Is the sub-optimal usability of some electronic health records (EHRs) leading to the kind of physician burnout that might be comprising patient safety? A team of researchers at the University of North Carolina-Chapel Hill has explored that question, and published their findings in the JAMA Open Network (an online extension of the Journal of the American Medical Association), in an article published online on April 5. The article, entitled “Association of the Usability of Electronic Health Records With Cognitive Workload and Performance Levels Among Physicians,” was authored by Lukasz M. Mazur, Ph.D., Prithima R. Mosaly, Ph.D., and Carlton Moore, M.D.; and it found meaningful differences in performance around interacting with and following up on abnormal test results, in basic EHRs versus enhanced EHRs (those designed to achieve improved clinician usability).
What the researchers did was to create a simulated EHR user environment, in which 38 participants were assigned to one of two different EHR environments. Twenty were assigned to use a baseline EHR (without changes to the interface), and 18 were assigned to use “enhanced EHRs (with changes intended to enhance longitudinal tracking of abnormal test results in the system).” The researchers developed a nuanced system to analyze how participants handled interacting with and following up on, abnormal test results, and following up on patients with a no-show status (without cancellation) for their scheduled appointment aimed at addressing previously identified abnormal test results.
And what was discovered? “A statistically significantly poorer performance was found in the baseline EHR group compared with the enhanced EHR group,” the researchers found. Among other elements, “The rate of appropriately managing previously identified critical test results of patients with a no-show status in the baseline EHR was 37 percent (34 of 90 failure opportunities) compared with 77 percent (62 of 81 failure opportunities) in the enhanced EHR. The rate of appropriately acknowledging new abnormal test results in the baseline EHR group was 98…compared with 100 percent (108 of 108 failure opportunities) in the enhanced EHR group.”
Further, “Participants in the enhanced EHR group indicated physiologically lower cognitive workload and improved clinical performance. The magnitude of the association of EHR usability with performance we found in the present study was modest, although many such improvements tend to have substantial value in the aggregate. Thus, meaningful usability changes can and should be implemented within EHRs to improve physicians’ cognitive workload and performance.”
Later, they write, “Overall, past and present research suggests that challenges remain in ensuring the appropriate management of abnormal test results. According to a study, 55%of clinicians believe that EHR systems do not have convenient usability for longitudinal tracking of and follow-up on abnormal test results, 54 percent do not receive adequate training on system functionality and usability, and 86 percent stay after hours or come in on the weekends to address notifications.” They suggested, among other things, using “the existing capabilities and usability features of the EHR interfaces to improve physicians’ cognitive workload and performance”; developing “explicit policies and procedures regarding the management of test results within EHRs, and implement[ing] them throughout the organization, rather than having clinicians develop their own approaches”; and establishing “a regular audit and feedback system to regularly give physicians information on their performance on managing abnormal test results.”