The Role of Design in the EHR
I have fond memories of spending time with my father and grandfather when I was a teenager. Some of my favorite memories center on the summer when I learned how to drive a car and earned my learner’s permit. I drove hundreds of laps around my high school parking lot in the baking July heat, weaving through cones and learning how to judge distance from the mirrors.
I remember being amazed by the quantity of information I had to take in from the dashboard to ensure that the car was performing optimally. I learned what each gauge measured, why it was important, and how to determine when something was wrong. At any given time, I could glance down at the dashboard and know my speed, the engine’s RPM, the engine oil temperature, the fuel quantity, the battery output, the total distance traveled by the vehicle, and the total distance traveled since I last reset the trip odometer (usually at gas fill-ups).
The only way this feat was made possible was through excellent design principles. Great care and thought had gone into deciding what information the car would report to me through its gauges.
Design is far more than just the colors and styles of all these different pieces. The people who build vehicles understand everything that a vehicle is capable of, and they determine from there how they want to give the user access to those key elements. They must put themselves in the driver’s seat and ask, “What do I need to know to drive safely?” Once those key elements are known, they can then lay out the tools and measures needed to interact with the vehicle and put them in useful places.
Once their creation is complete, they receive feedback from other users and adjust their design to incorporate new elements or remove unused ones. The dashboard of your vehicle is useful because it is the result of this design process.
So why does the EHR not match up? Likely, that is because it is not fully leveraging the design process.
EHR Design
The EHR is an oddity in software design due to its peculiar history. It was not created by an organic movement toward electronic record keeping; it was mandated by federal legislation, piece by piece, starting with the ONC and solidifying with HITECH and meaningful use. Therefore, the vendors who took on the task of creating the first version of the software were not inspired by a healthcare industry looking for digital solutions to healthcare problems. Instead, billions of available government dollars and minimally viable product standards did the talking.
Physicians were soon saddled with terrible software that is still cited as a major factor in job dissatisfaction. The standards set for EHRs provide more benefits for payers and outsiders looking into the healthcare industry than for the physicians that were trying to use the system to manage patient care. Common complaints include the following:
- Slow, unresponsive software that eats up close to half of a physician’s working day
- Forced recording of data, little of which physicians find useful for patient care
- Distraction from actual clinical work to manage paper work and busywork
The decade that has followed has seen most of the minimally viable vendors exit the market as superior products cut their segments out of the market. And only now is there a movement to demand that EHR systems be improved through the design process. We are at the point with these software systems in which feedback about the design and its clinical utility are becoming a market-moving part of the discussion.
Doctor as Designer
In a 2018 Harlow on Healthcare podcast, Joyce Lee, MD, MPH (aka Doctor as Designer) framed how design thinking is a participatory form of problem solving that requires both the creator and end user to collaborate on projects. “[There are] problems or issues that have been defined by the stakeholders,” Joyce says, “like patients or caregivers. They are nothing that I could have imagined or thought of as something that needed to be addressed.”
Joyce’s experience in medical design extends to her role as an Epic physician builder. Her efforts have been focused on creating better workflows for her fellow clinicians and meaningful touch points for patients. This process of constant feedback and construction has not been easy, she notes. “One of the things I’ve learned as a designer is that it always takes way longer that you think, and it’s always much harder than you think it will be.” But the potential for the EHR to be helpful instead of hindering drives the effort to bring the EHR through enough iterations of the design process to be clinically beneficial.
The Benefits of Personalization
While some aspects of this design process will be driven by organizations demanding higher standards of software design and stability from their vendors, there are existing tools for personalization and customization that can allow any organization to maximize design benefits form the EHR.
KLAS’ Arch Collaborative initiative focuses on research and partnerships with healthcare organizations working to improve the utility of the EHR. The power of personalization tools is well documented in the Collaborative research to date. Personalization tools allow organizations and individuals to adjust the software to meet the needs of end users without making any code changes (i.e., using functionality built into the system).
Making those changes takes significant time and effort, but the power of the design process can vastly improve the utility of your organization’s EHR.
Photo cred: Shutterstock, welcomia