR design and usability challenges we'll discuss in this section, most physician adopters agree that there are substantial benefits to introducing digital records into clinical practice. Recall, for example, that in the 2013 Rand/American Medical Association physician survey we discussed earlier, only 18 percent of EHR adopters would prefer to return to paper. However, physicians in that same survey complained about "poor EHR usability, time-consuming data entry, interference with face-to-face patient care, degraded clinical documentation (as a consequence of template-based notes) and inefficient and less fulfilling work content." 2 As we'll see, depending on the EHR physicians are using and, more particularly, its approach to data collection, these can certainly be valid complaints. 1