New MedStar-AMA study points to need for performance standards for EHR usability and safety for physicians, finds huge variability in completion efficiency and accuracy.
A new study published by the Journal of the American Medical Informatics Association (JAMIA) involving clinicians using electronic health records (EHRs) to perform certain common tasks provides compelling evidence that the design, development and implementation of these systems need to be improved to make them easier to use by clinicians and, ultimately, safer for patients.
The study, entitled “A usability and safety analysis of electronic health records: a multi-center study,” published on July 2nd was conducted by researchers with MedStar Health’s National Center for Human Factors in Healthcare, the American Medical Association (AMA). Researchers focused on the EHR vendors, Epic and Cerner at two sites per vendor, or four health systems.
During the study, twelve to 15 emergency physicians per site were given common tasks mimicking real patient cases—placing orders for medical imaging, lab tests, and medications. Researchers collected data pertaining to length of time and number of clicks to complete each task plus the degree of accuracy. The findings showed huge variability in performance across the sites.
For example, time to complete an imaging order varied from 25 seconds at one site to more than a minute at another. Placing an imaging order required an average of eight clicks at one site, while the same task at a different site averaged 31. For a medication order, one site recorded no errors while another had a 30 percent error rate. Error rates varied by task (X-ray 16.7% to 25%, MRI: 0 to 10%, Lactate: 0% to 14.3%, Tylenol: 0 to 30%; Taper: 16.7% to 50%).
EHR vendors are required by the federal government to employ user-centered design as they develop systems and to conduct usability testing near the end of the process. However, EHR usability challenges persist due to several key factors:
– poorly installed EHR implementations
– vendor design and development
– Lack of optimized EHR configuration/customization by health and vendor
– Workflow configuration/best practices during implementation
The resulting product may be significantly different from the one that was tested by the vendor for optimized usability and safety.
Authors of the study concludes that “basic performance standards for all implemented EHRs should be considered in order to ensure usable and safe systems. Both EHR vendors and providers should work together to ensure that usable and safe products are implemented and used.”
“Our findings reaffirm the importance of considering patient care and physician input in the development and implementation of EHRs,” said study co-author Michael Hodgkins, MD, chief medical information officer of the AMA. “There are multiple variables impacting the end user experience that contribute to physician burnout, a diminished patient-physician relationship, and unrealized cost savings. While design can be an important factor, so too can implementation choices made onsite. Increased collaboration between vendors, information technology purchasers and physicians is needed to optimize experiences and address current needs.”