The following is a guest article by Khalid Al-Maskari, Founder and CEO of Health Information Management Systems (HiMS)
EHRs are ubiquitous because they’re useful – but how useful are they really, and to whom?
The truth is that an EHR by definition serves multiple masters, satisfying some more than others. For many clinicians, EHRs have actually been a disservice, a major factor in burnout. That’s because they weren’t invented to help clinicians in the first place.
“Many EHR products were designed with billing, payer requirements, and meaningful use criteria in mind rather than clinician use, resulting in a user experience laden with data entry that causes decreased productivity and efficiency, and a diminished patient-physician relationship,” researchers wrote in the Journal of the American Medical informatics Association in 2019. It still holds true.
If the patient-clinician relationship is diminished, outcomes will suffer.
Wanted: More Patient Face Time
When physicians, psychiatrists, psychologists, radiologists, nurses, case managers, peer supports, therapists, and others use an EHR, they commonly have trouble with nonlinear workflows, history lookups, information handoffs within teams, turning encounters into notes, turning notes into billing codes, prescribing meds, ordering labs, and marshaling data to prove value-based care. Users are doomed to excessive clicking, scrolling, page-switching, and toggling. The upshot? What should be patient face time becomes screen time.
It’s a shame, but EHR users aren’t finding EHRs usable.
I believe we can put that ignominious history in the past where it belongs. In 2023, six decades after the introduction of the EHR, I’m convinced the EHR can serve all masters – people as much as institutions. It can serve every user from the patient to the receptionist to nurses, doctors, counselors, billers, and the CFO. In fact, each professional can effectively have an EHR of their own with all of their priorities immediately at hand on their home page. Ideally, the EHR becomes a personalized hub of information, communication, productivity, revenue generation, patient satisfaction, and value-based care. It becomes usable, even enjoyable.
Getting to Usability
EHR usability starts with the user interface (UI), which should be 1) configured to each user and 2) customizable by each user. The interface should be streamlined and intuitive out of the box and, with modest tweaking, as personalized as a smartphone. All the functions that the user needs should be front and center. The rest of the functionality should be buried or hidden. Empower the user, simplify customization, and get out of the way. This is digital minimalism – eliminating clutter and designing with intent.
Here are some other principles we’ve committed to:
User Centricity
All of the user’s priorities should be executable from their start screen (regardless of device type) with little or no scrolling, switching, and toggling. For example, a physician should be able to see all of her appointments for the day at a glance in one panel. She should be able to hover her mouse over any thumbnail to see a capsule description of the patient and their reason for the encounter. Screens could easily be split to enable two functions to occur on one interface.
Patient Centricity
Any clinician, staffer, or group should be easily assigned to any patient’s care team, immediately creating an intimate information-sharing ecosystem (not unlike a social media chatroom) focused on the patient and the workflow.
Clinician-Driven Design
To maximize usability, we’ve spent thousands of hours watching integrated health professionals at every level work. We’ve tracked their workflows, analyzed their clicks, captured their feedback, removed obstacles, automated once-tedious processes, and capitalized on what makes people more effective and productive.
Voice-Driven
Any EHR user should be able to issue any command or write any note by directing their voice toward any device. Clinician notes would be transcribed automatically, using artificial intelligence to suggest diagnoses and billing codes (as many as applicable) on the fly. Key terms would be normalized (e.g., revised to client, patient, or member as the organization prefers).
Click Relief
Multi-parameter searches should be stored as filters for future use. Multi-process operations should be saved as one-click macros. For example: Gather up patient summaries, codes, and claims, total them up, and send them to the CFO.
Value-Based Care
A compliance dashboard should remind staff to do the things that improve outcomes, lower costs, and trigger maximum reimbursement, such as delivering preventive care, following up, referring patients to PCPs, and screening for cancer.
These are the features an EHR would have had from the beginning if the category had been created for the people who see patients. We’ve torn it down and built it back up to drive outcomes, value, and performance. We’ve made it useful for everyone – including, but absolutely not limited to – the back office.
About Khalid Al-Maskari
Khalid Al-Maskari is the founder and CEO at Health Information Management Systems (HiMS), a Tucson, Arizona-based company that designs Electronic Health Records (EHR) software to transform the integrated healthcare experience. HiMS creates innovative solutions that lead to better outcomes, lower costs, and higher-quality care.
