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Understanding the Impact of EHR Interfaces

March 31, 2009

This article is re-posted from User Centric’s blog.

If you are evaluating or redesigning an EHR/EMR application, you will find it extremely it helpful to look at it from the perspective of the target HCPs. Regardless of whether the target audience of an EHR application are primary care physicians or specialists, HCPs tend to have little patience for data entry or navigating through three levels of menus.

Most HCPs will bluntly tell you that they did not go through medical training to become data entry clerks. They also are highly sensitive to time requirements because their days can be brutally compressed. For example, some specialists need to see 20-25 patients a day simply to break even when running a practice. And hospital-based clinicians often have very long days during surgery days or rounds.

So when HCPs use EHRs, there are often multiple, simultaneously things going through their minds:

  • • There must be a way to make order entry faster…
  • • What was the procedure code for that variation of a genetic test?
  • • Let’s see, should I order Test ABC or Test DEF (or both)?
  • • I need to check for Jane Doe’s lab results from yesterday.
  • • Why isn’t that med listed under antivirals?
  • • What does that obscure lab reading mean?
  • • Has the patient’s problem list changed in the last day or so?
  • • Why do I have to enter patient notes *this* way when the EHR at the teaching hospital has me enter it the other way?
  • • Are there additional contraindications?
  • • When was the patient’s last MRI?
  • • I’m running behind, but I still need to enter this script.

When evaluating/designing for HCPs, try to keep the following basic UI requirements in mind:

  1. 1. The structure and organization of an EHR application needs to reflect actual HCP workflow. Although office-based physicians often have very different workflows than hospital-based clinicians, many EHRs try to support a particular type of workflow (and size of practice or healthcare organization).
  2. 2. Key application features – especially those related to CPOE activities – should be immediately self-evident and self-explanatory

The EHR application should support basic user interface requirements such as:

  • • Rapid and intuitive access to medical history and status information for each patient
  • • Use of organizational filters popular among HCPs (such as patient schedules or patient census) to provide default caseload views
  • • Rapid access to common forms and relatively rapid data entry
  • • Notification of potential errors, including drug interactions or contraindications
  • • Persistent display of key patient identifiers
  • • Display/messaging of patient status updates and lab results for that patient

This basic UI list does not take into account functional “nice-to-haves” such as clinical decision support tools which are often integrated with EHR screens. Still, it’s good place to start.

In general, the best way of understanding HCP use of EHR applications is to watch them use EHRs in their workplace and observe their interactions, followed by brief interviews. Even a handful of observations can improve your understanding of physician behavior… So start walking!

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