Everybody has responsibilities for fixing EHRs

Tanya Albert Henry , Contributing News Writer

Now that the vast majority of physician offices, hospitals and clinics have adopted electronic health record systems (EHRs), the push is on to improve EHR design, development and implementation in a way that will fix known patient-safety risks and improve EHR usability issues that contribute to physician burnout. 

This push is coming from the AMA and the MedStar Health National Center for Human Factors in Healthcare. They have timed their effort to coincide with the 10th anniversary of the passage of the federal legislation that spurred rapid EHR adoption—the Health Information Technology for Economic and Clinical Health (HITECH) Act. 

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As part of their “Everybody Has Responsibilities” campaign, the AMA and MedStar have created a website that includes videos of health professionals experiencing the risks and challenges faced when EHRs can’t be used efficiently. For example, a confusing visual display of medications could lead to a physician ordering the wrong medication, or an automatic refresh of a screen could lead to a physician choosing the wrong medical record. 

The website also lays out what physicians and other health care providers, policy makers, EHR vendors and patients can do to improve the status quo. 

Physicians, for example, can also help create meaningful change by participating in EHR vendors’ usability and safety tests and by reporting issues to their own IT team. They can also report through formal channels, such as going directly to the Office of the National Coordinator for Health Information Technology (ONC). ONC maintains a website that walks physicians through the formal complaint process. 

Researchers from the AMA and MedStar published a study last year that found big differences in efficiency and error rates when physicians used EHRs. Researchers asked emergency physicians at a few sites that use Epic and Cerner, the two largest EHR vendors that comprise more than half of the market, to perform common tasks mimicking real patient cases.  

They found that the time it took to complete an imaging order was 25 seconds at one site, but more than a minute at another site. One site required an average of eight clicks to complete the order; another site averaged 31 clicks. Meanwhile, one site recorded no errors for a medication order and another site had a 30 percent error rate.   

The differences in performing the same function in the same EHR at different sites is likely attributable to local decisions during implementation and can also include differences in ancillary systems the EHR must interact with, according to Michael Hodgkins, MD, MPH, the AMA’s chief medical information officer.  

Dr. Hodgkins was a co-author of last year’s AMA-funded study “A usability and safety analysis of electronic health records: a multi-center study,” published July 2, 2018 in the Journal of the American Medical Informatics Association.  

“The results of this study reinforce the assessment that ensuring the usability and safety of the EHRs is a joint responsibility between physicians, technology vendors and technology purchasers that requires collaboration with these stakeholders at each stage of design, development and implementation,” Dr. Hodgkins added. “The health care system must have confidence in the EHR systems used to manage patient care.” 

The director of the MedStar Center, Raj M. Ratwani, PhD, echoed this point, and he noted that EHR safety should be a priority for all involved. Central to this effort would be allowing physicians and patients to report safety and usability challenges they observe and experience so common themes can be identified. 

“Nearly every high-risk industry promotes the sharing of safety information to foster improvement, and health information technology should be no different,” he said. 

Dr. Hodgkins agreed. 

“The reason for the focus on everyone sharing responsibility is that vendors can’t do a good job of user-centered design without more involvement from end users,” he explained. “Purchasers of EHR technology need to be wary of implementation/configuration decisions that adversely affect usability. Policy makers and health plans have a responsibility as well to avoid imposing requirements that add to the burden on physicians and other members of the health care team.” 

The MedStar center brings together human-factors scientists, clinicians and other experts to create a safer, more efficient health care environment. Its parent organization is MedStar Health, a not-for-profit health care provider in the Maryland and Washington, D.C. region. 

As the Everybody Has Responsibilities campaign continues to spread awareness, campaign organizers highlight that there are actions physicians can take now to help improve patient safety and reduce their own burnout.  

For example, physicians can participate in the AMA’s EHR Connect platform, which joins key stakeholders to collaborate around EHR development, usability, optimization and interoperability for improved end-user experiences. By joining EHR Connect, physicians can share their voice; learn from others’ expertise and experiences; and access news, events and resources. Learn more about the AMA’s digital health leadership activities.