Electronic health records are computerized versions of those old paper files you see at your doctor’s office. In an effort to trim the cost of health care, President Obama has pledge to support EHR use among more doctors.
In the course of other research, I had the opportunity to see the kinds of EHRs that are used in a major hospital. I was quite frankly appalled at the usability and wondered what kinds of mistakes, errors, and inefficiencies might occur with the wide scale use of such systems. This opinion piece from the Huffington Post agrees. The introduction of new technology to replace a well-used method is complex.
This is partially because the products are complex and require a great deal of training as they are built now. The worst are the industry leaders in use by many hospitals.
I completely agree. The system I saw was made by one of the biggest healthcare companies in the world, which of course I won’t name.
To make it more complex, the turnover in medical support personnel, front office and back office, is often frequent, so the training on these complicated products is ongoing and expensive. Support, services and training are the model by which some of these software companies increase their revenues.
Whenever I see the issue of Health care IT discussed, it is always about the nuts-and-bolts engineering issues such as interoperability (will the systems work and communicate together?). This is obviously important, but hopefully some discussion will be devoted to usability.
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You think with the issues that they had with electronic voting systems, that perhaps they would realize the same potential with electronic health records. What can we do to help create awareness. I assume that we could write a piece that could be published and shared. But I agree I think there is a large potential problem to be had.
Peter, I think your analog of voting machine interfaces is right on. Both systems are extremely proprietary and the development is closed and hidden. Even more so than other non-open source software. For example, when Microsoft makes Windows or Word, they are very open about the usability processes that they went through (e.g., programmers/engineers maintain blogs, present at conferences). We don’t see such openness with voting machines or EHRs. It’s clear that their overriding concern is stability, reliability, and security over usability.
This is an issue near & dear to my heart. In addition to EHR, the entire healthcare experience is in need of a major redo. Interactions with doctor’s offices, hospitals, scheduling & having medical tests done-it can be a nightmare. I am a usability engineer who desparately wants to break into this field & make a difference but I’m not exactly sure how.
I had a dr appt yesterday & asked the dr about EHR. He is on the verge of buying a system & has major concerns. He did comment that the sales rep assured him the system was user-friendly…And, the dr has concerns about the backend not being compatible w/ whatever standards are developed. He has hopes of him & his office mgr becoming power users who can help the others so as not to rely on the co many’s training.
Anyway, the risks are high if we do not get involved, build awareness and infuse ourselves into anything e-health related. Question is how. I’ve looked at several openings w/ a local software company and each position requires experience in the medical field. They need to understand how we can be involved and what a difference we can make.
Interesting update. A new Reuters report (of a research paper) seems to show that all digital hospitals lead to less patient deaths than paper hospitals. If true, this is good news. However, I can’t shake the feeling that the increase in attention engendered by switching to digital/EHRs has to be one major explanation for the fewer patient deaths. Imagine the training each person had to go through–constantly reminding them to be careful. I don’t have access to the original report. The only way to discount this possibility is an experiment with one hospital getting an EHR and the other getting some kind of placebo (e.g., maybe an awareness campaign on reducing errors).
This is the same item that Richard posted about in the comment section, but it showed up on Scientific American.
http://www.sciam.com/blog/60-second-science/post.cfm?id=fewer-deaths-in-hospitals-with-comp-2009-01-27
Thanks, Peter. SciAm helpfully linked to the primary source:
http://archinte.ama-assn.org/cgi/content/full/169/2/108
I think they did a correlation between electronic systems and mortality for the hospitals in the study, using the mortality rate during the time they sampled. They didn’t compare mortality to previous rates at those hospitals before the introduction of electronic record keeping.
We could test Rich’s hypothesis that it is the focus on safety by looking only at hospitals who have used the E-records for a number of years already. Another alternative hypothesis is that hospitals able to purchase such systems are likely to be wealthier, which might relate to reduced mortality.
Or hey, what might really be great is that E-records are already awesome and we can work out more of the kinks and live longer.
ACM Interactions ran a fascinating article a few years ago titled “Must Electronic Gadgets Disrupt Our Face-to-Face Communications?” (http://portal.acm.org/citation.cfm?id=1167948.1167968). The author specifically mentions the use of laptop computers by doctors during patient consultations.
The topic of electronic health records is indeed interesting. I wrote on the topic earlier this week:
“Human Factors Can Assist with Appropriate Implementation of Health Information Technology“
EHR and the entire health care system is in need of a major over haul. There needs to be a universal system for dealing with medical records. We live in the technological age and have to live with it. Just hope something can get done in the near future. Very scary when you stop and think about it.
Hi, My name is Megan and I am a student at Clemson U. I am making a video for my nursing class and was wondering if I could have permission to use your photo on the electronic health record? The video is purely educational and all credits would be paid to you.
Thanks,
Megan