Usability: Can Every EHR Be Above Average?

Usability is the key differentiator between the long-term success and failure of an EHR implementation. The findings of the recent MGMA study lead to the inescapable and troubling conclusion that too many physicians do not consider their EHRs “usable.” A bad EHR choice is costly for the particular physician(s) and, while it might suffice in the short term for the purpose of earning meaningful use incentives, it will do nothing in the long run to foster sustained EHR adoption. Recognizing this, the HIT Policy Committee’s Adoption and Certification Workgroup convened an 8-hour hearing last week on the subject of how to define and measure usability. Recommendations were offered that mirrored my EHR reform proposal, and various groups/studies are already working on usability testing. One such group is CCHIT, which has introduced a usability rating tool into its commercial certification (not to be confused with government-certification) process. In her testimony, Karen Bell, M.D., Chair of CCHIT, discussed the results (Chart 1) and her recommendations.

So what’s wrong with this picture?

What’s wrong is that, to be useful to physicians, it has to look like this:

This is not meant as an indictment of CCHIT—the organization is to be commended for having taken an important first step in defining usability and creating a process for measuring it. The problem—which Karen Bell did acknowledge when challenged about it—is that if this rating scale were an accurate reflection of usability, there would be many fewer complaints about EHRs and, in my opinion, many fewer failures.

To provide physicians with the objective information that will be valuable to them in EHR purchase decisions, the ratings must be comparative and follow a normal distribution, as illustrated in Chart 2 above. Because achieving this distribution would require more aggressive usability criteria, it would distinguish those EHRs that have the greatest positive impact on productivity and cost savings from those that have a lesser, or negative, impact in these areas.

Even more important, this more challenging evaluation will create a market in which vendors are forced to compete on usability and how to better meet the needs of physicians. Physician satisfaction levels will increase. It will elevate quality across the board and raise the level of the entire EHR industry. Perhaps, as Dr. Ross Koppel testified at the Usability Hearing, if health IT were more usable, we wouldn’t even need incentives to spur EHR adoption!

The Silent Majority Is Being Heard – Let’s Be Louder

The tide appears to be changing as the voices of the silent majority are finally being recognized in Washington. I have been repeatedly and emphatically expressing my concern that the needs of physicians—particularly high-performance physicians—are being ignored as the government attempts to encourage EHR adoption.

  • Last week, Gayle Harrell, an HIT Policy Committee member, made many of the same points that I have been making, as the Committee reviewed the initial set of recommendations on “Meaningful Use” and considered EHR certification. (Read the highlights in the post below, Finally, A Voice of Reason!)
  • In recent months, many of you have been speaking out on Straight Talk and other blogs. To the question asked in last week’s poll—is the government putting too much of a burden on physicians?—a resounding 90% of respondents answered “Yes.”
  • Physicians are voting with their pocketbooks, continuing to base their EMR purchase decisions on the best way to help their practices deliver the highest quality care in the most efficient manner, rather than on the promise of potential government incentives.
  • Even CCHIT (Commission for Certification of Healthcare Information Technology) has acknowledged these and other voices of reason. Just recently, CCHIT backed down on its all-or-nothing stance and proposed broadening its certification program to include alternative paths to EMR certification.

Comments like those of Dr. Boss (below) attest to the value of alternative, innovative solutions, such as the hybrid EMR, and to the importance of including them in the government’s plans for widespread EHR adoption:

“The best EHR system out there without a shadow of a doubt is SRS, even though it is not yet CCHIT certified. It is cost effective, user friendly to those of us who are not computer ‘geeks,’ and the company is extremely responsive to any needs of ours that arise. If the entire country was on SRS, a lot of our current difficulties would go away.”

Richard S. Boss, M.D.
Pine Medical Group, Fremont, MI
20-Physician Multi-Specialty Group

We will be sending you an e-mail tomorrow, giving you the opportunity to join us and have your voice heard before the final decisions are made in Washington.