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Making EHR Systems More Usable and Clinically Relevant

Series One: Electronic Health Records

Patient care documentation and order-entry are key contributors to physician burnout. EHR systems may satisfy billing and reimbursement requirements, but generally fail at supporting clinicians in healthcare delivery. The burdens that EHRs introduce are compounded by the lack of certain functionality in existing systems.

A recent article, entitled Care-Centered Clinical Documentation in the Digital Environment: Solutions to Alleviate Burnout, offers insight into how the EHR got to its problematic state, as well as general recommendations to EHR developers and vendors for achieving care-centered clinical documentation. The American Medical Association, in Improving Care: Priorities to Improve Electronic Health Record Usability states, “EHRs should be designed and developed to meet the cognitive and workflow needs of physicians. This involves adhering to proper user-centered design techniques and conducting research to understand how physicians perform their daily work. EHR vendors must also focus more on user interface and cognitive workflow design in the development of their products.” Some usability tools are available in existing EHR systems and can be teased out of these systems with the help of vendors and IT department staff. But the future of EHR is being developed now. Clinicians need to have a seat at the EHR development table to educate EHR developers and designers about their needs. An array of promising technologies for focusing EHR on end-user value and usability are in development, including:

EHR System Interoperability Technology

One of the original promises of EHR was interoperability. With interoperability, patient data flows directly from the laboratory, pharmacy or consultant into the EHR, becoming immediately available to the clinicians who need it. The current lack of interoperability is contributing to burnout and leaving some physicians feeling misled.

How Disparate EHR Systems, Lack of Interoperability Contribute to Physician Stress, Burnout
This article discusses the link between lack of interoperability and burnout.

The United States Office of the National Coordinator for Health IT (ONC) EHR Interoperability
The ONC is responsible for advancing connectivity and interoperability of health information technology. This website contains various reports, including, “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap,” which describes the policy and technical actions needed to realize the ONC vision of a seamless healthcare data system.

The Potential for Blockchain to Transform Electronic Health Records
This article proposes that emerging technologies, such as Blockchain, could significantly change the direction of EHR interoperability efforts.

Artificial Intelligence that Removes Administrative Burdens

Artificial intelligence (AI) may provide the means for a reduction in EHR-induced physician burnout. AI can automate clinician clerical work. Instead of typing patient information into the computer, with AI, the information would enter the system via speech recognition and create the patient record using natural language processing tools. AI would deliver the correct information at the right time at the point of care. It would capture data in faxes and scanned documents and make it searchable. It would make clinical decision-support alerts relevant to context, patient and physician. Secondary uses of patient data, for example for billing and reimbursement, could be machine-captured, significantly reducing the amount of irrelevant information clinicians and staff are currently required to enter into the EHR.

Can Artificial Intelligence Help Prevent Physician Burnout?
This brief overview article summarizes ways that artificial intelligence could reduce physician administrative tasks, analyze patient data and provide individualized decision support.

IBM Watson for Oncology
This video demonstrates IBM Watson for Oncology, which shows how AI analyzes a patient's medical record to help identify evidence-based and personalized treatment options.

Multiple Methods for Entering Patient Data

The EHR should allow multiple means for entering data: voice recognition, dictation, scribes or remote scribes, templates or some combination of different methods. Improvements in the accuracy of voice recognition software and gesture based interfaces suggest viable alternatives to drop-down menus, pointing and clicking, and otherwise typing information into a computer. Every physician works differently, and it’s important to find the data-entry method that suits each individual.

Natural Language Processing–Enabled and Conventional Data Capture Methods for Input to Electronic Health Records: A Comparative Usability Study
This article discusses a natural language processing-based EHR data capture approach in a clinical setting, which proposes that the combination of dictation, voice recognition and natural language processing can enhance the documentation process and end-user experience.

Gestures for Picture Archiving and Communication Systems (PACS) Operation in the Operating Room: Is there Any Standard?
This article discusses gestural interfaces for use in the operating room, the current state of the technology and how it could be improved.

Panel Discussion: Voice Technology in Healthcare
This podcast presents Dr. Yaa Kumah-Crystal, an Assistant Professor at Vanderbilt University and practicing pediatric endocrinologist, and Dan Albert, Associate Director of Health IT Product Development at Vanderbilt, discussing the creation of EVA. EVA, or EHR Voice Assistant, is Vanderbilt University Medical Center’s voice user interface for physicians that interacts with the hospital's Epic EHR.