EMR Usability and The Productivity Paradox of Healthcare

What do a penny, an EMR system, and the “productivity paradox” have in common? Give up? I’ll explain:

It wasn’t more than two months ago that I found myself sitting in the ER at my local hospital, looking across the room at my wife as we both worried about our five-year-old daughter struggling to calm herself down. Doctors and nurses were concerned about her esophagus swelling around a penny that had conveniently lodged itself in her chest.

Man, it’s crazy being a parent. You never know what the day will hold! But that kind of uncertainty is the everyday reality for amazing clinicians who stand on call to take care of us and our loved ones. Healthcare providers live for taking care of people caught in crazy situations, and they do so with poise and professionalism that make us feel at ease. God be thanked for these amazing clinicians and caregivers.

The Productivity Paradox

So where do EMRs and the productivity paradox come in? Well, as my daughter’s ER visit turned into an inpatient visit, data had to be moved from the EMR in the ED to the inpatient pediatric wing. I watched as a seasoned nurse stood, frozen, in front of a state-of-the-art information system because she was afraid to make the next click. I asked her why. She said that if she clicked the next button and any of the information was incorrect, there would be no way for her to go back and change the data without manually inputting the information all over again. 10 minutes and 2 consulting nurses later, the first nurse was able to move to the next screen with confidence.

10 minutes × Many patients = The Productivity Paradox.

As an industry, we rushed to implement EMRs. Providers, vendors, and the government focused more on creating and meeting regulatory requirements and replicating paper-based workflows than on how best to bring EMRs into hospitals and clinics. The result is what academics refer to as the productivity paradox. Simply put, a productivity paradox occurs when new technology that is purported to save time and effort actually costs time and effort.

Shifting to Optimization

With the initial wave of large EMR installations beginning to subside, the market’s energy has begun to shift to the community hospitals. For the larger organizations now getting past their implementation phases, the next step is optimization.

The road to optimizing digital healthcare will take us down many paths. For example, Dr. Rasu Shrestha, CIO at UPMC, told me, “As care providers, we are more detectives than we are clinicians, and this is due in large part to failures in the usability of the EHRs.”

In KLAS’s recent research on EMR usability, we’ve learned that an organization’s culture, governance model, and training have a big impact on at least two things: an organization’s ability to sift through the “haystack” and uncover the “needle” of usable data, and the overall satisfaction of the end users.

Solving Usability Issues

How do we solve the usability issues that seem to be leading to dissatisfaction in care delivery and even to clinician burnout? KLAS is excited to be a part the #hcldr tweetchat on Dec 5th and to learn from a community of problem solvers. We’ll also share what we have discovered from surveying over 15,000 caregivers over the past 12 months. I’ll close with the question I began with and my simple answer, and then I will let Rasu articulate it much more eloquently. What do a penny, an EMR, and the Productivity Paradox have in common? The answer: My five-year-old daughter and the clinicians trying to save her life.

“This rush to embrace the digital-form factor in healthcare has been both a blessing and a curse. We now have unprecedented amounts of digital content and abilities to exchange data and collaborate around a patient across vast geographies. But we have also created an electronic health record system that has its basis in a billing and documentation function. The core function is not focused on the patient per se, nor is it focused on empowering the clinician in dramatically improving their workflow. The usability of EHRs has been in the spotlight of late for the right reasons. The time is now for us to rethink the very premise and the framework around EHRs and leverage principles of design-thinking to address core facets of usability head-on.” — Rasu Shrestha

• T1 Who should be empowered to solve productivity issues in healthcare? Who should be responsible for it?
• T2 Who is suffering most because usability issues? Patients? Clinicians? Administrators?
• T3 Where has design-thinking been applied well in healthcare? Examples?
• T4 Where would we get most bang for the buck? Improving technology? Improving training? Rethinking care delivery?

References:

“Usability is Key to Unlocking Health Its Full Potential,” John Fleming MD, Oct 2017, https://www.healthit.gov/buzz-blog/usability/usability-key-unlocking-health-full-potential/, accessed on 11 November 2017.

“Health Care’s Current “Productivity Paradox,”” Roy Smythe, Forbes, July 2015, https://www.forbes.com/sites/roysmythe/2015/07/17/health-cares-current-productivity-paradox/#5e4888a450bf, accessed on 11 November 2017.

“A framework for evaluating electronic health record vendor user-centered design and usability testing processes,” Raj M Ratwani, A Zachary Hettinger, et al., JAMIA, April 2017, https://academic.oup.com/jamia/article/24/e1/e35/2631482, accessed on 11 November 2017.

“EHR Usability Toolkit: A Background Report on Usability and Electronic Health Records,” Westat, AHRQ, August 2011, http://www.dukeinformatics.org/wp-content/uploads/2014/11/Johnson-EHR_Usability_Toolkit_Background_Report.pdf, accessed on 11 November 2017.

“Health IT Usability,” NIST, https://www.nist.gov/programs-projects/health-it-usability, accessed on 11 November 2017.

“Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating,” HIMSS, February 2015, http://www.himss.org/defining-and-testing-emr-usability-principles-and-proposed-methods-emr-usability-evaluation-and, accessed on 11 November 2017.