In a recent Health Leaders post, many billions of dollar from private and government funds have been poured into electronic medical records (EHR’s) yet the return on this investment has not demonstrated a return. Outside the financial outlay for implementation, training and maintenance of these systems, many other issues are impacting healthcare delivery and safety for patients. An overall lack of user interface design (UI), poor or no interoperability and minimal ability to customize the EHR platforms to more effectively meet the needs of our patients.
There is no question that the primary driver of implementing EHR’s in medicine is to improve the delivery of care to our patients in a safe and efficient manner. Development of thoughtful user interfaces that address the needs of various healthcare providers can appear to be unnecessary and window dressing to make physicians happier when interacting with computers, but it is a requirement for better data visualization and to prevent missing critical information. In addition, design relates directly to how information is understood and communicated both between healthcare providers as well as for patients to better understand their disease and the plan of treatment. All of the major EHR’s are using standard components to present data. None of them have successfully replicated the viewing of complex, interrelated data such as that displayed on a paper ICU record. With this lack of UI design, providers are forced to search through various areas of the EHR to locate it. In addition, when a specific piece of data can not be found, one is unsure if the data was collected or was added to some arcane location. Outside of this frustration and possible duplication of work, a lack of UI design allowing for viewing interrelated or interdependent information requires providers to hold the information in their mind until all of the various pieces are collected. The simple act of finding a pre-operative blood glucose value so that it can be documented in my pre-operative evaluation can be a challenge with many of the systems I have worked with. Although this is one small issue that many would agree is insignificant, but when small items are missed or multiple items become compounded, patients are placed at risk. Given we are still in the early phases of Healthcare IT and there is an overall lack of standardization for these types of issues, they are impacting how physicians and other providers practice.
A somewhat related issues, not on the front end display but lingering in the background is storage of medial data. Database design is not only lacks standardization but also has not been normalized to allow for the easy sharing of information between systems. This results in much duplication of data as well as tests and studies into different medical record systems. Not to mention, interoperability has not yet been solved, creating frustration and concerns on Capital Hill with EHR providers. Work on interoperability is being done and the most notable way is through health information exchanges, but the issue is not to duplicate data in a third-party system but to develop a framework where providers can access patient information in a standardized interface, irrespective of the proprietary EHR where it resides.
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Finally, each of us work within different medical specialties and have varying requirements for medical data. A deluge of information in a tabular format does not promote efficient and safe delivery of information. More proactive design of information display has the potential to impact patient care, improvement physician workflow, and increase patient safety. No matter how minor, it is very difficult to change anything with respect to display and data entry in even the major EHR’s.
At its core, we have the tools, frameworks and understanding to deal with great amounts of data, display it in ways to foster understanding and improve communication between providers and patients. Other, data intensive business sectors have developed systems to foster quality care and we will be no different. Companies such as Zoeticx, are working on solutions to these problems, solutions that do not depend on the vendors themselves but allow for customization and interoperability. The most compelling aspect of a middle-ware platform is the ability to engage small development to address niche areas of medicine that are currently not being targeted either because there specific needs fall outside of the standard EHR models or are too small to warrant development resources.
Much like medicine itself, EHR’s are complex in design and implementation. Although many of the problems discussed in this article are well known and many physicians, administrators and politicians are strongly encouraging vendors to address them, we need to look for other solutions to address not only these current issues but also to be able to respond to unseen needs at the present time. It is my hope that EHR’s are not only able to address the needs of our patients but actually help to empower us to better take care of our patients and enjoy all aspects of medicine, including documentation and access to information in a coordinated and well designed way.