The Tenuous Balance

The EHR, Safety, and Cost

Excessive regulation & Red Tape = Increased Cost & Impaired Workflows

 

 

As the electronic Health Record marches full force to alter medicine completely, there will be some consequences.

The diagram above represents the battle between goal of patient safety, which attempts to use the EHR to solve problems, control behavior, and create new behaviors.  The problem is the end user is rarely consulted and or considered.  Government regulation forces companies to create products that decrease the ability of the end user to seamlessly integrate into their practices without the use of aids (scribes, assistants, computer jockeys, and voice activated technology, etc.).  The institutions and private practice are using EHR 1.0 and they really need EHR 2.0.  The financial commitment and government subsidies (meaningful use) create an environment of inertia that impedes rapid change to "best of breed" products.

The Right Click Dilemma!

What is the difference between a person who understands computers and the rest of us?  It is the ability to understand that programmers love to right click to create endless contextual menus.  these menus are interpreted by IT people because 1- they know they exist and 2- they read and act on these menus.  The rest of us stare in silence, stupidity, or disbelief.  How did they know"that"?  Why would they hide the menu from us?

When dealing with many Electronic Health Record systems, the right click is your arch nemesis.  You had endless hours of training, but still cannot remember what to do next.  You did not realize that you can right click something or everything and multiple hidden menus appear with the answer.  When you have suffered through multiple minor epiphanies and created multiple "work-a-rounds" and/or "favorites" the program becomes less onerous.

The real solution is end-user friendly Electronic Health Record do not rely on a right click, multiple hidden menus, work-a-rounds, and favorites to utilize.  The user should be able to look at the screen and intuit what to do next.  What is painfully obvious to the "programmer" is not obvious to all end users.

If the program takes endless hours of training, needs "super-users", and you forget things after only 1 week, the endless psychological toll it takes on the users is profound.  This leads to lost productivity, unhappy employees, and general disenchantment with the whole process.  The Electronic Health Record has many potential benefits, but this is often lost in the battle to process efficiently.