A recent study presented at the 2013 HIMSS conference revealed through the survey of 4,279 clinicians that EHR satisfaction has declined from 39% in 2010 to 27% in 2012.
While many organizations and publications have speculated about what has caused the decrease in satisfaction, I’d like to suggest we dedicate our resources to solving the problem instead of simply discussing the causes. Like so many transitions in the past, I wonder if the solution could simply be a matter of education? The study cited that the number of clinicians using EHRs who claimed to be “very dissatisfied” increased by 10% during those two years. This begs the question, are all users dissatisfied with their specific program, or may the dissatisfaction be caused by change itself? After all, physicians and nurses are being forced to change a long standing practice of paper charting.
According to the Pew Research Center’s Internet and American Life Project 20% of Americans did not use the internet and 13% did not have access to a computer in 2010. Outside of those numbers there are many medical professionals who are simply uncomfortable with computers or do not have strong typing skills. If a nurse is learning how to navigate a keyboard while simultaneously having to learn a system, it’s not surprising that he or she may be dissatisfied with the change. The disruption in workflow could be greatly improved by teaching nurses and doctors how to integrate EHRs into their daily tasks while still in the classroom.
Academic electronic health records programs, like EHR Tutor, allow students to gain exposure to EHRs before entering the workplace. Learning how to use electronic charting while still learning how to do the basics of their job, teaches students to be just as comfortable with a computer as they would be with a pen and piece of paper. This is something that may help ease the transition to electronic charting in the future.
In addition to being generally dissatisfied, the number of users dissatisfied with the “features and functionality” of their EHR system increased from 51% to 61%. One pain point seemed to be the fact that the features and functionality in many EHRs do not align well enough with clinicians’ workflow. Workflow can be determined by meetings with key stakeholders, shadowing medical personnel during their workday and conversations with designated doctor or nurse champions. The process works best when input from the people who will be using the system is carefully considered and fully utilized. However, improving workflows will not solve the entire problem.
For example, let us examine a problem like “alert fatigue”. In many systems, alerts pop up with warnings about drugs that may be unnecessary or elementary for a prescribing physician, or with a warning that a field is missing data that may not be relevant to the patient. An alert may also appear after a particular issue has been handled. While the alerts may seem logical to a programmer, they don’t necessarily make sense in the field. Thankfully, there are more and more schools offering courses on healthcare technology, which provide a foundation of knowledge for future developers and analysts.
Centers like the Training Hub for Operative Technologies in Healthcare at Imperial College in London offer full programs dedicated to healthcare technology. For current developers, Coursera.org offers free courses including “Health Informatics in the Cloud”, “Interprofessional Healthcare Informatics” and “Healthcare Innovation and Entrepreneurship”, all of which examine the real life work of medical professionals in relation to the technology they use. This is a knowledge set that is absolutely necessary for a programmer trying to design a system for those very people. By having companies sponsor those classes or conversations, we would open the lines of communication and enhance the education of program developers.
Along with a decrease in satisfaction regarding features and functionality, the amount of clinicians who said they would not purchase their current EHR system again if given the chance increased from 25% to 38%. This cannot be solely the fault of developers; some of the onus must fall on consumers themselves. Instead of hearing the lament, “If only I would have known…” after an EHR implementation, we can begin by making sure medical offices do know what they are getting with any particular system and what they should expect when shopping for an EHR. Educating consumers is imperative. For example, the level of computer skills and familiarity with technology needed when using different programs may be a huge factor for a practice with less computer savvy practitioners.
Reading the reviews on EHRCompare.com quickly revealed that AdvancedEMR can be difficult to set up and implement for less technologically inclined staff, whereas Practice Fusion seems to be less customizable, but easier to use (based on user reviews alone). Using EHRCompare to research multiple EHRs, a user can search by specialty, setting, and hosting preference. Then, all applicable EHRs will appear with an overview of features along with user reviews. That information not only gives consumers a great place to start, it teaches them what questions to ask and what to look for. What are some pain points a consumer may not have thought of? How do the program specs translate to office usage?
Another great resource is the Health IT government website which has a full list of all certified EHR systems: http://oncchpl.force.com/ehrcert/CHPLHome. It has a large checklist of features for each product, allowing consumers to see, at a glance, what is available and what is missing. That way, consumers know all the details even if the EHR sales rep did not disclose them all. Knowing what to look for can help buyers purchase the best system for their particular practice.
Overall, any change in procedure involves a long, arduous education process. While there are technical problems to overcome in the present, many problems can be prevented with simple education in the future. Using the resources available we can make sure new medical professionals, EHR programmers and consumers all have access to the best resources and knowledge base possible. This is something that can only lead to improvement.
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