AMA Calls for Design Overhaul of Electronic Health Records to Improve Usability

Much controversy has arisen regarding the usability and loss of efficiency when electronic health records were introduced and then incentivized as a mandatory component of physician practice. Electronic records have been in existence for 15 to 20 years, however most are woefully inadequate when it comes to usability.

ref: HITECH Answers

While AMA/RAND findings show physicians generally expressed no desire to return to paper record keeping, physicians are justly concerned that cumbersome EHR technology requires too much time-consuming data entry, leaving less time for patients. Numerous other studies support these findings, including a recent survey by International Data Corporation that found 58 percent of ambulatory physicians were not satisfied with their EHR technology, “most office-based providers find themselves at lower productivity levels than before the implementation of their EHR” and that “workflow, usability, productivity, and vendor quality issues continue to drive dissatisfaction.”

When EHRs are compared to other business software, and mobile applications they deserve a "FAIL"  Physicians have been coerced (read extorted) to acquire the obsolete software by a combination of inadequate incentives // penalties, if not used and according to a format that encourages analytics.

Standards for interoperability  are in place, however adoption remains a barrier. The Office of the National Coordinator for Health Information Technology (ONCHIT) stimulated the development of such a standard for EHR to insure interoperability between disparate EHR software.  While the standard is encouraged by incentives and penalties, adoption is slowed by lack of financial models.  

Different regions of the country use different health information exchanges and some have none. In addition, even those who have formed exchanges, there may be poor participation resulting in inadequacy.   Challenges remain, including user buy-in, lack of interest and/or need. Another challenge is the financial model for sustainability. Several different models exist.

Despite numerous usability issues, physicians are mandated to use certified EHR technology to participate in the federal government’s EHR incentive programs. Unfortunately, the very incentives intended to drive widespread EHR adoption have exacerbated and, in some instances, directly caused usability issues. The AMA has called for the federal government to acknowledge the challenges physicians face and abandon the all-or-nothing approach for meeting meaningful use standards. Moreover, federal certification criteria for EHRs need to allow vendors to better focus on the clinical needs of their physician customers.

Building on its landmark study with RAND Corp. confirming that discontent with electronic health records (EHRs) is taking a significant toll on physicians, the American Medical Association (AMA) called for solutions to EHR systems that have neglected usability as a necessary feature. Responding to the urgent physician need for better designed EHR systems, the AMA released a new framework outlining eight priorities for improving EHR usability to benefit caregivers and patients.

“Physician experiences documented by the AMA and RAND demonstrate that most electronic health record systems fail to support efficient and effective clinical work,” said AMA President-elect Steven J. Stack, M.D. “This has resulted in physicians feeling increasingly demoralized by technology that interferes with their ability to provide first-rate medical care to their patients.”

“Now is the time to recognize that requiring electronic health records to be all things to all people — regulators, payers, auditors and lawyers — diminishes the ability of the technology to perform the most critical function — helping physicians care for their patients,” said Dr. Stack. “Physicians believe it is a national imperative to frame policy around the desired future capabilities of this technology and emphasize clinical care improvements as the primary focus.”

To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs, the AMA framework outlines the following usability priorities along with related challenges:

• Enhance Physicians’ Ability to Provide High-Quality Patient Care
• Support Team-Based Care
• Promote Care Coordination
• Offer Product Modularity and Configurable
• Reduce Cognitive Workload
• Promote Data Liquidity
• Facilitate Digital and Mobile Patient Engagement
• Expedite User Input into Product Design and Post-Implementation Feedback