By Baha Zeidan, CEO, Azalea Health Systems
Twitter: @AzaleaHealth
Twitter: @bzeidan
Numbers don’t lie; according to a recent Mayo Clinic Proceedings article, a cross-sectional survey of nearly 900 US physicians from all specialty disciplines assessed the usability of their electronic health records (EHRs) using the System Usability Scale (SUS), and the mean SUS score was an appalling 45.9 out of 100.
The article states, “a score of 45.9 is in the bottom 9 percent of scores across previous studies and categorized in the ‘not acceptable’ range or with a grade of F.”
“F,” as in failing our medical system and, more importantly, our patients.
The Linkage Between EHR Usability and Clinician Burnout
The numbers have a lot to say about clinician burnout, too. Specifically, Medscape’s National Physician Burnout, Depression & Suicide Report 2019 cites increased use of EHRs as the third leading contributor to clinician burnout. This survey was conducted before the pandemic. Data collected just one year later tell an even grimmer story. The Medscape 2020 Physicians’ COVID-19 Experience Report surveyed nearly 5,000 clinicians in the United States and found that about two-thirds of US physicians (64%) said that burnout has intensified during the COVID-19 crisis.
Healthcare IT getting in the way of, rather than facilitating, patient care is a huge problem. And central to the healthcare IT stack is the electronic health record (EHR). According to a recent AMA article, EHRs are estimated to consume as much as two hours of physicians’ time for every one hour they spend delivering patient care. The article also includes the following passage:
“Too many physicians have experienced the demoralizing effects of cumbersome EHRs that interfere with providing first-rate medical care to patients,” said AMA President Patrice A. Harris, MD, MA. “It is a national imperative to overhaul the design and use of EHRs and reframe the technology to focus primarily on its most critical function—helping physicians care for their patients. Significantly enhancing EHR usability is key and the AMA is working to ensure a new generation of EHRs are designed to prioritize time with patients, rather than overload physicians with type-and-click tasks.”
This, then, leads to an obvious question: If electronic health records were envisioned to facilitate care plans and improve patient health, why is the current reality so skewed?
The Mismatch Between Consumer Expectation and Clinician Experience
Back in the late 90s and early 2000s, ecommerce sites like eBay and PayPal and innovations like the BlackBerry and the Palm OS combined to usher in a new era of technology consumerization. The focus was on user experience (UX), making tech tools intuitive and user-friendly for the masses. Fast-forward to the introduction of the iPhone in 2007 and the world experienced another paradigm shift, again resetting expectations for consumer convenience — devices functional and customizable right out of the box.
Jump ahead again to today and one could easily get lost in either the Apple App Store or the Google Play Store for days without running out of engaging, user-friendly applications to help with anything and everything from entertainment to productivity to fitness to business. The apps, themselves put an emphasis on user experience, and their availability in these super-convenient marketplaces, instantly accessible in the palm of one’s hands, is the gold standard for today’s consumer experience.
The divergence between the innovation and evolution in consumer technology and the stagnation of legacy EHR technology is glaring, and it has continuously widened over the first two decades of the 21st century.
EHR Usability Problems Are Not New
EHRs go all the way back to the 1980s or earlier, well before the mobile computing revolution fundamentally reset consumer expectations for convenience and user experience. Over the decades, a few early entrants into the emerging EHR marketplace secured significant market share, much of which they still hold today. They built and relied on solid brand recognition to carry the day in sales calls, appealing to back office decision makers often at the expense of frontline workers — the doctors, nurses and technicians who had to use these difficult and inflexible tools in their patient workflows.
Because much of their current-day success is largely attributable to a holdover from when they were the only games in town, legacy EHR vendors haven’t had to work hard to improve the useability of their solutions. But that’s not the only reason the legacy EHR vendors have been able to rest on their laurels instead of investing in improving UX: They’ve also managed to resist the calls for interoperability, the opening of their proprietary software to make their EHRs compatible with other vendors’ EHRs and related medtech tools.
Despite the 2014 roadmap to interoperability for healthcare IT laid out by the Office of the National Coordinator for Health Information Technology (ONC), legacy EHR companies have been opposing the effort to ensure electronic health records can share data across different vendors’ platforms. By resisting interoperability, they can accomplish two objectives critical to protecting their market share and profitability: They hold their customers captive with closed systems that require weighty contracts for ongoing support, and they slow the growth of upstart competitors who embrace interoperability by making it highly unlikely that these new vendors can find a place in legacy EHR customers’ tech infrastructure stacks. The longer they hold out, the longer they can avoid the investment in UX design that would make their EHR solutions more user-friendly.
How Hospitals and Care Facilities Can Counter Legacy EHR Stagnation
The new generation of EHRs that can force the legacy vendors to open their solutions and improve their support for clinicians working hard to improve outcomes for patients is already available in the marketplace. Light-weight, cloud-based, interoperable, and highly customizable, these new solutions are engineered for optimal user experience.
To accelerate adoption and bring about the modernization of healthcare IT, hospitals and care facilities have to start asking of their EHR providers critical questions like the following:
- Why shouldn’t our EHR be able to share data with other platforms like ONC has been calling for?
- Why should we continue to commit resources to on-premises technology when cloud-based solutions shift the burden of maintenance away from our operating budgets?
- Why doesn’t our EHR solution have the flexibility to support the workflows of all our service lines, especially those that are growing the fastest, like behavioral health and telehealth, without having to engage tech teams through lengthy and costly custom integration contracts?
- Why can’t we convert our EHR from an unintelligent data storage repository into a clinical tool by accessing outside data and collaborating with other physicians to generate useful clinical insights?
- Why should we put up with legacy EHR solutions that are out of step with today’s baseline expectations for technology to work the way we need it to right out of the box?
- Whose interests are you looking out for — the clinicians who are working on the front lines of population health and patient outcomes? Or someone else’s?
The louder and more frequent the calls for change coming from customers of legacy EHR vendors, the quicker we’ll see improvements in EHR usability. These greatly needed improvements in UX will give clinicians more time with patients, reduce clinician burnout, and, most importantly, improve healthcare outcomes across the board.