The world of electronic health records needs to open itself up to critical comparisons and earnest user evaluation if it wants to avoid formal regulation by the Food and Drug Administration, according to a discussion paper released this month by the Institute of Medicine.
Not only is there nowhere for health IT users to share publicly their experiences with different products, but vendors often prohibit users from sharing screenshots or otherwise publicly discussing EHR problems, notes the paper, "Comparative User Experiences of Health IT Products: How User Experiences Would Be Reported and Used."
The result, according to the discussion group?
"After a decade of development and experience, EHRs and other health IT products have not advanced sufficiently; nor have they been adopted widely and enthusiastically, in step with other consumer products such as smartphones and iPads," wrote the authors, convened by the IOM to analyze the issue. "With EHRs, unlike other consumer product areas, there has been little opportunity for cross-vendor comparison, which has stifled the evolution of this technology."
The group recommended gathering and reporting user experiences in several ways, including:
- "Flight simulator"-like laboratory evaluation of test scenarios designed to determine ease and effectiveness of use, and to filter out unofficial workarounds developed by users trying to circumvent usability challenges.
- Point-of-use reporting, such as a button on every screen for reporting problems with each aspect of the system.
- Studying patterns of use behind the scenes, such as how many clicks are required to complete each task.
- User surveys by third parties, including randomized surveys to compare similar products from different vendors.
- Direct user-to-public reporting, preferably through a single government-hosted website, including filtering tools enabling users to customize their research.
- Formal hazards reporting of EHR features or flaw that endanger public safety, with no repercussions for those reporting the problems.
"Barriers to reporting problems with usability are multi-faceted and include users' fear of retribution, vendors' fear of liability, lack of trust in the impartiality of the entity collecting the data, time required of individual users to generate a report, cynicism about the futility of reporting [users may feel discouraged when no response to earlier reports has occurred; users may become fatigued by the automatic attribution of hazards to "user error"], and the sheer volume of reports that may be generated," the authors wrote.
The IOM group recommended subdividing EHR ratings for each modality, allowing healthcare providers to compare only the products they need.
Developing meaningful metrics for comparing user experiences will not only aid providers trying to choose a product, but will help drive product improvement, according to the paper.
The drive for improvement could be a long journey. A recent Booz Allen Hamilton report noted that EHR design is roughly the same as in 1982. Other challenges: Reorienting platforms originally designed for billing, capturing the complexity of healthcare without being too complicated for users, and building information-exchange capabilities in designs not intended to support exchange.