1. Areas Of Focus For Next Generation Of EHRs
Amirthavarshini Gunasekaran, B.Tech and Janani Ramachandran, B.E
The University of Texas at Austin Health Informatics and Health IT Certificate Program, Summer 2015
ABSTRACT
ACKNOWLEDGMENTS
DISCUSSION AND CONCLUSION
REFERENCES
CONTACT
INTRODUCTION
RESULTS
PURPOSE
A wide portion of the healthcare community has been exposed to
Electronic Health Records (EHRs) and it continues to expand
rapidly, making EHRs an integral part of healthcare delivery. The
requirement for EHRs to evolve grows, thereby making it essential
for EHRs to consider certain areas on which to concentrate. To
throw light on which areas the EHRs should focus on, we reviewed
a number of articles in this research and discovered three major
areas of focus – human factors, interoperability and usability.
METHODS
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generation electronic health record: perspective of key leaders from the US department of Veteran Affairs.
Journal of the American Medical Informatics Association. 20(e1):e175-7. doi: 10.1136/amiajnl-2013-001748.
Epub 2013 Apr 18.
2. Blackford Middleton, Meryl Bloomrosen, Mark A Dente, Bill Hashmat, Ross Koppel, J Marc Overhage, Thomas
H Payne, S Trent Rosenbloom, Charlotte Weaver, Jiajie Zhang (2013). Enhancing patient safety and quality of
care by improving the usability of electronic health record systems: recommendations from AMIA. Journal of
the American Medical Informatics Association Jun; 20(e1):e2-8. doi: 10.1136/amiajnl-2012-001458.
3. Mark W. Friedberg, Peggy G. Chen, Kristin R. Van Busum, Frances M. Aunon, Chau Pham , John P. Caloyeras,
Soeren Mattke, Emma Pitchforth, Denise D. Quigley, Robert H. Brook, F. Jay Crosson, Michael Tutty (2013).
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems,
and Health Policy. American Medical Association (AMA)
4. Richelle J. Koopman, MD, MS, Linsey M. Barker Steege, PhD, Joi L. Moore, PhD,Martina A. Clarke, MS, Shannon
M. Canfield, MPH, Min S. Kim, PhD, and Jeffery L. Belden, MD (2015). Physician Information Needs and
Electronic Health Records (EHRs): Time to Reengineer the Clinic Note. Journal of the American Board of Family
Medicine. vol. 28 no. 3 316-323 doi: 10.3122/jabfm.2015.03.140244 May-June 2015.
5. Ann S. O’Malley, Kevin Draper, Rebecca Gourevitch, Dori A. Cross, Sarah Hudson Scholle (2015). Electronic
health records and support for primary care teamwork. Journal of the American Medical Informatics
Association. 22(2):426-34, Mar 2015;. doi: 10.1093/jamia/ocu029. Epub 2015 Jan 27
The past decade has seen a major shift towards the
adoption and use of Electronic Health Records (EHRs) by the US
healthcare system. While the adoption of EHRs by the health care
system has led to certain advantages like improved quality of care in
some aspects, and improved access to patient data, Health
Information Technology (HIT) leaders consistently identify major
areas for improvement in EHRs.1,2,3
Even within integrated delivery systems, essential EHR
functionalities such as clinical decision support (CDS) have not
achieved the expected impact.1 This is due to multiple factors such
as failure to apply key strategies and practices like usability testing,
redesigning workflow processes to integrate functionalities
optimally, and inconsistent and incomplete implementation.1
Current EHRs also lack standard user interfaces. Due to the
differences in interface design, clinicians who work across multiple
care settings may struggle with cognitive overload, leading to
reduced provider productivity and adverse impacts on patient
safety.2
With this in mind, we conducted an extensive research to
identify major areas that should be in focus when developing a next
generation of EHRs. We have consolidated a few areas of
functionalities expected from the EHRs that would enhance user
satisfaction for patient-centered care.
We used Google Scholar and PubMed to locate articles for this
research. We used the keywords: next-generation, EHRs and
improvements and directions to future EHRs. We reviewed
articles from the Journal of the American Medical Informatics
Association (JAMIA), the Journal of the American Board of Family
Medicine (JABFM) and the American Medical Association (AMA).
We used articles published between 2013 and 2015 that
reported on current needs and future directions for EHRs.
We would like to thank our mentor Mr. Bob Ligon and Ms. Kathryn
Flores, AVP, Applications, Health System Information Resources, UT
Southwestern Medical Center, for their valuable time and guidance
during this research project. We would also like to thank Dr. Field
and the entire UT HIT team for the valuable education.
The research results illustrated in Figure 1 and Table 1 indicate impacts of
certain important factors of EHRs functionality and usability on physicians.
While physicians approve of many EHR components, a majority of
physicians express some degree of dissatisfaction with functionality and
usability, thereby giving rise to discussion for better EHR functionality in
the future.
Table 2 and Figure 2 outline 3 areas of focus for next generation of EHRs:
1. Usability: Functionalities such as clear closure and reduction of clutter
that deal with the ease of use of the system by end users of EHRs
constitute to nearly 27% of the recommendations.
2. Interoperability: Research published in JAMIA1,2,5 and JABFM4 showed
improvement of interoperability functions as a basic requirement for next
generation of EHRs. Nearly 27% of recommendations from the end users
requested improved interoperability in future EHRs. In addition, it is
anticipated that Meaningful Use 3 will require a higher degree of
interoperability.
3. Human Factors: These are functionalities such as cognitive support and
improved CDS that deal with the user requirements and expectations from
the EHR system and constitute nearly 47% of the recommendations.
Overall, the results indicated that physician satisfaction with current EHRs
was less than optimal. Physicians and other providers indicated a need for
improved usability and functionality across several areas. These areas are
viewed as crucial to improved satisfaction with EHRs but may be difficult to
implement due to both vendor and physician challenges. It should be
noted that many of the areas needing improvement such as reminders,
alerts, and messaging capabilities are required for meaningful use
compliance3. In conclusion, this research has determined that the next
generation of EHRs need to concentrate on how they meet the human
factor, interoperability and usability requirements of the healthcare world.
The purpose of this research project was to explore and identify
areas of focus for the next generation of EHRs.
Functionalities of next generation of EHRs. Data was collected and outlined by
AMIA and AMA
Amirthavarshini Gunasekaran varshini.gunasekaran@gmail.com
Janani Ramachandran janani.ramachandran88@gmail.com
Illustration of the areas of focus for next generation of EHRs.
Data was collected by various polls conducted with different
personnel of the healthcare industry.
PercentageofFunctionalityRecommendations
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Figure 2. Areas of Focus for Next Generation
of EHRs1,2,3,4,5
Usability Interoperability Human Factors
Areas of Functionality
Table 2. Principles and Functionalities of Next Generation of EHRs1,2,3,4,5
Principle Functionality of Next Generation of EHRs
Area of
Functionality
Minimalism Minimalist design and elimination of redundancy
Human Factors
Memory Cognitive support and minimization of memory overload
Meaningful Use
Reduction of documentation overload with respect to
meaningful use criteria
Error Improved clinical decision support for error prevention
Information
Synthesis
User language utilization through natural language
processing
Communication
Improvement of communication among providers for
enhanced patient care, Facilitation of face-to-face clinical
care
Control
Enhanced user control, Improved customization, Help with
management of information
Flexibility
Customizable system, Increased synchronization between
user interface and user workflow
Usability
Messages Display of useful error messages
Closure
Clear closure i.e., each task has a well-defined beginning,
middle and end
Reversibility Facilitation of reversible actions
Reduce Time
Elimination of time consuming data entry, Reduction of
clutter
Documentation Support creation of sharable documentation
Interoperability
Visibility
System state visibility, Data availability, Interface usability,
Sufficient health information exchange
Match System and world match
Consistency Design consistency and standards utilization
a b c d e f g h
0
10
20
30
40
50
60
70
Survey Items
PercentageofHealthcareProfessionals
Figure 1. Responses to Survey Questions About EHRs3
Improved
Professional
Satisfaction
Worsened
Professional
Satisfaction: Usability
Worsened Professional
Satisfaction: Human
Factors
Table 1. Responses to Survey Questions About EHRs3
Survey Item and Question Percentage
a EHR improves job satisfaction 36.5
b EHR improves some aspects of quality of care 61
c EHR enhances patient-doctor communication that is not face-to-face 54
d EHR requires physician to perform lower-skilled work 61
e EHR slows down physician while providing clinical care 43
f
EHR interferes with patient-doctor communication during face-to-face
clinical care
36
g Receive overwhelming number of electronic messages due to the EHR 31
h Prefer using paper medical records to electronic records 18
The figure and table above show the survey questions about current EHRs and the responses of various healthcare professionals