EHR and Physician Workflow

In a recent Health Leaders post, many billions of dollar from private and government

funds have been poured into electronic medical records (EHR’s) yet the return on this

investment has not demonstrated a return. Outside the financial outlay for

implementation, training and maintenance of these systems, many other issues are

impacting healthcare delivery and safety for patients. An overall lack of user interface

design (UI), poor or no interoperability and minimal ability to customize the EHR

platforms to more effectively meet the needs of our patients.

There is no question that the primary driver of implementing EHR’s in medicine is to

improve the delivery of care to our patients in a safe and efficient manner. Development

of thoughtful user interfaces that address the needs of various healthcare providers can

appear to be unnecessary and window dressing to make physicians happier when

interacting with computers, but it is a requirement for better data visualization and to

prevent missing critical information. In addition, design relates directly to how

information is understood and

communicated both between healthcare providers as well

as for patients to better understand their disease and the plan of treatment. All of the

major EHR’s are using standard components to present data. None of them have

successfully replicated the viewing of complex, interrelated data such as that displayed

on a paper ICU record. With this lack of UI design, providers are forced to search

through various areas of the EHR to locate it. In addition, when a specific piece of data

can not be found, one is unsure if the data was collected or was added to some arcane

location. Outside of this frustration and possible duplication of work, a lack of UI design

allowing for viewing interrelated or interdependent information requires providers to hold

the information in their mind until all of the various pieces are collected. The simple act

of finding a pre-operative blood glucose value so that it can be documented in my preoperative

evaluation can be a challenge with many of the systems I have worked with.

Although this is one small issue that many would agree is insignificant, but when small

items are missed or multiple items become compounded, patients are placed at risk.

Given we are still in the early phases of Healthcare IT and there is an overall lack of

standardization for these types of issues, they are impacting how physicians and other

providers practice.

A somewhat related issues, not on the front end display but lingering in the background

is storage of medial data. Database design is not only lacks standardization but also

has not been normalized to allow for the easy sharing of information between systems.

This results in much duplication of data as well as tests and studies into different

medical record systems. Not to mention, interoperability has not yet been solved,

creating frustration and concerns on Capital Hill with EHR providers. Work on

interoperability is being done and the most notable way is through health information

exchanges, but the issue is not to duplicate data in a third-party system but to develop a

framework where providers can access patient information in a standardized interface,

irrespective of the proprietary EHR where it resides.

Finally, each of us work within different medical specialties and have varying

requirements for medical data. A deluge of information in a tabular format does not

promote efficient and safe delivery of information. More proactive design of information

display has the potential to impact patient care, improvement physician workflow, and

increase patient safety. No matter how minor, it is very difficult to change anything with

respect to display and data entry in even the major EHR’s.

At its core, we have the tools, frameworks and understanding to deal with great

amounts of data, display it in ways to foster understanding and improve communication

between providers and patients. Other, data intensive business sectors have developed

systems to foster quality care and we will be no different. Companies such as Zoeticx,

are working on solutions to these problems, solutions that do not depend on the

vendors themselves but allow for customization and interoperability. The most

compelling aspect of a middle-ware platform is the ability to engage small development

to address niche areas of medicine that are currently not being targeted either because

there specific needs fall outside of the standard EHR models or are too small to warrant

development resources.

Much like medicine itself, EHR’s are complex in design and implementation. Although

many of the problems discussed in this article are well known and many physicians,

administrators and politicians are strongly encouraging vendors to address them, we

need to look for other solutions to address not only these current issues but also to be

able to respond to unseen needs at the present time. It is my hope that EHR’s are not

only able to address the needs of our patients but actually help to empower us to better

take care of our patients and enjoy all aspects of medicine, including documentation

and access to information in a coordinated and well designed way.