Healthcare is so omnipresent in modern life that its functionality is taken for granted. Many people do not realize the amount of information, which flows between hospitals, pharmacies, medical centers, doctors, and patients. Yet, the quality of such data transfers are immensely important in healthcare delivery. Electronic health record (EHR) are a technology, which allows to maintain the flow of information in the fast and consistent manner. Not only does it store all the necessary medical information, but it also enables doctors to make timely interventions based on the EHR information. Understanding the functionality of the technology is essential in ascertaining possible improvements of usability and user experience.
Functionality of the Specified Technology
In essence, electronic health record is a digital database where health information about patients is stored. Each medical facility serves as a data point, which feeds information into a shared storage. For instance, when the doctor assigns the patient to MRI, the results of this study are uploaded into the database. As soon as they are available, the doctor can consult them and prescribe treatment without the participation of the patient (Van der Bij et al., 2017). The doctor’s prescription is also uploaded and the patient’s medical history is updated. Such a system is designed to remove the patient’s fallible memory from the equation.
In order for the technology to work, facilities need software, which would allow instant data transfers. Naturally, hardware with the access to the Internet is also essential since the information cannot not be uploaded otherwise. However, software packages are different, which means that no single program method of input exists. Therefore, in order for healthcare providers to understand the information stored in EHR, the International Classification of Primary Care (ICPC) is necessitated (Kaipio et al., 2020). It is a code, which is used to describe health issues and avoid the differences among the differences between software packages.
Usability
Provided the user understands ICPC and has the necessary software package, the technology will function adequately. Technical problems may impede and complicate the process of data upload. According to Kaipio et al. (2020), physicians find EHR more complicated to understand and use than nurses. Another problem lies in the fact that different brands have unique EHR systems. This implies that in case the doctor accesses the patient’s information, which were extracted from a different EHR, they will possibly have difficulty comprehending the information. Therefore, the first factor, which influences the perception of usability is one’s familiarity with the EHR of a particular brand.
The differences between the brands aside, there are two usability challenges in EHR. The first one is the use of medication administration record. Each time certain treatment is administered, the corresponding information has to be submitted to the health record. However, many medical specialists report that the procedure required to enter patient data is “time-consuming” (Kaipio et al., 2020, p. 4). It is manageable when it is performed once, but when there are multiple administrations, users become dissatisfied and irritated. This problem is especially relevant to nurses who spend much time distributing treatment and filing the medication records.
The second challenge is the use of tools required to file documentation. Each EHR has its own documentation module, in many cases it is not intuitive and demands practice to make the input fast. However, documentation errors can also be present either due to the technical deficiencies or to human mistakes (Aldosari, 2017). Such probability forces some medical organizations to make back-ups. In many cases, it is required to fill both types of records – electronic and paper. Considering the complaints concerning the convenience of the software, the workload may increase significantly because of the usability issues.
User Interface
Regardless of the complexity of the actual software, there will always be differences in how different users perceive its difficulty. Nevertheless, some methods of working with information are objectively inefficient. For instance, keyboard-and-mouse user interface is not adequate when compared to other alternatives. Each time patients’ EHR is edited, the clinician has to authorize by typing a password. Not only is it not convenient, but is also not an adequate security measure in comparison with the existing alternatives. As a result, clinicians spend more time working with records, rather than treating patients.
Reliance on mouse clicks has another implication, which stems from the limited ability to maintain concentration. EHR uses dialogue boxes, which are opened by clicking on a mouse. However, as the user fatigues and loses concentration, they may open unnecessary dialogue boxes, which may lead to documentation errors (Collier, 2018). The resulting discrepancy with the standards of care is attributed to the deficiencies of the user interface, which uses an outdated system of dialogue boxes (Aldosari, 2017). Overall, it should be evident that human factor plays a key role in the appearance of mistakes in health records.
Suggestions for Improvement
The main problem in the functionality is the choice of a software package. Some packages have the ICPC coding installed, which removes the responsibility of manually typing it from the users (Kaipio et al., 2020). It is possible to switch to the package with the support for automatic ICPC coding. It will save time that clinicians spend on trying to edit the health records according to care standards without mistakes.
As usability challenges are highly subjective, there is no single improvement, which would benefit everyone. Nevertheless, it is possible to use user feedback as a reference for improvements. Ratwani et al. (2018) argue that contracts prohibit many organization from sharing information about EHR. Changing the terms of the contract to include the ability to expose EHR information and make changes based on user feedback is a way to correct usability issues.
Finally, the most effective change to the user interface is to use more advanced ways of user recognition. Doctor badges, voice or face recognition, virtual script are all viable alternatives to passwords (Collier, 2018). Furthermore, adding touch-based technology removes the click fatigue. As clinicians will not be required to utilize mouse and keyboard exclusively, there will be no click-related mistakes and subsequent errors in health records.
Conclusion
Altogether, it should be evident that electronic health record is a beneficial technology, which has considerable implementation issues. The lack of a unified software package creates diverse experiences for different users. Usability is not intuitive and is not easily changed due to rigid legal terms. User interface relies on outdated types of input, which are time-consuming. Suggested changes include choosing a software package with the automated ICPC input, changing legal terms to allow fixing the usability based on user input, and switching to alternative input methods. Combined together, these solutions will allow the EHR to fulfill its original purpose, which is qualitative and cost-effective healthcare.
References
Aldosari, B. (2017). Patients’ safety in the era of EMR/EHR automation. Informatics in Medicine Unlocked, 9, 230-233. Web.
Collier, R. (2018). Rethinking EHR interfaces to reduce click fatigue and physician burnout. CMAJ, 190(33), 994-995. Web.
Kaipio, J., Kuusisto, A., Hyppönen, H., Heponiemi, T., & Lääveri, T. (2020). Physicians’ and nurses’ experiences on EHR usability: Comparison between the professional groups by employment sector and system brand. International Journal of Medical Informatics, 134 (104018), 1-9. Web.
Ratwani, R. M., Hodgkins, M., & Bates, D. W. (2018). Improving electronic health record usability and safety requires transparency. Jama, 320(24), 2533-2534. Web.
Van der Bij, S., Khan, N., Ten Veen, P., de Bakker, D. H., & Verheij, R. A. (2017). Improving the quality of EHR recording in primary care: A data quality feedback tool. Journal of the American Medical Informatics Association, 24(1), 81-87. Web.