Lack of Training is at the Core of Physician EHR Usability Complaints

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By Michael Burger, EHR Practice Lead


You hear it all the time: electronic health records (EHRs) are proliferating yet doctors allegedly hate them because of perceived usability issues. As a product manager, I’ve been the recipient of many a tirade from an unhappy physician client saying, “It’s not intuitive,” or “There are too many clicks,” or “Why can’t this be as simple as an iPhone?”

Physician disdain for EHRs has been expressed loudly and often enough that regulators have included usability testing as a certification criterion for EHR incentive programs. Consequently, everyone is searching for underlying causes. Some studies have tied usability issues to physician burnout. And recent studies from March 2019 and December 2020 have identified how the lack of training impacts physician usability perspectives.

EHR usability challenges. EHRs are certainly not perfect. Software improvements can always be made to tighten up the user interface (UI) to be more logical and reduce the number of clicks. Workflows can always be streamlined.

EHR vendors face a significant hurdle regarding usability. Because of its inherent function, an EHR simply can’t be as easy to use as an iPhone. A UI that’s perfect for Instagram and Twitter isn’t practical for a task as complex as documenting the patient visit of a 72-year-old with comorbidities.

Equally challenging is finding the right balance between what information a clinician would like to see and how much is too much. In this regard, medicine is as much an art as a science, with each clinician having his or her own preferences. For this reason, EHRs are designed to be flexible in order to accommodate the unique style of the individual user.

EHR training is a constant tug of war. Because EHRs are necessarily complex, education is essential. Unfortunately, it’s often difficult for clinicians to set aside time for such in-depth training. Clinicians are among our best-trained professionals, having spent years of study in medical school. While clearly recognizing the value of proper training, they somehow fail to perceive that learning about EHRs is an investment.

Shedding light on the problem. Now we have data to illuminate the problem. A published study (72,000 clinicians at 156 provider organizations) by the Arch Collaborative  examined EHR satisfaction. Its conclusion: “If health care organizations offered higher-quality educational opportunities for their care providers, and if providers were expected to develop greater mastery of EHR functionality — many of the current EHR challenges would be ameliorated.”

Across this extensive dataset, the study notes that “the single greatest predictor of user experience is not which EHR a provider uses or what percent of an organization’s operating budget is spent on information technology, but how users rate the quality of the EHR-specific training they received.”

These are telling statements that highlight the challenges EHR vendors face regarding client satisfaction. With as many as 30% of practices looking to replace their EHRs, one wonders if their experience with a new EHR will be any better without a commitment to training. They also explain why EHR vendors that impose prescriptive training requirements are perceived as having a better product when compared with those that allow their clients to dictate the training curriculum and requirements.

These also help to explain why many of the advanced features that EHRs offer are underutilized. Population health comes to mind.

Population health works when well-trained clinicians breeze through optimized workflows that sequentially match the patient exam. Actionable population health information interspersed within such a workflow is unobtrusive and valuable. Instead of being an interruption, population health becomes a component of clinical decision making.

With the advent and increase of manufacturer population health teams, there are more opportunities for pharmaceutical companies to help address the challenges to achieving better outcomes. - Those interventions can build patient loyalty and satisfaction.

Opportunities. The conclusions of these studies suggest some opportunities for the pharmaceutical-biotech industry to support their health system clients. Organizations such as pharmaceutical, medical device, and medical services companies can work with physicians and their staff to build utilization of advanced, automated EHR features . To address medical need, key account managers, sales teams, and medical science liaisons can bring information to their customers to help inform and frame future EHR change requests to implement new features or tweak existing workflows. This can speed the health systems’ planning process for implementing EHR configuration changes. It is clear EHR training may be available but is underutilized. Healthcare professionals and staff may not have the experience to understand an EHR’s capabilities to identify gaps in care, target patients for treatment, or better educate patients about conditions. 

Pharmaceutical companies can play a bigger role in helping health systems and practices implement EHR changes which support better patient outcomes.

Point-of-Care Partners are experts in EHR workflow. We can help your organization better prepare for discussions with clinicians about EHRs, including best practice workflows. Let me know how we can help. Please contact us.