Impact of EHR Usability on Provider Efficiency and Patient Safety in Non-Hospital Settings

Healthcare organizations may reap benefits transitioning to electronic health records (EHRs), such as decreased healthcare costs and better care. However, severe unintended consequences from implementation and design of these systems have emerged. Poorly implemented EHR systems may endanger the integrity of clinical or administrative data. That, in turn, can lead to errors jeopardizing patient safety or quality of care. A literature review of 40 sources identified how EHR implementation and design can impact provider centric, patient centric, and outcomes. These categories provided the basis for a comprehensive EHR impact model that was evaluated in non-hospital settings through focus groups interviews

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

The Impact of EHR Usability Issues on the Perceived Efficiency of Non-Clinical Hospital-Based EHR Users

A survey-based study of the impact of the EHR systems usability issues on the perceived efficiency of work among non-clinical users in the hospital settings was performed June 20th to July 24th 2015. There were 160 valid responses. The results were processed in SPSS (IBM statistical application) and I determined the usability dimensions with the greatest impact on efficiency, for all EHRs and for the major EHRs (Meditech, Epic and Cerner). Helpfulness was the most frequent problem for users of all EHRs. The survey is experimental and cross-sectional. The format was 20 Likert-type questions, along with screening and demographic questions. Due to the nature of data collected (ordinal) the non-parametric analysis was performed in SPSS. The goal of the study was to figure out the main usability issues among non-clinical users of the EHR systems and to generate actionable insights for designers and developers of EHR systems

Electronic Health Record Optimization for Cardiac Care

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are presented to clarify and propose a new framework to study EHR-provider interaction. Four focus areas were defined - workflow, communication, medical decision-making and patient care. Using Human Computer Interaction best practices, an EHR usability framework was designed to include a realistic clinical scenario, a cognitive walkthrough, a standardized simulated patient actor, and a portable usability lab. Cardiologists, fellows and nurse practitioners were invited to participate in a simulation to use their institution’s EHR system for a routine cardiac visit. Using a mixed methods approach, differences in satisfaction and effectiveness were identified. Cardiologists were dissatisfied with EHR functionality, and were critical of the potential impact of the communication of incorrect information, while displaying the highest level of success in completing the tasks. Fellows were slightly less dissatisfied with their EHR interaction, and demonstrated a preference for tools to improve workflow and support decision-making, and showed less success in completing the tasks in the scenario. Nurse practitioners were also dissatisfied with their EHR interaction, and cited poor organization of data, yet demonstrated more success than fellows in successful completion of tasks. Study results indicate that requirements for EHR functionality differ by type of provider. Cardiologists, cardiology fellows, and nurse practitioners required different levels of granularity of patient data for use in medical decision-making, defined different targets for communication, sought different solutions to workflow which included distribution of data input, and requested technical solutions to ensure valid and relevant patient data. These findings provide a foundation for future work to optimize EHR functionality

Strategies for Applying Electronic Health Records to Achieve Cost Saving Benefits

The American Recovery and Reinvestment Act (ARRA) of 2009 authorized the distribution of about $30 billion incentive funds to accelerate electronic health record (EHR) applications to improve the quality of care, safety, privacy, care coordination, and patients\u27 involvement in healthcare. EHR use has the potential of saving$731 in costs for hospitals per patient admission; however, most hospitals are not applying EHR to reach the level at which cost savings are possible. The purpose of this single case study was to explore strategies that IT leaders in hospitals can use to apply EHR to achieve the cost saving benefits. The participants were IT leaders and EHR super users at a large hospital in Texas with successful experience in applying EHR. Information systems success model formed the conceptual framework for the study. I conducted face-to-face interviews and analyzed organizational documents. I used qualitative textual data analysis method to identify themes. Five themes emerged from this study, which are ensuring information quality, ensuring system quality, assuring service quality, promoting usability, and maximizing net benefits of the EHR system. The findings of this study included four strategies to apply EHR; these strategies include engaging training staff, documenting accurately and in a timely manner, protecting patient data, and enforcing organizational best practice policies to maximize reimbursement and cost savings. The findings of this study could contribute to positive social change for the communities because EHR successful application includes lower cost for hospitals that may lead to the provision of affordable care to more low-income patients

Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating

For more information about the Information Experience Laboratory, visit http://ielab.missouri.edu/Electronic medical record (EMR) adoption rates have been slower than expected in the United States, especially in comparison to other industry sectors and other developed countries. A key reason, aside from initial costs and lost productivity during EMR implementation, is lack of efficiency and usability of EMRs currently available. Achieving the healthcare reform goals of broad EMR adoption and “meaningful use” will require that efficiency and usability be effectively addressed at a fundamental level. We conducted a literature review of usability principles, especially those applicable to EMRs. The key principles identified were simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, effective information presentation, and preservation of context. Usability is often mistakenly equated with user satisfaction, which is an oversimplification. We describe methods of usability evaluation, offering several alternative methods for measuring efficiency and effectiveness, including patient safety. We provide samples of objective, repeatable and cost‐efficient test scenarios applicable to evaluating EMR usability as an adjunct to certification, and we discuss rating schema for scoring the results. (42 pages

COMBINING HUMAN FACTORS AND DATA SCIENCE METHODS TO EVALUATE THE USE OF FREE TEXT COMMUNICATION ORDERS IN ELECTRONIC HEALTH RECORDS

Medication errors are a leading cause of death in the United States. Electronic Health Records (EHR) along with Computerized Provider Order Entry (CPOE) are considered promising ways to reduce these errors. However, EHR systems have not eliminated medication errors. Moreover, in some cases they have facilitated errors due to issues such as poor usability and negative effects on clinical workflows. The use of unexpected free text within a CPOE system can serve as a marker that the system does not adequately support clinical workflow. Prior studies have looked at the use of free text within medication orders, but the inclusion of medication related information in communication for non-medication orders (CNMOs), a type of free text order, has not been adequately studied. This mixed-methods study identified the prevalence, nature and reasons for the inclusion of medication related information in CNMOs using a large sample of CNMOs placed at a mid-Atlantic hospital system in 2017, and via interviews with physicians. The study found that more than 42% of CNMOs contain medication related information. Moreover, the use of CNMOs varied significantly across provider types, hospital locations, patient settings and other factors. The study found 10 themes that might cause providers to adopt such workarounds, including missing functionality and poor usability. The viii study also identified several general challenges in communicating medication information in the EHR, and potential solutions to mitigate these challenges. This dissertation also demonstrates how natural language processing could be used to identify medication related CNMOs

Which electronic health record system should we use? A systematic review

The UK government had intended to introduce a comprehensive EHRs system in England by 2020. These EHRs would run across primary, secondary, and social care linking data in a single digital platform. This systematic review's objectives were to identify studies that compare EHRs in terms of direct comparison between systems and evaluate them using System and Software Quality Requirements and Evaluation (SQuaRE) ISO/IEC 25010. A systematic review was performed by searching EMBASE and Ovid MEDLINE databases between 1974 and April 2021. All original studies that appraised EHR systems and their providers were included. The main outcome measures were EHR system comparison and SQuaRE's eight characteristics: functional suitability, performance efficiency, compatibility, usability, reliability, security, maintainability, and portability. A total of 724 studies were identified using the search criteria. After review of titles and abstracts, this was filtered down to 40 studies as per exclusion and inclusion criteria set out in our study selection. Seven studies compared more than one EHR. The following number of studies looked at the various aspects of the SQuaRE respectively. Nineteen studies addressed functional suitability, n=18 performance efficiency, n=12 compatibility, n=25 usability, n=6 reliability, n=2 security, n=16 maintainability, and n=13 portability. Epic was the most studied EHR system and one of the most implemented vendors in the USA market, and one of the top ten in UK. It is difficult to assess which is the most advantageous EHR system currently available when looking at them in accordance with SQuaRE's eight characteristics for software evaluation

The Impact of Electronic Health Records on Healthcare Service Delivery, Patient Safety, and Quality

The HITECH Act has provided over $30 billion of support through the Meaningful Use program to implement Electronic Health Records (EHRs) with aims to improve healthcare service delivery, efficiency, quality, and patient safety. New healthcare models, such as pay-for-performance and value-based purchasing, were envisioned to aligning quality with reimbursement mediated with the use of EHRs. It is unclear of how EHRs and Meaningful Use have impacted health service delivery, patient safety, and quality of care. Thus, making it difficult to determine if the specific set of objectives for Meaningful Use have had a positive impact on outcomes, which ultimately is the goal of the program. The objective of this dissertation is to study the impact of EHRs on healthcare service delivery outcomes related to e-health services and productivity. Furthermore, the objectives are to study the impact of EHRs and Meaningful Use attestation on patient safety and inpatient quality of care. The results demonstrate gains in efficiency may be achieved during patient-physician interaction time with the use of fully EHRs, where physicians saved 1.53 minutes per visit in time spent with the patient, or a 6.1% gain in efficiency. EHR use significantly improved the odds of providing e-billing, e-consults, and e-prescribing. We found that fully-implemented EHRs that did not attest to Meaningful Use had a significant positive impact on 3 patient safety outcomes, and hospitals that attested to Meaningful Use had a significant positive impact on 2 patient safety outcomes. However, there were no significant differences in patient safety composite scores. Last, there were significant differences in inpatient quality composite scores. Hospitals attesting to Meaningful Use had 18% improvements in mortality for selected conditions, and 8% improvements in mortality for selected procedures. In conclusion, EHRs and the Meaningful Use program have had positive impacts on healthcare service delivery and inpatient quality of care. More efforts may be needed to improve patient safety with the use of EHRs, which may need to focus on EHR certification or Meaningful Use objectives. Future studies should determine specific EHR functionalities and Meaningful Use objectives that are associated with positive outcomes to further direct policy development