Vendor misconceptions hamper EHR usability
■ Physicians can work as partners with technology companies by offering feedback that helps enhance systems to better fit their needs.
Usability is often where blame is directed for physicians' dissatisfaction with their electronic health record systems.
The problem, say Nancy Staggers, PhD, RN, and Lorraine Chapman, is that vendors have misconceptions about what physicians want or need from their EHRs and what makes them easy to use. These misconceptions are what they refer to as EHR “usability myths.”
Staggers, professor of informatics at the University of Maryland School of Nursing, and Chapman, director of user experience research at Macadamian Technologies, a software consulting firm in Gatineau, Quebec, delivered a usability myth presentation at the annual Health Information and Management System Society's conference in New Orleans in March. If the standing-room-only crowd at the presentation wasn't enough to confirm the importance of usability, then perhaps results from an EHR satisfaction survey released the same week would be convincing.
A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that EHR user satisfaction declined from 39% in 2010 to 27% in 2012. The rate of those “very dissatisfied” increased from 11% to 21% during the same period. Usability was cited as a major cause for the decline in satisfaction.
AmericanEHR Partners, founded by the American College of Physicians, maintains a vendor-neutral database of EHR products and vendor ratings based on satisfaction reviews submitted by its member organizations, which represent more than 700,000 physicians. The American Medical Association signed on as a member in May 2012.
Many of the misconceptions Staggers and Chapman discussed centered around EHR system design. For example, some vendors place everything on one screen within an EHR, and others think more features mean a better system.
“Unfortunately, physicians buy a system and it's implemented and installed, and that's when they discover the usability issues,” Chapman said. “They don't do their due diligence before.” She said practices should not only ask to test systems before they buy, they also should talk with other practices that have the same systems. In addition, they can volunteer to be beta testers for new versions of the software.
Usability part of meaningful use
Some of the usability issues will be addressed in stage 2 of the meaningful use incentive program. During that stage, usability will be made part of the certification process vendors must go through to have their products approved as complying with meaningful use. But even if a practice already has purchased a system, that doesn't mean it's too late, Staggers said.
One myth, she said, is that usability is solely the vendor's responsibility. It's important for physicians to speak up and tell vendors where their EHR systems are failing them, Staggers said. Vendors who get usability right will be the ones who value customer feedback.
Chapman said practices should ask potential vendors if they have a user experience team, or if anyone is collecting implementation findings or user surveys and how those findings are worked in to the development cycle.
“If you get the deer-stuck-in-the-headlight looks, then you'll know they have no idea what you're talking about,” Chapman said.
Clinicians are uncomfortable with technology, and users just need more training. Physicians often are pegged as not being savvy when it comes to technology, or as being dissatisfied because they have not embraced the work flow changes that come with EHR adoption. However, Chapman said, is that the issue is not about being comfortable or uncomfortable using the technology. It's that using the technology cannot add time to a physician's day unless there is a compelling reason, such as patient safety.
Chapman said physicians should have an idea of how long it takes to accomplish certain tasks on paper. Then they should ask the vendor to accomplish the same tasks on that system. If the developer of the system cannot accomplish a task in a reasonable amount of time, then that's a red flag, she said.
Whoever has the most features wins. Vendors use bells and whistles to sell their products, but features are good only if they add value to the practice.
During the selection process, Staggers said, practices should focus on the core features they know they will need. That doesn't mean the system won't come with additional functionality, but those often can be turned off or not used until the practice is ready to start using the system in advanced ways.
If they like it on the desktop, they will love it on mobile. Due to customer demands, most vendors are pushing development of mobile versions of their products. Many vendors are not optimizing their systems to work effectively on a mobile device, or physicians are deciding a mobile version isn't working as well as expected. Vendors and practices should communicate about what they are most and least likely to do on a mobile device. And vendors should offer physicians the opportunity to beta-test new products before they are rolled out, Staggers said.
Usability = only pretty and friendly. “Some people would say beauty is in the eye of the beholder,” Staggers said. That may be true for visual appeal, but there are measurable ways to determine the attractiveness of a system. “Is it more efficient? Is it more effective? And is it more satisfying? You could pick some core tasks and measure the efficiency and effectiveness,” she said.
Many companies put in a lot of effort to make systems look pretty by hiring graphic designers and design teams, Chapman said. “But once you start using the system you can tell right away if they've just applied lipstick,” she said. The key is to “test, test, test.”