Physician Burnout

Who Suffers the Most from EMR Usability Issues?

Several of us from KLAS participated not long ago in a discussion on usability issues. The topic was raised by Mitchell Josephson, who had recently been able to turn a cent into $15,000. That would have been an interesting magic trick—if only it hadn’t been a $15,000 bill for removing the penny his daughter had swallowed. Mitch mentioned that the clinician who had helped get them checked in had been left frozen when entering their data, triple checking for errors. She explained that if she clicked forward in the data entry, the EMR would not let her go back and fix any errors without a significant hassle.

With such issues now commonplace as healthcare organizations have pretty much finished the initial wave of EMR installations, it begs the question: Who suffers the most from usability issues? Initially, my thoughts go to patients and the delays, costs, and potential harm that unusable EMRs may cause patients to endure. Yet, as we’ve begun to analyze the data from our Arch Collaborative participants, I have grown convinced that clinicians bear the brunt of poor usability.

Clinicians know how much these gaps in efficiency can (and indeed do) affect patients. These clinicians do as much as they can to act as a buffer between their patients and the problems of the EMR. This “clinician martyrdom” only compounds the frustration clinicians already feel.

End user concerns run deeper than simply, “I don’t like how my screen is set up.” Many clinicians are made to feel powerless and, honestly, a little stupid when, after multiple years of post-college education, they’re defeated daily by what they’re told is the newer, easier age of digital healthcare.

Frequently, after I tell people what we’ve learned through the Arch Collaborative, they ask, “So you’re saying that the EMR needs a better UI?” In reality, healthcare is the most complex services industry in the world, and we’re trying to run it through a regulation-and-documentation platform that has been “trojan-horsed” into the clinician workflow disguised as an electronic record. If all we do is slap a new UI over the system, we are dogs barking up the wrong tree. These usability issues are EMR agnostic; every vendor we’ve measured has some share in these concerns.

Thankfully, there are some solutions to these problems. For starters, we’ll continue the dog metaphor and talk about training. Training is something we do for dogs, clinicians need education. Instead of simple “sit” and “stay” style instruction; our end users need extensive and personalized education. We need to actively engage our end users in their EMR training, give clinicians opportunities to feel empowered, and mold certain clinicians into superusers who can lead out among their peers.

Our most recent research into usability has shown that initial EMR education impacts clinicians for years after a go-live. Regardless of the EMR, a botched initial education has repercussions that taint a user’s experience for years to come. Similarly, a well-executed go-live with the right kind of education means you’ll have physician advocates for just as long.

“But Taylor,” you may respond, “we went live years ago! It’s a missed opportunity for us.” Thankfully, our research shows a ray of hope. KLAS found that ongoing EMR education—meaning only six hours per year—was correlated to a 36-point increase in user satisfaction. This makes sense; the world’s most complex service industry certainly requires complex tools. The more complex the tool, the more opportunities users will need to learn, ask questions, and develop their skills.

While the usability problem may seem a grim scene, we’re confident that there’s a path to success for healthcare providers. It also may be of comfort to know that organizations who spent over 4% of their operating budget on IT only saw marginal increases in satisfaction; how often do we come across a healthcare IT conundrum with a solution that isn’t to throw more money at the problem?

Ultimately, my hope is to see every healthcare organization joining the 70+ who are part of KLAS’ Arch Collaborative. Through this effort, we’ll continue to identify best practices, benchmark success, and help providers find suitable paths to ending usability woes.

You can read our recent Arch Collaborative here and learn how to join the Arch Collaborative be part of the solution.