NATIONAL ELECTRONIC HEALTH RECORDS

National Electronic Health Records

National Electronic Health Records

Introduction

Widespread adoption of health information technologies holds the promise of transformational change in the way health care is delivered—improving quality, enhancing safety, and reducing costs. The increased availability of patient information and decision support at the point of care has tremendous potential for reducing errors and increasing evidence-based care delivery. In pursuit of these goals, various initiatives have sought to foster the adoption of technology including the Institute of Medicine (IOM) which in 1991 called for paperless records in 10 years, the establishment of the Office of the National Coordinator for Health Information Technology with the goal of nationwide Electronic Health Record (EHR) use by 2014 and, more recently, EHR-related incentives and penalties introduced through ARRA. Despite these initiatives and the many successes achieved through EHR implementations, physician adoption of clinical EHR systems is still estimated at less than 10 percent nationally.

While much attention is paid to the financial and technical reasons for limited EHR use in this country, the usability of these systems and their ability to effectively integrate with clinical decision-making and workflow has not been adequately explored to date. Information design, the art and science of preparing information so that it can be used by human beings efficiently and effectively, is central to system usability and implementation success. As such, the further exploration of EHR information design has been identified by AHRQ as an opportunity for innovation in health IT that will improve the safe, efficient, effective, patient-centered, equitable, and timely delivery of care (Bell, 2008).

Insights gained from this report, and its companion (Electronic Health Record Usability: Evaluation and Use Case Framework) are intended to foster research and policy development to inform the next generation of EHR products and the clinical communities that use them.

Analysis of the plan

The National Institute of Standards and Technology (NIST) define usability of the plan as the “effectiveness, efficiency and satisfaction with which the intended users can achieve their tasks in the intended context of product use.” This concept is critically important in promoting both the widespread adoption and “meaningful use” of EHRs prescribed in ARRA. Usability has been cited as a major factor in both the acceptance, and effectiveness, of EHRs in the clinical setting. Examples describing potential negative impacts of EHRs on efficiency, cognitive load, team collaboration, and medical errors can all be linked, at least in part, to issues directly related ...