Making Electronic Records Better, Stronger, Faster

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Professional EHR usability experts have been designing better electronic health records for years, but many vendors would be surprised to learn such experts even exist.

You may not have heard of them, but since 2010 the Strategic Health IT Advanced Research (SHARP) researchers have been hard at work using federal funds to investigate just what’s wrong with electronic health records and how to fix them. With 11 locations, four years and 15 million dollars of Office of the National Coordinator funding, all that EHR research is about to pay off.

HealthBiz Decoded took a closer look at what they’ve uncovered at the Houston outpost, which focuses on EHR workflow and usability.

Led by Jiajie Zhang, Ph.D., dean of The University of Texas School of Biomedical Informatics at Houston, they’ve been developing software tools, guidelines and visualizations to help usher EHR design into the future.

“We know, in fact everyone knows, that EHR systems today, whether they’re ones by big or small vendors, have a lot of challenges,” Zhang told HealthBiz Decoded.

Though providers generally like EHRs and prefer an electronic method to plain-old paper, actually getting data into the systems can be tough, he said.

“For the major tasks, like e-prescribing, computerized physician order entry (CPOE), clinical summaries and other important tasks, the EHR systems do not always speed up the process.”

Dr. Theodore Mayer, a Detroit area pathologist, agreed.

“Right now, it takes an enormous amount of time to enter data, clinicians are working extra hours every day,” Mayer told HealthBiz Decoded.

“I spoke to one of our most tech-savvy clinicians, an orthopedist, and he was lamenting that he has to spend two and a half extra hours every day entering data,” he said.

In general, taking patient histories is very fluid and “analog,” he said, and doesn’t lend itself to being packaged as discrete data points. The EHR systems on the market today don’t reflect the actual practice of medicine, and Mayer thinks the products probably won’t get much better soon.

“These systems have been designed by software developers who did not consult clinicians,” he said.

That’s where Zhang’s team comes in.

They focus on optimizing user interfaces and identifying what hurts usability so they can make recommendations to vendors for future designs.

They’ve developed software tools like TURF, which can be used to evaluate and test EHR usability, measuring its performance with end users.

“The surprising part at a top level is that many vendors were not aware that usability can be designed, tested and evaluated objectively,” Zhang said. “In their mind, usability comes from talking to users, which is good you want to talk to the users, but that’s not the whole thing.”

Many were surprised that “EHR usability” is actually a science-based profession, he said. In reality, vendors don’t have to wait for consumers to tell them what’s wrong with their product: it can be designed optimally from the start.

Zhang and his fellow experts have been developing guidelines, tutorials and videos which are available online to everyone, and will be organized into a central website at the domain “sharpc.org” in the next one to two months, Zhang said.

In the meantime, SHARP –C is talking with investors and stakeholders about commercializing some of their products, like TURF, just in time for the Meaningful Use Stage 2 deadline. The federal grant for SHARP expires in March 2014.

For MU2 certification, which is anticipated to be much more difficult that stage 1, vendors will have to test their EHRs in 8 use cases, many of which depend on usability to succeed.

“The mandate is not something that all the vendors like, but they have to do it,” Zhang said. In the end vendors with usability tools like the ones SHARP developed will be able to make safer and easier to use products, and that’s a good thing, he said.