Regenstrief Institute Outlines Ways to Improve EHR Usability

Healthcare stakeholders can boost EHR usability and efficiency by thinking about the user experience and streamlining processes.

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By Jessica Kent

September 04, 2019 - Improving efficiency and EHR usability will require developers and end-users to optimize documentation processes, minimize training requirements, and share best practices, according to a recent editorial by Regenstrief Institute research scientist Michael Weiner.

In the article, published in the Journal of General Internal Medicine, Weiner discussed the shortcomings of EHRs and their impact on care delivery. 

“When I am reading a patient's EHR, a lot of what I want to know and am seeking is what other healthcare professionals learned when they assessed the patient, and what they thought were the most important findings in terms of diagnosis and treatment,” said Weiner, MD, MPH. 

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“What I encounter much too often is that key pieces of the patient's record are in the wrong place or embedded so deeply in the EHR that they are hard to locate or may not even have been documented.”

He noted that in addition to technical challenges, EHRs have display and usability issues that need to be addressed as well. 

“Currently, there are too many distractions in the EHR, such as descriptions of old, resolved problems that are repeatedly cut and pasted again throughout the record, making it difficult to focus on information that matters. The technical challenges are complex, but we need to redesign EHR platforms so that relevant data are clearly and readily accessible,” Weiner said.

To address these issues, Weiner outlined several recommendations for both EHR developers, as well as end-users, trainers, and others working in healthcare settings. 

He suggested that stakeholders use checkboxes or short-answer form fields when questions have answer options that are few, discrete, and structured. This may help decrease errors, improve analyzability, and cut time requirements, Weiner noted. Additionally, he recommended that EHR developers avoid having users enter information more than one time in clinical text. 

“Avoid promoting repetition within a single note. For example, automatically extract problems and diagnoses from assessments and plans, instead of requiring the user to document each problem twice,” Weiner wrote. “This could improve overall efficiency, decrease errors, and decrease time requirements.”

Developers and organizations can also minimize requirements for training and practice by making the system intuitively easy to use and understand. This could reduce the amount of time clinicians spend in the EHR and cut the potential for errors.

Health systems can also share EHR best practices with each other to optimize processes, and vendors can develop new ways of updating systems so that the information presented is always accurate and actionable.

“Foster similarities of beneficial approaches across disparate medical-record systems, to improve consistency and decrease errors that may otherwise be caused by required variation in usage by system,” Weiner said. “Developers can also create innovative ways to update standing lists, so that they are periodically and perhaps semi-automatically purged of useless information.”

Moreover, Weiner recommended that end-users group related information together in the EHR, and that developers make searching for information within a record or across records as easy as it is on the rest of the computer. He also stressed the importance of involving patients in generating parts of the data, including reviewing systems and current medication lists. 

As developers and users continue to improve EHR usability and efficiency, Weiner noted that it will be critical to keep in mind the physician’s integral role in patient care.

“Most of all, when it comes to the record and me, I still want my voice, that part of the record that tells other people what I think the problem is, and what should be done about it. Variation or not, that is the most important part of the medical record,” Weiner concluded.

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