I am not at all surprised by this, and, in fact, would bet a substantial portion of my income that most of their attending physicians are not either (“Med students not ready to use EHRs: study,” Health IT Strategist, Jan. 26). We have certainly lagged terribly in our instruction to both students and staff about how the electronic-record paradigm differs from the paper chart, both for finding information and (perhaps more critically) for inputting information into the system.
But before we blame my colleagues in academic medicine and education entirely for this problem, we must recognize that the genesis of the problem stems from poor system and interface design. In my experience the software developers don't really comprehend the paradigm shift from paper to computer either, and have not yet designed an electronic health record that enhances efficiency and patient care, and collects and displays information in a manner that improves decisionmaking.
One reads again and again about the difficulties and loss of efficiency encountered by practitioners and institutions when migrating to an EHR. Why must this be? When you last used a new Internet browser, how much instruction did you need to make it work? An intuitive and logical interface, based on previously learned computing conventions coupled with the developer's understanding of the user's needs and workflow, enabled you to begin using it immediately and (if the design was good) permitted you to work faster and better. What EHR can make that claim? I submit that this is largely because the developers, few of whom have any clinical experience, lack an understanding of two fundamental and critical issues:
1. How do doctors and nurses think and work? What is it that they really do with the record? Is the medical record just a repository of regulatory and billing documentation, or is it a tool for clinical decisionmaking and transmittal of information?
2. How do we use the EHR differently than the paper record? Do we just convert the paper to screenshots, or does the EHR enable us to develop a completely different interface to clinical information? What is the information that the clinician needs and how can we best present it to them in a multimodal and correlative manner? What is the best way for that clinician to enter their data, thought processes and treatment plans in a way that improves patient care, safety and efficiency?
We have suddenly realized that medicine is far behind the times in the use of computing to improve care. However, we suffer from a paucity of data and understanding as to how to implement the enormous computing power that is available to us, and have few experts who can synthesize the realms of clinical medicine and innovative interface design.
David M. Polaner
Associate professor of anesthesiology and pediatricsChildren's HospitalDenver