Improving usability of electronic health records (EHR) – a history

Electronic health record usability

Electronic Health Records (EHR), like most technologies, have evolved over time. And their advancement continues as health systems and physician practices demand a more integrated and complete EHR. But to get to where we are today and to understand where this technology is going, it’s helpful to know how EHR came to be.

The EHR evolution was predated by specialized systems in hospitals that focused on ancillary areas such as radiology, pharmacy, registration, and billing. Clinical and administrative systems followed. These too were mostly standalone. Most had unmanageable interface engines, separate databases, no analytics strategy or capability, and patient index problems. Databases were separate, which meant that fields (such as name or birthdate) often didn’t match, meaning patients would have to re-register in each department.

To address these problems, vendors started designing interfaces to create cross-departmental workflow. These helped but were often difficult to maintain and update.

All of this was improved upon with integrated EHR. These have a single, consistent user interface, a single database, and a single record for each patient. But there were unanticipated challenges when it came to usability. You might recall that the American Recovery and Reinvestment Act drove implementation of EHR, and Meaningful Use (MU) forced the quick deployment of EHR. While vendors worked to meet MU requirements, and hospital systems and physicians purchased EHR in pursuit of government incentives, often the people whom the tools were created for were not always top of mind. Usability and workflow fell short because these systems were created to collect the data for billing and incentive programs.

Added to that, the old systems were built for a fee-for-service model; now the industry is focused on value-based care. Physicians want clinical informatics to leverage the right data at the right time to help them make good decisions on behalf of the patient. This means interoperability can no longer be ignored, especially as data is being collected from many doctors.

The opportunity for improvements continues to grow, as does EHR competition. The industry is also experiencing a lot of EHR switching, especially when one health system acquires another.

Physicians and hospitals know that there’s no magic bullet—no EHR is perfect. Many health systems use other technology components in conjunction with their EHR. They’re taking advantage of new technologies like FHIR, APIs (application protocol interfaces), and SaaS. Some of these technologies will make tasks easier when integrated with the EHR.

The evolution of the EHR continues as the industry also grows and changes. To learn more about the road to improved usability and to see examples of what is working for some health systems, watch the on-demand webinar, “A more integrated electronic health record,” with industry expert Drex DeFord.

To learn more about the Quanum EHR call us at 1.888.835.3409.


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