Hot-button topic: How can we make EHRs better, more usable?

Sara Berg
Senior Staff Writer
AMA Wire
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Electronic health records (EHRs) have become one of the greatest administrative challenges facing physicians today. They are associated with time-consuming data entry that can interfere with the patient-physician relationship and diminished physician well-being. Finding ways to overcome EHR burdens is vital for maintaining professional satisfaction, increasing efficiency and improving relationships.

Key stakeholders and physicians joined together to discuss EHR usability and optimization, best practices and other learning opportunities during a recent discussion in the AMA Running Your Practice Community. Here are some highlights from that digital exchange of viewpoints.

Can implementation decisions affect EHR usability?

The EHR discussion was led by a number of panelists with a variety of medical backgrounds. While AMA Chief Medical Information Officer (CMIO) Michael Hodgkins, MD, MPH, did not dismiss vendor responsibility for poorly functioning systems, he focused on how an organization’s implementation decisions can affect the usability of EHRs. Here were responses from some of the other panelists.

Mark Friedberg, MD, senior natural scientist at Rand Corp., practice lead in payment models and health care delivery for Rand Health Advisory Services and a practicing general internist: “Because physician practices and even large health systems often don’t have much experience with EHR configuration (especially with installations that are new to them), third-party consultants are frequently engaged to help with configuration and training. ... The quality of the services provided by these consultants is likely to vary—meaning that even for the same underlying EHR vendor product, the configured tool that physicians actually use could be quite different across installations.”

Chentan Lin, MD, chief medical information officer at UCHealth, a seven-hospital, 400-clinic system in the Rocky Mountain region: “Implementation decisions are a huge part of usability. This is the reason we have invested in having a 24-member informatics team. ... We focus on relationship-building and understanding our front-line clinicians and solving their problems. This means taking the vanilla EHR system, keeping the best standard processes and then creating a best-practice workflow for each specialty. This is a ton of configuration that we are starting to tackle ... we are getting rave reviews from specialists as we ramp up these efforts.”

How are you approaching EHR optimization?

Dr. Hodgkins: “Unfortunately, optimization strategies can vary considerably from EHR to EHR and in the characteristics of the organization. Other than consulting with your vendor and, to the extent they have them, utilizing their tools to identify users who may not be using the EHR in the most efficient way, an approach that has shown promise is ‘shadowing.’ ... Of course this is not to excuse the vendors’ responsibility for improving their designs, which requires working closely with those at the ‘front lines’ to gain insights into workflows.”

James Jerzak, MD, practicing board-certified family physician at Bellin Health, Green Bay, Wisconsin: “We hope that vendors will work to improve the usability of their systems. However, like many front-line docs, we are deeply skeptical that this can be done in a time frame that will allow for meaningful relief of the burnout docs are experiencing, to a large extent due to the EHR burden. Our solution at Bellin Health was to institute an advanced team-based care model, one that up-trains staff (CMAs and LPNs) to do the majority of the EHR work and to redesign in-basket flow to more of a team approach (the STEPS Forward module on in-basket redesign has some of our strategies for this).”

Dr. Lin: “We are rolling out team-based care, with MAs or other clinical staff working to the top of their certification and assisting with charting and pending orders in the room. ... In the long run, I have hope that EHR and clinic redesign make this less [necessary] or unnecessary.”

What are your rules for releasing test results to patients?

Dr. Jerzak: “We had a lot of debate about this and ended up releasing lab results immediately when complete. For the most part, it has worked well—patients often come for their visit knowing their results, which has been a satisfier. We do pre-visit labs for all planned visits, so even if they have a concern about their CO2 level being one point above normal, we can simply address that at the visit. So our concerns that releasing them ahead of time would cause problems have really not been an issue.”

Keith Griffin, MD, CMIO at Novant Health Medical Group and a practicing internal medicine physician at Lakeside Primary Care in Concord, North Carolina: “We have found it hard to gain consensus among our providers for immediate release of labs, despite trying to message the benefits and lack of drama seen at other organizations. ... There will be continued education and efforts to move us more towards real time release and the more positive stories we hear from others will certainly help that cause.”

Dr. Lin: “We were able to demonstrate back in 2004 that immediate release of the entire medical record over the course of the year, despite grave concerns from physicians, did not impact physician or nurse workload. ... Our urology practice saw a one-third drop in telephone-call volume when we turned on open test results.”

The expert panel discussion on the impact, optimization and usability of EHRs is just one of many on important topics that will be periodically conducted in the AMA Running Your Practice Community, which is open to AMA members and nonmembers. The community is designed to foster a digital dialogue among physician practice leaders and administrators to discuss practice management ideas, hear success stories and share thoughts with peers. Sign up now to participate and check out the AMA’s other digital communities covering practice management, medical ethics, medical education, health care innovation and more.

The AMA offers online CME to help you improve your practice. Explore education on EHR implementation and other modules in the STEPS Forward™ practice transformation series.

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Comments

I am glad to see the committee working on this but clearly the key to all of this is a nationally standardized medical record system both for inpatients and outpatients. That one step would be enormously valuable in reducing physician workload and improving record keeping and accessibility. The implications for macro scale research are enormous. Why is this not a priority for the AMA committee and the government? It is so obvious it begs a solution.
I have worked with over half-a-dozen EHRs and every time I do I am reminded of the story of the British Hawker Hurricane fighter plane of WWII. Just like EHRs, the economically focused development of the Hawker Hurricane represented a culmination of design compromises from existing commercial plans. This included the seating of a fuel tank directly in front of the pilot’s instrument panel. All it took was single enemy, red-hot tracer bullet hitting its fuel tank and its pilot was immediately immersed in flames. Remember this the next time you get burnt by an EHR! By the way, why is it that, despite it being a decade since JAMA (March 9, 2005) published its editorial, Waiting for Godot, are computer programmers still making medical personnel adopt to the machine rather than the other way around?
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Oct 20, 2017
A decision by the New Jersey high court could affect 2,000 cases. It could also undermine patient-physician decision making and informed consent.