It’s no secret that electronic health record (EHR) systems can cause unnecessary administrative burden for users. In fact, one study found that primary care physicians spend more time working within EHR systems than face-to-face time with patients. By optimizing for usability, organizations can take advantage of the benefits while getting the most out of health IT investments.
Challenges of EHRs
More than 500 physicians across the US participated in a 2019 Medscape poll on EHR experience. The most commonly cited deficiencies included: a lack of input, contribution to burnout, not being user-friendly, redundant and hard-to-find data, and a lack of interoperability.
A cross-sectional survey found similar challenges reported by clinicians. The top five challenges reported were:
- Excessive data entry requirements (86.9 percent)
- Unnecessarily long cut-and-pasted notes, also known as “note bloat” (75.2 percent)
- Inaccessible information from other organizations (73.1 percent)
- Notes geared towards billing rather than patient care (73.1 percent)
- Problems with work-life balance (63.1 percent)
The Link Between EHRs and Burnout
Many of the above challenges have been linked to burnout in physicians and clinicians. Medscape’s 2019 National Physician Burnout, Depression & Suicide report found that nearly one third of physicians reported EHRs as a main contributor to burnout symptoms.
Many of the factors that contribute to burnout are related to usability. “If an interface isn’t designed thoughtfully and carefully for a user’s needs, it can add to the cognitive load of completing a task,” Edward R. Melnick, MD, MHS, the lead author of a Mayo Clinic Proceedings study on the association of EHRs and burnout. This study found that a physician’s odds of burnout decrease 3 percent for each point they favorably rated EHR usability.
New HHS Strategy for Reducing Burden
In February 2020, the US Department of Health and Human Services (HHS) issued the Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs—a comprehensive report aimed at shifting the focus for clinicians from administrative requirements toward patient care.
The report, developed by the HHS Office of the National Coordinator for Health Information Technology (ONC) with the Centers for Medicare & Medicaid Services (CMS) outlines three main goals:
- Reducing the time and effort required by healthcare providers to record information in EHRs
- Reduce the time and effort needed to meet regulatory reporting requirements
- Improve the functionality and ease of use of EHRs
The report outlines clinical documentation, health IT usability, federal health IT and EHR reporting requirements, and public health reporting strategies and recommendations that HHS is considering to alleviate EHR-related burden for providers. These include reducing regulatory burdens around documentation requirements, leveraging health IT, improving usability, and increasing coordination with provider prescription drug monitoring programs (PDMPs).
5 Strategies for Optimization
While policy changes may be considered ideal, there are other ways to optimize EHRs for more immediate benefit. An EHRIntelligence.com article shared the following five activities for optimizing EHRs and improving clinical efficiency.
1. Reduce information overload
- Information overload or alert fatigue can overwhelm physicians, nurses, and other practitioners by requiring them to sift through vast amounts of data or override alerts. In fact, studies show that 49-96 percent of alerts are overridden. Implementing new note designs or implementing alerts that sift through data can help.
2. Specialize clinical workflows
- Working with EHR or third-party vendors to create custom workflows designed to meet the needs of specific departments can boost clinical efficiency.
3. Adopt health IT tools
- Integrating health IT tools that prioritize usability into EHR systems can have a positive effect on processes. These could include tools that are accessible via phones or real-time notifications that deliver concise information.
4. Involve nurse informaticists
- Nurse informaticists are both users of EHRs and experts in technical design. They can “triage EHR usability problems that center on a number of clicks, time inefficiencies, and data display.”
5. Integrate PDMP data
- Direct access to external databases like prescription drug monitoring programs (PDMPs) can reduce the number of clicks and log-ins for physicians, nurses, and other clinicians. The Community Hospital of the Monterey Peninsula (CHOMP) turned to health IT to integrate with California’s PDMP, so physicians automatically get critical prescription information as soon as a patient presents to the emergency department. This, combined with additional efforts, has led to a 32 percent decrease in opioid deaths.
In addition to the above strategies, some organizations have introduced creative and individualized solutions like EHR “happy hour”. A Medscape article details how a small group of physicians gather monthly to work together with members of EHR staff to work out issues with documentation and workflows. Combining social support with learning opportunities focused on low-effort, high-yield solutions leaves physicians with ways to work more efficiently and share successes.
Taking steps to improve EHR usability and functionality can help reduce provider burnout, optimize health IT investments, and put the focus back on what’s most important—patient care.
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