Usability and HIT: Evolution and a Brief History of Cell Phones

By Joe Wivoda, Chief Information Officer

All week I have been using a cellular phone analogy for Health IT. I stated a couple of times that we are in the “bag phone” stage of HIT: bulky, unreliable, difficult to use and not very appealing. Our electronic health records (EHRs) and patient portals, it could be argued, are in the same state. At least I hope so. It can be somewhat comforting to think about what happened with cellular phone technology. From bag phone to iPhone, the evolution has been astounding. But also remember that cellular technology is a consumer product with an enormous market, and this evolution still took thirty years or more.

Consider how far we have come with EHRs in the last 10 years, however. It was common to have terminal-based (“green screen”) EHRs not that many years ago, and these were primarily billing and lab systems. Thanks partially to Meaningful Use, EHRs are commonly implemented with computerized physician order entry (CPOE), patient portals, radiology, clinical decision support, and all sorts of other safety or productivity features. Unfortunately, we hear more and more that the EHR is not user-friendly or that productivity has decreased for some users.

I did say “some users.” Other users of EHRs report significant improvement and would never go back to paper. Consider billing and lab for a moment. EHRs started out as billing systems for the most part, and although they are still not perfect, we hear much less from billing departments about usability. Similarly with lab, since lab was the next area to be automated, the EHRs have gone through an evolution of usability and functionality. The same will happen in nursing and provider documentation, but when?

It is really up to the users of EHRs to work with the vendors to improve their systems. We are the “environmental stimulus” in the evolution of EHRs. How do you communicate ideas and suggestions to your vendor? What process does your vendor have for listening and using your input? Do you have a cohort of similar facilities that has a stronger voice? Particularly in rural and with EHR vendors focused on rural, working with a cohort of similar facilities carries much more weight. Talk with your friends and see what their issues are, I bet you have some of the same ideas!

It is easy for me to say, “be patient, this is a normal part of the evolution of technology.” I don’t have to use EHRs every day! There are ways to speed up the evolution, with government regulation (Meaningful Use), customer pressure (suggestions and feedback), and market forces (have you seen how many mergers are occurring?). Remember when Nokia was hailed for its innovation when they came out with cell phones that had a choice of colors? Then the iPhone happened. If you have an EHR, do this today:

• Use the test system to understand how documentation workflows can be modified
• Think about all the steps in those workflows, not just the number of clicks or screen changes. Is there a better workflow? Flow chart it!
• Consider what information would be useful to have at each step in the process. Don’t think in terms of the paper-based ways that have existed for 100 years; think about the basic information you need.
• Keep looking for improvements and innovative ideas, the communicate those to the vendor 

We will get there. Evolution takes time, but we can help speed it along.