An EHR Vendor Performance Measure May Lead To EHR Optimization

Healthcare stakeholders should develop a standard, quantitative measure of EHR vendor performance to incentivize EHR optimization, alleviate the burden of clinical documentation, and inform clinical workflow improvements, according to a JAMA Network op-ed.

While the EHR was originally designed to improve care quality through a streamlined workflow, evidence has shown that the EHR imposes significant burdens on clinicians which may worsen clinical care quality, the authors noted.

For instance, a study of EHR use measurements across two vendor products found that ambulatory, non-teaching physicians spent over five hours on the EHR for every eight hours of scheduled clinical time, the op-ed pointed out.

Standard quality measures exist for healthcare organizations to identify gaps in performance and care quality, such as the National Quality Forum’s quality measure; however, such measures do not exist for EHR vendors.

Standard, reliable metrics of vendor performance could be used to compare vendor performance, identify differences in EHR use among clinicians, and spur EHR optimization, the authors explained.

Specifically, EHR use metrics could determine time spent on specific activities, task switching between activities, the number and rates of mouse clicks per task, and the influence of teamwork on clinician EHR usage per day, the op-ed authors noted.

“The nascent science of EHR use measurement has already started, albeit in a preliminary phase, and has evolved from collecting data via survey, self-timing, and direct observation to automated audit log capture at scale,” the authors wrote.

“Originally intended to track inappropriate access to protected health information, audit logs capture granular observational data (every screen viewed, keystroke, and mouse click) in an automated fashion,” they continued.

However, the validity of audit log data is questionable because they lack standard data definitions, such as time-out lengths, said the authors.

Still, early EHR use measurement findings offer critical implications. For instance, an unadjusted, longitudinal analysis in an academic health care system found that female ambulatory physicians across specialty disciplines spent 33 more minutes in the EHR per day than their male counterparts, the authors noted.

“Over the past 30 years, quality measurement and reporting have striven to enhance care consistency and transparency, with pipelines for accountability in performance,” the authors wrote. “Drawing attention to the EHR user experience with empirical measurements could add visibility and transparency to what is happening—the hours wasted and the risks incurred—that could stimulate usability improvements.”

What’s more, the authors suggested that the ONC require vendors to consistently report EHR use metrics to maintain EHR certification.

“Scientifically sound measurements could provide an accurate and meaningful characterization of the current state of EHR use, including comparisons within and across products, groups of clinicians, and individuals, as well as before and after policy, regulatory, or workflow changes,” the authors wrote.  

These data-driven insights could guide EHR redesign, as well, the authors suggested.

“For example, comparison between US and international users of the same EHR vendor product highlight major differences in total EHR time and time on specific tasks such as order entry and inbox that may reflect key differences in the regulatory and policy environments,” they wrote.

“Highlighting how much time is spent on documentation and other EHR tasks not directly related to clinical care could inform local redesign and future policy regarding the documentation, billing, or regulatory requirements,” the authors continued.

Instead of leading to clinician burden, the EHR documentation process could live up to its original purpose; improving care quality, the noted.

“Clinicians should find that EHR use measures reduce clerical burdens and are useful to improve their practice; practice leaders should find they improve care delivery and increase workforce retention; and vendors should find they drive product improvement and allow product comparison that can increase market share,” the authors wrote.