An example of the kind of safety issues that electronic health records (EHR) was designed to mitigate were errors in prescription writing caused by illegible handwriting. In the words of The Office of the National Coordinator for Health Information Technology (ONC), the main goal of health information technology is to improve the quality and safety of patient care.
However, a common perception among many doctors today is that EHRs create more work and hinder positive engagement between the provider and the patient. They perceive this technology was supposed to increase efficiency, reduce costs and assist in raising the quality of care.
Therein lies the rub. The regulators driving adoption and the users whose industry they govern do not seem to be aligned with the intended purpose of EHRs. This does not mean perceptions are right or wrong, valid or invalid, but they are definitely in need of better harmonic orchestration to achieve the end goals of all participants. A recent article published on the website of WBUR, Boston’s NPR Station, reflects some dissatisfaction among doctors regarding the use of EHR technology.
Beyond the ideals of improved quality and safety of patient care are financial considerations. Fee-for-service rewarded doctors for the number of health services they delivered—in quantity, rather than quality. Now, doctors receive their payments according to the quality or outcome of the services they provide, not in volume or service or frequency of engagement. The different quality measures, from Meaningful Use to MACRA, add the need for data input and reporting to the EHR application, which means more clicks for doctors. Another example of “feature creep” the EHR companies recently absorbed was the transition from ICD-9 to ICD-10, which expanded a medical coding set from 15,000 to 65,000.
Both the shift to value-based care compensation and the expansion of medical codes have made the medical billing process more complex. This has driven the need for practitioners to invest additional time and resources to recoup for their services. When medical practitioners are tasked with medical billing duties, they have less time to spend providing care for patients. In understaffed medical practices, this increases overhead and limits the quality of care.
As EHR manufacturers, we are striving to rise to the challenge of revising the application interface to meet these new data requirements while maintaining a smooth workflow for doctors and other medical professionals. The expansion of regulations has the EHR industry countless man-hours in re-coding, re-testing and re-certifying products before they may be approved for continued use by their customers.
Saving Doctors Clicks in EHR Software
The benefits of digitization in healthcare seem to be in alignment with the insurance companies and patients safety needs, and perhaps not yet with the all medical workers who have had this system intertwined with their profession. EHRs have made it easier access patient records, and increased accountability in care. The drudgery of paper file management has been all but eliminated in many care settings. The common perception that they put doctors into a situation of “death by a thousand clicks,” is due to their being in the front end of the digital cycle, where the data entry that drives the benefits needs to occur. The investment of this front-end time in better quality healthcare is only realized after the record entry, and at the end of the patient engagement cycle. The EHR is the tool by which the medical practice demonstrates to the government that the care they provide is aligned with an outcome based practice and inherently improves record portability.
Creating government standards for user interface (UI) improvements is one possible option to bring doctors and EHR companies into alignment for saving clicks in EHR software. The federal government has driven similar interface improvements in the past. For example, section 508 outlines the guidelines for web page design in order to make them more accessible to people with visual impairments, and concurrently improves the user experience for those without any impediment, just as streets with curb cuts at intersections make crossing the road easier for people in wheelchairs, walkers and skateboarders (OK—skateboarders should walk too, but the point remains that designing a standards based system can improve the user experience for all).
The government has conducted studies about software interfaces related to non-tethered patient records and their interaction with provider-EHRs. They could also create a similar program focused on the provider’s EHR graphical user interface (GUI).
Government influence is one option for driving click savings in the GUI, which would encourage collaboration between doctors and application vendors. The other and currently employed option is the continued hand of the free market as the deciding factor towards the interfaces that work the best for doctors as they continue to organically establish winning designs.
Some EHR companies now also offer medical billing services which alleviates all medical billing duties for the medical practice, saving them lots of clicks in valuable administrative resources and time to spend providing health care.
Whether standardization comes from the federal government or the free market’s ability to select the best products and services, only time will tell. In the meantime, the most provider-considerate EHR companies strive to create the best doctor experience, providing many click-saving features for every new regulation in order to help doctors focus on patient care. The medical providers have let it be known that every click is counted, and the time-saving EHR application which helps doctors optimize practice efficiency and shorten administrative time will win the market.