Summary: 1. Paper use is prevalent even where EMR have been in place for years. 2. It is important to understand workflow, users and human preferences. 3. A huge opportunity exists for simplifying and developing better user interfaces to bridge the gap.
Paper use continues to be prevalent even wen EMR and EHR have been in use for years. In a study published in the Journal of the American Medical Informatics Association in their March 2013 issue, analysis of 11 primary care practices users used paper charting. 120 clinical staff members all part of three larger health care organizations were observed. Reasons included efficiency, memory and awareness. The EHR designed in-house had been in use for several years and tailored to fit an organization’s needs. Many of the same workarounds existed at all 11 sites. Workarounds included writing patient vitals on paper, using paper-based reminders (i.e., Post-it notes), paper-based reminders alerting co-workers of new or important information added to a patient’s record.
Further “Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools,” concluded the authors.
The electronic system has to match the most efficient work flow that the clinician is used to using. There are varying level of users and one of the complexities is to design a system that caters to sophisticated and simple users. Both ought to be involved in the design and selection.
Usability will be included in the certification process that EHR vendors must go through to have their system approved for stage 2 of the meaningful use incentive program. The federal program pays physicians up to $44,000 from Medicare or nearly $64,000 from Medicaid for the adoption and meaningful use of EHRs.