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    Poor design hampers EHR usability, doctors say

    Difficulty finding patient information, problems navigating between screens, an overreliance on checklists as opposed to unstructured data and struggles with developing patient-specific problem lists are among the litany of complaints doctors cite when asked about lack of user-friendliness in their EHRs. 

    To Mark Friedberg, MD, MPP, an internist and senior natural scientist at the Rand Corporation in Boston, these problems all spring from the same source: poorly designed technology.

    “Good design is supposed to make it easy for a user to do the right thing, and in a lot of ways we’ve achieved the opposite in EHRs,” says Friedberg, who was not part of the survey. “The people designing them may be good at things like how to organize a database, but for actual human factors, putting together a tool so that it’s intuitive to use, in general they’re terrible.”

    Friedberg, who uses Epic, cites the example of information clutter on the system’s screens. “We actually had to buy larger monitors to be able to use Epic because there’s so much crap on the screen,” he says. Moreover, the information presented often isn’t what he needs for treating his patient.

    “So you’re constantly hunting around, scrolling, clicking out of tabs,” he says. “Good design requires design experts who can say, ‘Here’s how a display should look for a doctor who has to solve this problem at this time.’ But right now no one is providing that.”

    For Jeffrey Kagan, MD, an internist in Newington, Connecticut and Medical Economics Editorial Advisory Board member, a user-friendly EHR is one that would enable him to track when patients arrive and are roomed, something his current system, gloStream, can’t do.

    As a result, he sometimes encounters patients who complain they’ve been waiting a long time in the exam room—only to find out later that the patient arrived late for their appointment and had to be seen out of sequence.

    Similarly, he says, “You want to know who’s not paying their bills, who’s not showing up for appointments, who’s not showing up for referrals. Unless that provider sends me a fax saying Mrs. Jones didn’t keep her appointment, I have no idea.”

    Poplin, a survey participant who practiced for most of her medical career at a Washington, D.C.-area military hospital, objects to trying to capture the nuances of a patient’s condition via a checklist, rather than unstructured text.

    She recalls the early days of her residency when nurses would provide her with detailed notes about any changes in a patient’s conditions since she’d last seen the patient. But when the hospital changed from paper to electronic records, information was transmitted instead via standardized checklists.

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