Are You in an Abusive Relationship with Your EHR?

Running a company that sells EHRs, I get to hear quite a bit about what clinicians don’t like about them. One of the most frequent complaints I receive is that EHRs make clinicians spend more time typing and clicking and less time interacting with their patients. On top of the time spent clicking and typing, they generally only get about fifteen minutes with each patient. If you haven’t noticed a theme in my posts yet, I’m going to tell you again — it doesn’t have to be this way.

Scenarios like the one above happen initially due to poor user interface design, or, more commonly, the initial design was pretty good and had a whole lot of clinician involvement, but several versions of the software have been released since and the great design was lost bit by bit with each new version. A new feature is added here, another alert is added there, and suddenly, before you know it, the user interface is a cluttered mess — not to mention slow. There are people who will say this is an inevitable result in the development of software. Again, that’s not quite true.

Keep the clinicians in the room

One way to combat the slow, sluggish software that results many releases down the road is to keep clinicians involved. When new features need to be added, continue involving practicing clinicians to work through the UI design process with the developers. I must emphasize practicing clinicians. Hiring a bunch of clinicians who are no longer involved in the day-to-day practice with patients is not the answer. You need the clinicians who are still in the trenches. Their perspectives are so important.

I’m sure it seems like no big deal to add a check box here or an alert there and just have developers handle it, but eventually these little changes add up. On our team, clinicians handle these new feature requests while taking into account the entire system. This is expensive, but effective. Because we do it this way, our interfaces stay easy to use. We are also very selective about who works on the clinician team. They must be practicing clinicians, but they also must have an informatics background. Not only do we expect them to be active in healthcare, we also want them current in IT. It is clinicians like these who are the rock stars in health IT. They move seamlessly from working in our development wiki and Kanban boards to tinkering in the EHR. Who knows better how the system should work — a team of clinicians who practice medicine, or a software developer working alone?

The roll-and-scroll illusion

Another common statement I hear is that the old dinosaur EHR is “the best” because it uses a roll-and-scroll screen and that method of data entry is the fastest. Really? Who fed you those words and convinced you it’s true? A statement like that is only true because you have been using this ancient EHR so long that you know all the keyboard shortcuts and menu commands, so it seems faster. This is an illusion. There is no reason a well-built graphical interface can’t be just as fast.

I understand the attraction to roll-and-scroll interfaces, I really do. As a developer, they can be more efficient — but that is due more to a lack of quality UI design and twenty years of memorizing commands. Roll-and-scroll is great for ordering. But what about displaying data? It is beyond horrible for this, and horrible at displaying trends. Looking at a giant table of textual data makes it nearly impossible to notice trends in the fifteen minutes you have with a patient.

You can have both

So where am I going with this? It is possible to have the best of both worlds. You can have the simplicity of roll-and-scroll ordering that only takes seconds. You can also have a beautiful interface where you see all the patient’s data in a way that steers your attention through visualization and helps you spot potential problems. The human mind is excellent at spotting patterns, so why not leverage that for the patient’s benefit? There is no reason you shouldn’t be able to write orders in seconds without a flurry of mouse movements and clicks. The interface also shouldn’t strain your eyes when you look at it. Most clinicians work well beyond forty hours a week — so why can’t EHR vendors get this right?

Stop abusing these people and give them something that’s easy to look at. If you want to go home at the end of your workday without being exhausted by undue cognitive load and repeated eyestrain from poorly designed software, the fix already exists. We just have to insist on it.