Key EHR usability challenges and the solutions

By Jo Makosinski 17-Oct-2022

Inga Shugalo, a healthcare industry analyst at Itransition, highlights the challenges facing the healthcare industry and how technology can help to tackle them, including the diagnostic potential of healthcare IoT and opportunities for precision medicine, robotics, and VR

Electronic patient records are key to delivering healthcare services, but they must be effective and intuitive if they are to realise the intended benefits

Electronic patient records are key to delivering healthcare services, but they must be effective and intuitive if they are to realise the intended benefits

Despite the fact that electronic health records (HER) usability has been widely discussed in the healthcare community for some time, not every hospital can claim to have achieved it.

According to KLAS Midsize/Large Ambulatory EMR 2022 report, 70% of EHR users in healthcare organisations would like vendors to pay more attention to EHR usability.

So, what are the usability problems trusts experience and how do we solve them?

Electronic health records are supposed to improve patient care, but many providers find them frustrating and difficult to use.

Physicians report spending up to a third of their workday on EHRs.

The main reasons why EHRs can be so time consuming include:

Screen hopping

When working with EHR solutions, doctors have to open multiple screens in search of information because so-called review pages designed to host the core data – vitals, lab results etc. A recent JAMA paper covering the difficulties doctors face when using EHR in the pediatric hospital confirms this. To complete prerounds, the study participants clicked through 12 pages per patient on average to find information on only two patients. In a real-life situation, doctors need to perform prerounds for more patients daily

Electronic health records are supposed to improve patient care, but many providers find them frustrating and difficult to use

The survey helped discover yet another related usability issue – the participants couldn’t see the account of some of the patients’ tests and procedures on the results review page and had to recheck the lab results and notes sections to get a full view of the patient. This also increased the time they spent on prerounds.

Data errors

Unfortunately, the instances of erroneous data in EHR systems are not uncommon.

What is more, data errors in EHRs typically range in severity.

There can be issues with patient identification, which often happens in clinics scattered across several locations. A patient can visit one clinic regularly and get into another hospital due to an emergency, where yet another EHR system entry is created for them. As a result, the provider ends up with partially duplicate data.

Overlays are yet another data error midsize or large hospitals can come across.

It takes place when certain EHR system fields for several patients overlap.

As a rule, this concerns names, city districts, or cities. In the end, the provider gets an unidentifiable ‘ghost’ patient.

Alert fatigue

While the issues above can hamper patient experience and provider reputation, some data errors can cause patients harm.

Such issues often concern unaccounted allergy cases or bad medication compatibility.

According to a joint 2020 study by specialists from the University of Utah, Harvard University, and Brigham and Women’s Hospital, about 30% of EHRs fail to detect harmful drug interactions and other medication errors.

Alert fatigue occurs when clinicians are exposed to an excessive number of EHR alerts. This can lead to burnout and exhaustion, which, in turn, can reduce the quality of care.

As the number of alerts increases, it becomes more difficult for clinicians to discern which notifications are more important. This leads to alert fatigue, which is characterised by a loss of energy and enthusiasm for work.

Clinicians may also experience feelings of guilt or anger due to their inability to respond appropriately to all the alerts they receive.

Solving the challenge

EHR usability problems come from the fact that vendors are out of touch with the clinical setting.

Their software, albeit of good quality, is most likely built by programmers who are not very aware of the work processes in clinics as well as the level of training of doctors who work with their EHR.

So what steps should vendors take to improve EHR usability?

Here are the steps we recommended:

Involve doctors in the development process. This will allow both doctors and developers to understand the specifics of the future solution’s work. Logically, it’s better to attract clinicians with sufficient computer skills. To identify them, vendors can run simple digital literacy tests available online.

Software, albeit of good quality, is most likely built by programmers who are not very aware of the work processes in clinics as well as the level of training of doctors who work with their EHR

By attracting computer-literate clinicians to the development process, programmers will be able to cater to, for example, the specifics of work processes for a particular specialty.

And doctors, in turn, will get acquainted with the solution in the course of its development, which can facilitate easier onboarding.

Involve users in usability testing before the final release in order to eliminate potential bottlenecks. This can be either system usability testing (SUS) by users or so-called summative testing.

The latter involves performance testing, risk assessment, and usability testing. In this setting clinicians can help evaluate cognitive load, efficiency, time cost, and other EHR usability parameters.

Offer EHR training to clinical staff. A well-designed training course is key to good usability and overall EHR system success.

The training course should cater to users of different literacy levels, not only pros.

Besides, it should present the material incrementally.

For instance, instructors can start with basic day-to-day features everyone needs and then proceed with advanced features like running clinical decision support tools with champions. Later on, the champions can train other users in case they need to work with some complex functionality.

Improve the system continuously. As we know, a healthcare institution is not a static facility. New treatments emerge and established processes turn obsolete, so it’s important to review the system regularly to ensure it is still up to date.

At this point, user champions can help again. They can signal the provider’s IT partners the need for adjustments to the EHR system.

Review the system data. The key system data is not static either. To work efficiently, EHR systems need up-to-date data sets.

A provider can clean their EHR independently or turn to professional data cleaning services.

The benefits of good EHR usability

A good EHR usability offers providers a range of benefits that can help streamline overall facility performance, including:

  • Higher EHR adoption rates. Higher usability scores mean users do not need to overwork when learning how to use the system. The adoption of such a system usually goes smoothly, so more clinicians are likely to onboard easily
  • Fewer medical errors. Medical errors remain a sensitive issue in the healthcare industry, but it’s possible to prevent them. When set up with regard to clinical specifics, EHR automatically checks potentially-dangerous medication interactions, errors with dosages, and more. The tool notifies clinicians in case some risks are detected, helping to improve patient safety in a facility
  • Reduced alert fatigue and burnout. When working on EHR usability, the development team should consider setting up EHR solution filters that mute low-importance or irrelevant alerts. This way clinicians can focus on what is most important and are likely to experience less fatigue and burnout

As we can see, EHR usability is not only a matter of ease of use, but is also a factor in ensuring the safety and satisfaction of patients and doctors through the reduction of errors, burnouts, etc.

This makes EHR usability very important for the treatment and health of both patients and doctors.