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Ebola article highlights EHR usability problems, says doc

In this letter to the editor, doctor and professor Alan Ducatman discusses EHR usability problems.

Editor's note: This is an email responding to a recent SearchHealthIT opinion piece on Epic Systems Corp., health data interoperability, EHR usability and response to the Ebola virus. The letter has been edited for style but not for content.

Your article addresses a topic that I have not seen covered in news media that way (I'm not a news junkie, so I'm not asserting you are the first), but the topic is one that is likely the dinner conversation of every clinician couple -- it sure has been at our house.  

Clinicians go where we need to go in the EMR, and have time for only so many clicks.

It is so poignant because any of us could do this wrong with bad consequences. My third observation below is the most important to me, but all of them relate to how and why we can interact poorly with the current EMR.

Thank you for calling attention to this.  

Details and policy aspects both interact with this story, in ways you see with your tech brain differently than I frame them.

1. I doubt the public knows that the modern EMR has many silo places [that] are terra incognita for the clinician who is responsible for the patient. Clinicians go where we need to go in the EMR, and have time for only so many clicks. There are a number of implications of this:

  • Support staff are hired to collect [and] enter data to reduce the increased time pressure of recording. That the support staff may learn something does not necessarily imply that the responsible clinician learns it. 
  • The EMR teaches us to think in terms of successfully closing the encounter. Ugh. 

2. This is not just a tech failure story. 

  • The reason we go this way is only partly the problematic self-interest of EMR creators.
  • In addition, the expanding e-workload stems from federal policy about pressing all the right buttons to get paid for the care, which in turn influences the number of silos in the medical record.
  • Individual insurers and their policies add to the problem, even independent of national policy. 
  • This is not an anti-government screed (the Feds have mostly been hands off, not hands on); it is just a problem of the never-ending, escalating workload associated with the subsurface interactions of payers and providers. The extreme proliferation of EMR activities, which are unrelated to the patient's needs, is required to make sure that an encounter is paid.

3. Finally, there is the human failure of how we interact with tech. We need to remind each other all the time that it is not just about the EMR activity of checking the boxes. If something is important, the care team needs to be talking to each other about it.

Alan Ducatman, M.S., M.D.
Professor of Public Health
Professor of Medicine
West Virginia University

Let us know what you think about the story; email Don Fluckinger, news director or contact @DonFluckinger on Twitter.


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