User feedback is key to improving EHR systems

Practices shopping for an electronic health record system or seeking to improve an existing system should have a central clearinghouse of reviews, feedback and tips from other users, says an Institute of Medicine discussion paper.

The paper, published in September, is intended to foster discussion of a recommendation the IOM made in an earlier report that examined ways EHRs can be improved. The institute recommended that the Dept. of Health and Human Services’ Office of the National Coordinator for Health Information Technology work with public and private sectors to make comparative EHR user experiences publicly available.

The paper’s authors said there is no place for EHR users to share publicly their experiences with their systems. That means there is a lack of transparency and improvements to make EHRs easier to use.

By creating a central database that is publicly available, health care organizations “will benefit from lessons learned by similar health care organizations about how to improve the performance and safety of their existing systems,” the IOM paper said. “The information may include ideas on effective product upgrade practices or applications, safety risks associated with a specific vendor’s product, warnings about data entry combinations that could result in erroneous clinical orders or suggestions for ways to enhance user training.”

The report recommended the creation of a central hub, hosted by a government agency or a trusted private entity, to link to various sources of data, including other rating and evaluation websites. One example cited was AmericanEHR Partners, a user-driven EHR rating site created by the American College of Physicians. The American Medical Association is also a member organization of AmericanEHR Partners.

The report said the hub would have many methods of gathering user experience data. They include “flight simulator” lab evaluations of systems, point-of-use reporting, data mining of use patterns, third-party administered user surveys, direct user-to-public reporting, and a formalized system for reporting hazards.

Without consumer comparisons, innovation is stifled, which is why adopters of health IT products are not as enthusiastic as adopters of other technology, such as smartphones and tablets, the report said.

“There are a lot of elements and a lot of players that would need to work together for it to be constructive,” said paper co-author James P. Keller, vice president of health technology and evaluation for the ECRI Institute, which focuses on using technology to develop best practices in health care.

Getting EHR vendors involved

Participation of EHR vendors, many of whom prohibit public reporting of EHR problems, would be key to the program’s success. Keller said an initial meeting held to discuss the concepts presented in the paper had good vendor participation — an encouraging sign.

The industry needs a surveillance system that detects issues and provides feedback, said Kenneth Mandl, MD, MPH, associate professor at Harvard Medical School and director of the Intelligent Health Laboratory at Boston Children’s Hospital. “But it will only be so effective if we don’t also have an action arm around this,” he said.

One feature contributing to the popularity of mobile devices that EHR systems have not experienced is the ease in which users can download apps or delete them if something better comes along, Dr. Mandl said. Doctors should have that same ease when it comes to changing health IT systems, he said.

Dr. Mandl is working on a platform — the SMART project — that allows physicians to download health IT apps that would work with existing EHR systems. The ONC is funding the project.

Dr. Mandl said the SMART project goes hand-in-hand with the recommendations spelled out in the IOM report.

He said the proposed surveillance system will be a signal to developers of what they need to do. They can rapidly make changes to apps or design new ones and take them to market in a much faster way than new products or upgrades are made available to users.

Physicians could look to user data to choose apps that make sense for them.