How EHR Informatics Can Drive EHR Usability for New Clinicians

EHR informatics as a discipline

Quality EHR training is essential to provider users, especially those new to the technology. An effective EHR training program can improve EHR usability which also reduces the likelihood of clinician burden and boosts satisfaction.

While EHR training programs are popping up at the collegiate level, Julia Adler-Milstein, PhD, researcher at the Center for Clinical Informatics and Improvement at the University of California, San Francisco, recommended EHR training programs should include EHR informatics.

“I don't think we're introducing clinicians to the topic of the EHR informatics as a discipline, as a consistent part of training, yet it's really important,” Adler-Milstein said in an interview with EHRIntelligence.

Integrating EHR informatics into a training course will allow users to understand EHR design and it will provide context to the intricacies of the technology.

“Users need to understand the billing and regulatory requirements,” Adler-Milstein explained. “Users need to understand that the data that goes into the EHR is used for many purposes, including quality measurements and public health reporting.”

Adler-Milstein said it is very difficult to fully understand the EHR without that context.

Furthermore, she often describes the EHR as serving many masters, like the folks on the revenue cycle side of things, and clinicians are just one of those many masters.

“Users need some understanding of those other masters and then that will help them at least start to understand it as a different type of tool that needs to be able to support many different use cases beyond direct patient care,” she continued.  

“It is just having that appreciation and understanding. Then, trying to think about what does good EHR use look like in the context of team-based care and how can we be more thoughtful about communication, division of labor and responsibilities; who does what?”

EHR user feedback

Health organizations need to accept feedback from its EHR users, while also giving users feedback on how their EHR use behaviors compared to their peers.

Gaining feedback from clinicians is a key factor to sustaining EHR usability and optimization. But according to a 2018 Deloitte survey, 66 percent of physicians were not asked to provide feedback in regards to EHR optimization decisions.

Adler-Milstein stressed the importance of discussing and talking to colleagues about how they complete their work and asking the most important things that they’ve learned about using the EHR.

“The more that there's thought given as opposed to just throwing them into situations,” Adler-Milstein continued.

“We just say, ‘Here's the tool.’ We give users a little bit of training on the basics but we don't really talk about the broader issues about how the EHR is being used and how to improve its use over time, especially in the context of team-based care.”

EHR advancements improving, but limited

Each generation or class of EHR users are more used to utilizing technology in their day-to-day lives. In fact, some clinicians might even demand a level of functionality and interaction that an EHR, because of its complexity, does not yet deliver.

“The old barrier used to be, physicians didn't want to touch the keyboard, and touching the keyboard is now such a natural part for young, up and coming professionals that it is no longer the barrier that it used to be,” David West, MD, medical director of health informatics at Nemours Children’s Health System, said in an interview with EHRIntelligence.

At Nemours, West encounters young clinicians or EHR users who assume everything should be on their respective smartphones and they should be able to do everything, such as gain full EHR access, from their smartphones.

“No, we're not there yet,” West explained. “We need to teach them why that's not there yet. Some of the complexities that are involved in the EHR, I don't get much resistance on that point, but I have had people who have expressed that as a wish list kind of thing is, if I could just carry around my phone and do everything on that, that would be great. But we can do a lot on our phones. It's not like we can't do anything, but you can't do everything.”