{"id":9999,"date":"2014-05-02T15:36:44","date_gmt":"2014-05-02T22:36:44","guid":{"rendered":"http:\/\/nnlm.gov\/pnr\/dragonfly\/?p=9999"},"modified":"2026-02-03T16:50:05","modified_gmt":"2026-02-03T16:50:05","slug":"ehr-usage-update","status":"archive","type":"post","link":"https:\/\/news.nnlm.gov\/region_5\/ehr-usage-update\/","title":{"rendered":"EHR usage update"},"content":{"rendered":"

We are now three years into the Centers for Medicaid and Medicare’s Meaningful Use<\/a> EHR adoption incentive program. According to CMS’s website,<\/a> as of March of this year, $14.8 billion in payments have been made to the over 470,000 providers and hospitals participating in the program. Those are some big numbers! But what about the people who are using the systems? Can we tell whether or not any of this is making a difference in quality of care? What about health care provider workflow or job satisfaction? <\/p>\n

Earlier this year, the Annals of Internal Medicine published a systematic review<\/a>,\u00a0carried out by the Rand corporation and funded by the Office of the National Coordinator (the main federal body overseeing Health IT efforts) which\u00a0examined the effectiveness of several Health IT system functionalities, including those required to achieve\u00a0Meaningful Use, for improving the delivery of health care. In\u00a0the review, they evaluated\u00a0236 articles published between 2010 and 2013. \u00a036% of the studies selected addressed clinical decision support (CDS), 21% computerized provider order entry (CPOE) and 20% looked at more than one functionality that’s required for Meaningful Use. The authors looked at quality, safety and effeniency outcomes reported in the articles. Overall, the measure of efficiency seemed to be the most mixed bag of positive, negative and neutral outcomes, illustrating that in\u00a0clinics Health IT systems both increase efficiency in the some cases and cause a time burden in others. They noted that though there is an increasing amount of literature looking at these sorts of issues, findings remain inconclusive, owing to methodological\u00a0limitations, especially failing to take into account details around organizational context and system deployment. In most studies though, both CDS and CPOE show primarily positive effects, noting specifically that CPOE reduces medication errors.<\/p>\n

While these results are touted by HealthIT.gov<\/a>, at the same time we’re hearing\u00a0a lot of dissatisfaction amongst EHR users. This can be seen both through more formalized surveys<\/a> and anecdotally via blog articles<\/a> and blog commenters (scroll to bottom for comments)<\/a>. \u00a0What can be driving this seeming disconnect between the clinical care improvements suggested by research findings and the groaning and anger\u00a0we see on a provider level? Perhaps the answer is in user experience and usability. \u00a0Let’s consider\u00a0how this could play out through a more universal\u00a0computer experience\u00a0than an EHR: \u00a0a calendaring system. \u00a0Imagine\u00a0a person works for a company that has a required company-wide (maybe even in-house designed) online calendaring system. \u00a0The system possesses none of the intuitive functionalities we come to be expect through\u00a0Google calendar and it doesn’t integrate with the company’s email so each appointment\u00a0must be entered painstakingly by hand. \u00a0This isn’t an issue related to a learning curve – each time entering an appointment is as difficult as the last. \u00a0These difficulties may lead to feelings of frustration and employees to complain and protest. \u00a0At the same time though, because they are using a calendaring system and not trying to keep appointments and meetings in their head (or on paper), the employees are alerted\u00a0by their computer when a meeting is about to occur and thus are less likely to be late. \u00a0So – the system is working, but it might not feel like it to the end user. \u00a0When the user experience is poor, dissatisfaction will be high. \u00a0This is probably why we are hearing talk that 2014 is the year of the EHR platform switch, with one in six providers<\/a>\u00a0unhappy enough to plan on changing EHRs.<\/p>\n

There are, of course, other factors that can be causing the dissatisfaction seen amongst EHR users, such as cost, workflow issues, poorly managed implementation<\/a>s, and feelings that systems are\u00a0focused on billing rather than patient care, to name a few prominent ones. \u00a0Looking forward though we will hopefully see improvements in usability promoted to a higher level of importance. \u00a0Calls from groups like AMIA to improve Health IT usability will spur usability assessments and research into better system design, like this recent eye tracking study that examined how doctors look at electronic charts. \u00a0 Findings from studies like these will lead to improved interface design\u00a0and from there, greater user satisfaction and potentially patient safety outcomes.<\/p>\n

 <\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

We are now three years into the Centers for Medicaid and Medicare’s Meaningful Use EHR adoption incentive program. According to CMS’s website, as of March of this year, $14.8 billion in payments have been made to the over 470,000 providers and hospitals participating in the program. Those are some big numbers! But what about the… Read More »<\/a><\/p>\n","protected":false},"author":54,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[8],"tags":[],"class_list":["post-9999","post","type-post","status-archive","format-standard","hentry","category-technology"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/posts\/9999","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/users\/54"}],"replies":[{"embeddable":true,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/comments?post=9999"}],"version-history":[{"count":2,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/posts\/9999\/revisions"}],"predecessor-version":[{"id":16958,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/posts\/9999\/revisions\/16958"}],"wp:attachment":[{"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/media?parent=9999"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/categories?post=9999"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/news.nnlm.gov\/region_5\/wp-json\/wp\/v2\/tags?post=9999"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}