JAMA: 5 tips to fix EHR usability, 10 years post-HITECH

By | February 10, 2019

Hard as it may be to believe, it’s been a decade, almost exactly, since the healthcare information and technology industry was turbocharged and totally transformed by tens of billions of federal incentive dollars.

It was February 17, 2009, when, in the ongoing aftermath of the Great Recession, a newly-inaugurated President Barack Obama signed the American Recovery and Reinvestment Act into law.

It contained $ 787 billion of stimulus funding at the time, with $ 19 billion of it earmarked specifically for health technology investments – a number that would almost double in the years ahead. (Read our coverage of it here.)

Over the past 10 years, electronic health records were installed or upgraded at hospitals and physician practices nationwide, and are now nearly ubiquitous. It’s been a sizable change for a healthcare industry that was still largely paper-based for the early part of the 21st Century.

As will be visible to anyone attending the HIMSS Global Conference and Exhibition in Orlando next week (follow along with our full coverage here), a whole lot has happened with health IT since 2009.

The rocket fuel of federal funding enabled mass uptake of essential technologies, and has helped enable a wide array of other innovations to flower. It’s ushered in huge opportunities – but also plenty of challenges.

Not least of them: ongong frustrations with the usability of EHRs. In fact, those complaints seem in many ways to be approaching a boiling point, with more talk than ever about the epidemic of physician burnout – caused in no small part by poor UX and burdensome documentation requirements.

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Writing this week in the Journal of the American Medical Association, three healthcare experts take a look back at the decade since the HITECH Act, and offer what they call a “path forward,” with suggestions to help EHRs fulfill their potential.

Raj M. Ratwani, director of MedStar Health’s National Center for Human Factors in Healthcare; Dr. Jacob Reider, CEO of Alliance for Better Health (and former chief medical officer of Office of the National Coordinator for Health IT); and Dr. Hardeep Singh, chief of the Health Policy, Quality & Informatics Program at Michael E. DeBakey VA Medical Center, agree that HITECH was a success at boosting promoted the adoption of health IT.

“The majority of US hospitals and ambulatory clinicians have adopted an EHR and some benefits, such as easier access to patient information and the ability to more easily order certain medications, laboratory tests and diagnostic tests, have materialized,” they said.

“However, usability – defined as the extent to which technology can be used efficiently, effectively, and satisfactorily – remains suboptimal,” they added. “Usability challenges in the last decade have had unintended consequences. Poor EHR usability contributes to errors that are associated with patient harm. It also results in clinicians spending extra time using the EHR, contributing to clinician frustration, which, in turn, has been reported to jeopardize patient safety.”

While federal incentive money might have done wonders to encourage wide adoption of these IT systems, government efforts to address improved usability have had only “modest effect,” according to Ratwani, Reider and Singh.

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ONC’s certification programs, for instance, “require a design and development process that promotes usability and requires usability testing, but some vendors have not adhered to these requirements.”

And while research from AHRQ – which has advocated since the early days of HITECH for usability certification – has allowed for a better understanding the “nuances and complexities” of EHRs and other healthcare software, “the scope of usability challenges is much larger than anticipated, and useful research findings have not been effectively translated by industry, they said.

Still, clinicians and patients expect and deserve much better: “Usability of commonly used software tools has improved exponentially in the past decade,” but health IT systems still often seem stuck in the now-distant past.

Toward a better way forward for usability and user experience, the JAMA article offers five suggestions:

  1. Create a National Database of Usability and Safety Issues
  2. Establish Basic Design Standards
  3. Unintended Harms Must Be Addressed
  4. Simplify Mandated Documentation Requirements That Affect Usability
  5. Develop Standard Usability and Safety Measures So Progress Can Be Tracked and the Market Can React

Read more detail about each of those proposals here.

“Overcoming usability challenges that have affected health IT for the last decade will require shared responsibility and greater collaboration among vendors, researchers, policy makers, health care organizations, clinicians, and patients,” write Ratwani, Reider and Singh.

“While policymakers need to initiate many of these actions, success is dependent on true engagement from all groups, particularly vendors who should now consider greater transparency of their products,” they said. “This shared commitment is imperative because another decade of poor usability and related patient safety challenges would be unbearable, especially for patients.”

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Twitter: @MikeMiliardHITN
Email the writer: mike.miliard@himssmedia.com

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