In a previous post, “Meaningful Use: A Bridge to Digital Transformation?” I shared perspective about whether the government driven forced adoption of Electronic Health Records (EHRs), pejoratively labeled “Meaningful Use”, would further drive the appetite for technology in the medical community, or stop it cold in its tracks.
While I wouldn’t necessarily change the previous post’s conclusions, in probing three important questions, I ultimately was curious to know:
Are the doctors, clinicians and their provider organizations using the EHRs happy with them? According to this Healthcare IT News survey, the answer is “sort of”. After years of frustration, the survey results indicate satisfaction is getting better but there is plenty of work left to make these systems more user-friendly. Apparently, the forced march was so intense and urgent that good User Experience designers and principles were often not invited to the party.
At the time, evidence of satisfaction levels and even efficacy using EHRs were unclear then. However, a newly published article jointly researched and published by Fortune Magazine and Kaiser Health News, “Death by 1,000 Clicks: Where Electronic Health Records Went Wrong”, presents strong evidence that not only are many doctors unhappy with EHRs, but the poor usability and User Experience (UX) designs have actually harmed patients.
What went wrong
Patient harm: Electronic health records have created a host of risks to patient safety. Alarming reports of deaths, serious injuries, and near misses — thousands of them — tied to software glitches, user errors, or other system flaws have piled up for years in government and private repositories. Yet, no central database exists to compile and study these incidents to improve safety.
Signs of fraud: Federal officials say the software can be misused to overcharge, a practice known as “upcoding.” Some doctors and health systems are alleged to have overstated their use of the new technology, a potentially enormous fraud against Medicare and Medicaid likely to take years to unravel. Two software makers have paid a total of more than $200 million to settle fraud allegations.
Gaps in interoperability: Proponents of electronic health records expected a seamless system so patients could share computerized medical histories in a flash with doctors and hospitals anywhere in the country. That has yet to materialize, largely because officials allowed hundreds of competing firms to sell medical records software unable to exchange information.
Doctor burnout: Many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients. An emergency room doctor can be saddled with making up to 4,000 mouse clicks per shift. This has fueled concerns about doctor burnout, which in January the Harvard T.H. Chan School of Public Health and Massachusetts Medical Society called a “public health crisis.”
Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual “gag clauses” that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families. 1
The verdict is in
While the findings from the research are disheartening, the article brings light to the specifics of how negative outcomes could have happened with the Meaningful Use initiative. It’s not that digitizing the patient chart and medical records wasn’t and isn’t a good thing. EHRs have huge potential to revolutionize healthcare with the right technology, training, and timing. Rather, the core reason Meaningful Use didn’t work and clinicians and patients are frustrated with their EHRs is largely because it was a rushed and forced mandate of technology by the government. Normal market dynamics, with a sound strategy that incorporates UX, product design, and development practices, were bypassed by some vendors – many driven by money and regulatory compliance penalties.
Looking back, moving forward
Unfortunately, the result for many has been Death By 1,000 Clicks. Going forward, we can hope that valuable lessons can be learned from these missteps to ensure better technology design, incorporating the human behavior factor will lead to enhanced care, utilizing EHRs in the future.
David Karabinos is CEO of PointClear Solutions, a Digital Health firm that specializes in providing software strategy, design, development, and management services for the healthcare industry.
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- Schulte, Fred. “Death By 1,000 Clicks: Where Electronic Health Records Went Wrong,” Kaiser Health News. March 18, 2019. https://khn.org/news/death-by-a-thousand-clicks/?mc_cid=b507d1938b&mc_eid=a067903eef.