November 19th, 2019
Clinicians are pretty vocal about how difficult electronic health records (EHRs) are to use. However, the usability of EHRs has not been measured against other technologies, using a standardized scale. Perhaps EHRs aren’t as bad as clinicians believe?
Unfortunately, it seems clinicians are correct when it comes to EHR usability. A recent study in Mayo Clinic Proceedings asked 870 to rate their EHR usability using the “System Usability Scale” (SUS) a metric used across industries to measure usability of products and programs. The SUS evaluates the usability of technology based user satisfaction (do doctors like using their EHR?), learning curve (did it take a long time to learn how to use the EHR?), and how complex or cumbersome the tool is.
What they found will come as no surprise to clinicians—overall, EHRs received a 45 out of 100, which is a failing grade. To put that in context, Microsoft Word has an usability score of 76 and a microwave oven has a score of 87. The low grade puts EHR’s in the bottom 9% of scores; among technology we use every day, EHRs were rated worse than 91% of them.
There was some variation in usability based on physician specialty and type of hospital. For example, doctors at academic medical centers rated their EHRs lower than average, whereas doctors working at VA hospitals rated their EHRs higher than average. Anesthesiologists, pediatricians and general internists rated their EHRs highest, while dermatologists, orthopedists, and general surgeons rated their EHRs the lowest.
Why are EHRs so terrible for clinicians to use? A large reason is because they were developed primarily for billing and coding purposes, rather than clinical purposes. Thus, doing seemingly simple tasks like pulling up a patient’s medication list can be arduous. “Looking for communication from another doctor or a specific test result in a patient’s chart can be like trying to find a needle in a haystack,” said Dr. Ted Melnick, Emergency Medicine doctor at Yale University and lead study author, in The Hartford Courant.
Given how difficult EHRs are to use, it’s no wonder that they contribute to physician burnout. Researchers found a strong association between EHR usability and burnout in almost all specialties. For every point that EHR usability increased, there was a 3% decreased odds of professional burnout. While this does not prove that EHR clunkiness causes burnout (it’s possible that physicians who are burned-out rated are more likely to rate their EHR poorly), it adds evidence to a body of research finding EHRs as a driver of burnout.
Clearly EHR programs must be drastically changed to improve their usability. EHRs should be streamlined to reduce unnecessary clicking and reformatted to prioritize tools that doctors use in their clinical encounters, rather than prioritizing billing. Government agencies should continue to push EHR vendors to make their systems interoperable and consider creating a national health information highway.
However, the fault may not be only with EHR vendors. As the differences in usability ratings between specialties and locations shows, usability may have as much to do with the administrative requirements at their institutions as it does the mechanics of the EHR software. An example the study authors give is that some hospitals may require physicians to re-enter their passwords before prescribing a medication while other hospitals do not have the same requirement.
Improving EHRs must be a collaboration between government agencies, EHR vendors, and hospital & clinic administrators. Vendors must be held accountable for making EHRs more usable and interoperable, but administrators should also work to “get rid of stupid stuff” in the EHR. Now that we have clear proof that EHR usability is at an “unacceptable” level, we need to work to raise the score.