Do you remember when Washington first began encouraging the use of electronic health records (EHRs) back in 2009? That was more than a decade ago. Here we are in 2022 and it seems like doctors are as averse to EHRs as they were some 13 years ago. But are doctors the problem, or is it the software?
A fascinating post published on the Medpage Today website makes the case that we can improve physician jobs by redesigning EHRs. The post was written by registered nurse and clinical informaticist Leigh Wiley. As someone who has now seen both sides of the EHR equation, Wiley is confident that ongoing issues are the result of poor software design rather than physician resistance.
Happy to Embrace Technology
Wiley had more than enough opportunity to observe physician jobs and the doctors who held them while working in ER and ICU units. She claims that, during her years in a mostly clinical setting, she observed doctors who were more than happy to embrace technology. She observed physicians who used all the latest technologies in their own personal lives.
Even more interesting is Wiley’s acknowledgment that the physicians within her professional circles were not technology Luddites. They were not neophytes who had trouble checking email and posting to social media. The only place they seemed to have trouble with technology is interacting with EHRs.
Some of the more common EHR complaints she heard on the job were:
- software limits (e.g., an EHR being little more than an insurance app)
- requiring tasks normally done by secretaries and office assistants
- software that required too many clicks to enter relevant data.
Wiley concluded that EHR technology’s biggest problem is that it is designed from the developer’s perspective rather than the clinician’s. As a result, clinicians are expected to adapt to the way technology developers think and see the world. This is backwards.
Designing Apps Around Users
The desire to improve physician jobs notwithstanding, this is actually a problem common to all sorts of software. Cloud applications, desktop software, and mobile apps alike are not necessarily designed by the same people who use them. They are designed by professional developers who know how to put lines of code together to create an end product.
An easy-to-understand comparison can be made with accessibility. Anybody who lives life in a wheelchair knows that the people who design accessible doorways, ramps, etc. probably have very little experience in a wheelchair. They have no idea how difficult it is to navigate narrow passageways crowded with people. They do not understand how much more difficult it is to move a manual wheelchair across a thick carpet.
Just as designers and architects could benefit from spending a few days in a wheelchair, healthcare IT developers can learn some things by trying to actually use the software they design over the course of two or three weeks.
Clinician Input Is Needed
This is not intended to be a knock against software developers. They do what they do because they are good at it. They have the skills and knowledge required to create apps of all sorts. But in the case of EHRs, they really need more input from clinicians.
Physician jobs could be made better if EHR software was designed around clinical needs. Doctors are not naturally resistant to EHRs. All they want are apps that are efficient and streamlined. They want apps that actually make their jobs easier rather than requiring extra hours after work. Design EHR software that works the way the clinician works, and resistance magically disappears. Imagine that.