EHR Satisfaction and Ease of Use

If you are a healthcare worker in any field, you are probably aware of the HITECH Act.  This Act was the inception of the electronic medical record (EHR), and meaningful use.  Meaningful use was the proposal from CMS and ONC.  The idea was to have the electronic medical record have interoperable capabilities throughout the United States (cdc.gov 2019).  We know now that is not in effect.

The introduction of the HITECH Act was to demonstrate to the reader that the front line healthcare worker (Physician, Nurse, Physician Assistant, Certified Nurse Assistant, etc.), are the workers that are the most impacted by the use of the electronic medical record.  If that EHR is not user friendly, that will create some MAJOR problems.  Therefore, it is time we look at the groups that are affected the most, summarize their feelings about the EHR, and research what may be on the horizon in the year 2021 and forward.

An article from the Mayo Clinic published in November 2019 surveyed physicians randomly from across the US.  30,456 physicians were invited.  5197 (17.1%) completed the entire survey.  Out of this subset, 25% (1250 random physicians) completed a sub survey evaluation the EHR’s usability.  870 physicians completed the sub survey.  This was to measure the System Usability Scale (ranked from 0 t0 100) which would then allow the researchers to assess the possibility of burnout.  To summarize, the usability score given by the physicians was an F, with a high potential of burnout (Melnick et al 2019).

To further support the propensity of clinical burnout, the publication “Healthcare IT News” supports the tangible proof of clinician burnout due to the fact of suboptimal user experience, the physician’s view of the medical record as a “repository” or “dumping space” for patient data that is not only inefficient, but also cumbersome to ascertain at moments when it matters (traumatic accidents, severely critical moments in medicine where an established patient comes to the ER in cardiac arrest, and the ER physician cannot find the patients recent or past information).  Exacerbate these situations with the federal and state laws required to use the record, obtain prior authorization, and then tally up this aggravation with malpractice fears. Ultimately, the physician will being to believe that he/she has lost control of practicing medicine for the patient (Miliard 2019). 

What can be done to preserve a healthcare practitioners’ state of mental health, strengthen their belief in practicing medicine for the patient, regaining control, and protecting themselves (as best as they can) from malpractice lawsuits?  Create an electronic medical record that is in sync with the practitioner.  Thus, artificial intelligence (AI).

The promise of AI is threefold:  Targeting healthcare worker burnout, improving interoperability, and levering data.

A great example from EHR Intelligence states that once the physician is trained on the AI platform, they can complete 11.4 hours of work in 6 hours!  That will help anyone avoid burnout.

AI will also finally aid the physician use the interoperability that was once promised.  There are a handful of organizations that are testing the software currently.  The concur that the software will “play nice” or interact easier with other EHR platforms to send healthcare information nationwide (if not international). 

Finally, AI platforms will help state and local health and human service departments track health data with greater ease (for example, areas of Philadelphia would have an easier time tracking the areas where COVID-19 is highly prevalent).  Also, having the ease of speaking to the AI platform about pulling laboratory data on a patient from a certain time (asking the platform to pull the patient’s last five blood draws , and only pull the data that focuses on the patient’s clotting data such as PT/PTT, INR and anticoagulant level).  Then, imagine the physician giving the command to the AI platform to “trend the data” in bar graph form.  Having the patient sitting in the office, they would both see whether the patient’s anticoagulant medication is effective or not. 

This is an expensive idea, no doubt.  There are ways to thwart expense.

1. Rent the hardware and begin the partnership with the AI vendor on a contingency basis. This means that if there are too many problems in the beginning, they need to lower their price for using their software.  If problems persist, find a new vendor.

 
Move all information to a cloud-based system. Why?  Two very important reasons:

1. A cloud-based system will give a hospital and/or health system more storage capabilities. When moving something as vital as health information, a physician would like to be assured that the data is completely stored within a system that has enough capacity.

 
2. MOST IMPORTANTLY! A cloud-based system can provide security from outside attacks such as ransomware.  In an article from 2019 from zdnet.com, the cloud-based system has immediate backup in place, should such an attack occur.  Secondly, cloud-based systems store data in two parts of the nation.  Therefore, if something were to happen in one part of the nation (such as California experiencing a devastating earthquake) another backup is on the east coast.  Cloud-based systems encrypt data, back the data up, and then inherit and defend that data.

Therefore, there is hope for our first line defenders.  Physicians, nurses, and all that support the first line deserve technology like this. 

They should all be deserving enough to receive this technology now.

Citations

 
1. Miliard, M. (2019, December 16). EHRs in 2019: Still a source of frustration, but getting better bit by bit. Retrieved September 18, 2020, from https://www.healthcareitnews.com/news/ehrs-2019-still-source-frustration-getting-better-bit-bit
 
2. Disease Control, C. O. (2019, September 09). Introduction. Retrieved September 18, 2020, from https://www.cdc.gov/ehrmeaningfuluse/introduction.html
 
3. Melnick, E., Dyrbye, L., Sinsky, C., Trockel, M., West, C., Nedelec, L., . . . Shanafelt, T. (2019, November 14). The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians. Retrieved September 18, 2020, from https://www.sciencedirect.com/science/article/pii/S0025619619308365
 
4. Jason, C. (2019, December 02). EHR Intelligence: Adoption and Implementation News; How Can Artificial Intelligence (AI) Improve Clinician EHR Use? Retrieved September 18, 2020, from https://ehrintelligence.com/news/how-can-artificial-intelligence-ai-improve-clinician-ehr-use
 
5. Barbaschow, A. (2019, December 04). Avoid ransomware by moving to the cloud, says AWS Public Sector boss. Retrieved September 20, 2020, from https://www.zdnet.com/article/avoid-ransomware-by-moving-to-the-cloud-says-aws-public-sector-boss/
 

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