Commentary: Design EHRs with the business of patient care in mind

Electronic health records need to be redesigned to focus more on a hospital's business of treating patients, not its corporate strategy to increase the business units' value, according to a recent post to the Health Affairs blog.

The Dec. 16 post, by Scott Wallace, a visiting professor at Dartmouth's Geisel School of Medicine and first President and CEO of the former National Alliance for Health Information Technology, expresses concern that EHRs were designed around the corporate priorities of billing and high-level record keeping at the expense of the business strategy of providing care to patients. EHRs, as currently designed, he says, also add to the burden of information gathering and shifts that burden to the clinicians, raising costs when EHRs should be lowering them. 

"EHRs can, and should, provide relevant information when and where clinicians need it, recognizing that care is not a commodity and that different care processes have different information needs," Wallace says. "User interfaces must anticipate clinicians' needs rather than require individual user design. EHRs need to eliminate low-information pop-ups and alarms and instead provide alerts and reminders that are both timely and relevant. They must be designed with assiduous attention to data entry requirements, replacing blind mandates with thoughtful assignment of the task and the timing."

Wallace suggests that healthcare organizations invest in clinician-assisted EHR design, obtain clinician feedback, update the EHR accordingly on a frequent basis and be interoperable. He also recommends that they organize care delivery into integrated care and how patients experience health, not by medical specialties and procedures.

EHR design has long been a problem, with many denouncing current EHRs as time-wasters, difficult to use, and creating their own patient safety hazards. The American Medical Association, frustrated about lack of improvement in design, issued its own a new framework to improve the usability of the systems.

To learn more:
- read the blog post