Complexity of EMRs discourages new users, doctors tell HHS panel

Washington -- Physicians say they want electronic medical records to be fast, accurate and easily customized, but they are reporting that usability of EMRs doesn't appear to be the focus of the federal government when establishing meaningful use standards and certifying products.

Physicians are frustrated with newly purchased EMRs, doctors told a Dept. of Health and Human Services panel that makes recommendations on health information technology policy. They said physicians might not be as tech-savvy as other professionals and are encountering problems with the technology while trying to earn potentially tens of thousands of dollars in Medicare and Medicaid EMR bonuses.

Physicians discussed the usability issue during an April 21 hearing of the Certification/Adoption Workgroup, part of the HHS Health Information Technology Policy Committee.

Some physicians using the technology have become deeply discouraged, said Christine Sinsky, MD, an internist at Medical Associates Clinic in Dubuque, Iowa. For instance, one primary care physician told her it takes 10 minutes to navigate drop-down menus to order a routine mammogram. The same task should take no more than a few seconds of a clinician's time, Dr. Sinsky said.

"Novice users are acutely aware of the contrast between their speed interacting with the [EMR] and the speed of the salesman who sold them the product," said Abel Kho, MD, an internist at Northwestern Medical Faculty Foundation in Chicago. "Most issues at this stage relate to ease of use, which training and post go-live support can address."

At the hearing, the American Medical Association recommended that future certification of EMR systems by HHS-approved groups include testing and tracking usability. Excessive click-through screens, design limitations and alert overload are factors discouraging doctors from using EMRs.

Failing to take usability into consideration can lead to unintended patient safety issues, the Association said. Examples include computer screens with too much information, nonintuitive steps to gain key data, small font sizes and the potential for selecting the wrong patient when multiple records are open at one time. The AMA asked HHS to play a larger role on these EMR-related issues. Its recommendations:

• All vendors seeking certification should be required to address patient safety issues.
• Reporting methods should incorporate automated reporting functions, which are the most effective methods developed to date for tracking clinical safety issues.
• Reporting processes should use protections developed by certified patient safety organizations.
• The national health IT coordinator should track patient safety issues raised by vendors.
• Information gained from these processes should be used to improve patient safety and usability of EMRs.