Vendors and healthcare systems and professionals alike all bought into the notion that the EHR should be aimed at administrators and clinicians most of all. So, it's no surprise that welcoming patients onto the care team, digitally speaking, was and remains an afterthought in terms of design. Yet to whom does the individual medical record belong? It belongs to the patient. Ironically, EHRs often lack patient-centered capabilities. Giving patients immediate access to their information, completing visit forms, transmitting information to providers, integrating medical devices and providing education tools are all key features that could enhance the patient experience. These tools could improve patient safety (patients can correct information) and help connect patients to the healthcare system, to community services or even to each other as appropriate. Changing the balance of power to the patient shifts the care paradigm and allows the patient to have a more robust voice and participate in meaningful shared decisionmaking.
Many providers have envisioned the day when computers would offer real-time support for clinical decisionmaking based on the unique characteristics of the patient. This has indeed occurred for many areas, notably medication administration. Yet often the clinical-decision support, or CDS, comes at an additional premium price from the vendor, exceeding the budget capacity of smaller institutions and many physician offices. CDS frequently takes the form of alerts or “pop-ups,” with so many occurring that users develop “alert fatigue” and ignore important warnings intended to help them. EHRs have in many cases transposed their design from the previously flawed and fragmented paper system. It can take over 100 clicks to enter simple orders. That is bad design, bad execution and bad practice. Who wants to use that?
The Institute for Healthcare Improvement Leadership Alliance, a collaboration of major healthcare organizations, recently convened representatives from industry, government, consumers and healthcare systems to consider some new principles for EHR redesign. The alliance challenged the vendor industry in particular to consider how to make usability a priority, as it is with smartphones. Smartphone features we take for granted in everyday personal use would help move EHRs toward true meaningful use—intuitive ease of use; simplicity of design; standardization, but with multiple applications suited to individual users; integrated voice recognition and search; and geospatial recognition, to name only a few.
At the gathering, there was broad consensus that the best way forward would be a multistakeholder effort, one that elevates user input to improve functionality as well as the safety and quality features of future EHR efforts. We urge the EHR community at large, including vendors, health systems, government and entrepreneurs, to address the challenge of usability by rapidly incorporating smartphone functionality into EHRs, including intuitive screens based on human factors design, easy search functions, voice recognition command, seamless interoperability and customer-centered focus—changes that are essential for patient safety and provider satisfaction alike. If we can send a man to the moon using computers less powerful than a smartphone, vendors can produce a user-friendly EHR that improves the quality and safety of the care we provide to patients with increased satisfaction to all its users. The key to achieving this national imperative is the collective will to succeed.
Dr. Mark Jarrett is a member of the IHI Leadership Alliance and senior vice president and chief quality officer at Northwell Health. Dr. Michelle Schreiber is a member of the alliance and senior vice president and chief quality officer at Henry Ford Health System.