JAMIA EHR Usability Research: Additional Insights Needed
A recent research paper published by the Journal of the American Informatics Association (JAMIA) titled: “A usability and safety analysis of electronic health records: a multi-center study”, published on June 8th, 2018 studied the usability and safety of EHRs used in the emergency departments of four organizations by approximately 12-15 emergency physicians. The conclusion called for improved EHR implementation as well as ongoing improvements to vendor designs for EHRs.
This was an interesting study design in that, so few organizations and clinicians were involved and even still a key finding was that EHR implementations needed to be improved to improve EHR efficiency while reducing errors.
Recently the Arch Collaborative passed over 115 global organizations surveyed, a total representing well over 50,000 clinicians. This research effort has generated approximately 700,000 data elements on the topic of EHR usability and efficiency.
Key findings from this research indicate that initial EHR training, higher adoption of EHR personalization tools, and clinician trust with organizational leadership/IT are key factors in identifying organizations who have higher EHR satisfaction. In fact, with these findings the Arch Collaborative can accurately predict 70% of the EHR satisfaction of an organization and where improvements can be made to enhance usability and efficiency.
When the term implementation is used it can convey wide variations of context as to what functions are included for this process. Data supports the initial EHR training as a key component of implementation, something we’re sure the JAMIA authors agree with.
Arch Collaborative findings show that provider organizations who have at least six hours of initial EHR training typically have higher EHR end-user satisfaction. This is especially true for organizations who present EHR training based on clinician type and specialty. The first question we would have of JAMIA’s research is how many hours of training did the ED physicians at the four organizations receive, and was the training focused on ED workflows?
Regarding the ED workflows, were the ED physicians in the study involved in designing standard workflows for the ED that incorporated EHR personalization tools (e.g. order sets, templates, macros, etc.) that supported higher levels of usability and efficiency?
How have the ED physicians at the organizations in the study been provided with follow-up EHR education? How many upgrades to the EHRs used have taken place since the ED physicians had initial EHR training? How many hours of follow-up education been provided to these ED physicians to promote improved EHR usability and efficiency?
Arch Collaborative findings show that organizations that provide their clinicians with 3-5 hours of follow-up education annually have improved EHR satisfaction. It is also important to provide this follow-up education through departmental meetings lead by physicians who are highly proficient with the EHR. Do the ED physicians in the JAMIA study have this level of EHR education?
Another question I have is do the ED physicians at these organizations are receiving the support they need from organizational leadership/IT? Additionally, how long does it take requests from the ED physicians for EHR changes to be incorporated for minor modifications? How many committees does a change request have to go through before minor EHR enhancements are approved. What is the time frame from request to delivery for the minor EHR enhancement requests? Are the ED physicians in the study able to request and receive at-the-elbow EHR operations support from peers or IT staff that know and understand their workflows?
Questions like these are vital to understanding that EHR usability and efficiency is directly related to initial training, follow-up education and effective use of EHR personalization tools. Beyond that, the answers to those questions help in creating a culture of teamwork and trust between organizational leadership/IT and the clinicians they support.
Ultimately, it helps to understand that the EHR is not a static environment. This changing nature dictates continuous evaluation of the EHR’s success in supporting and enhancing clinician workflows. We wonder what the results of the JAMIA study would have been for organizations who have been identified by the Arch Collaborative as having high EHR satisfaction scores.