EMR goes back under the microscope

Researchers embarked on their original study the same day that Australia went into its first covid lockdown.

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Australian researchers are taking another look at Australia’s electronic medical record system usability from the perspective of health professionals, three years after their first study.

They are keen to see whether clinicians’ views have changed since 2020 – and are also hoping to capture a greater response than they did in the middle of the covid pandemic.

Leading the study is Dr Sheree Lloyd, a senior lecturer at the University of Tasmania’s Australian Institute of Health Service Management, along with researchers from Griffith University, Queensland University of Technology, Monash University and the University of Wollongong.

The researchers plan to compare their findings with data from the original project.

“The day we launched the [original] study was the day that Australia went into lockdown, and so our response rates across Australia were not as high as we would have anticipated,” Dr Lloyd told The Medical Republic.

The first part of the project will comprise a survey, which has been launched, followed by a focus group, which will run later this year.

The original study – the first national examination of EMR usability in Australia – found experiences varied among health professionals. Results were published in the International Journal of Medical Informatics in October 2021.

Researchers found that medical professionals working in primary care had more positive experiences with the technical and quality features within EMRs than others working in areas like nursing and hospitals.

Results of the national survey into EMR usability made comparisons between medical and nursing professions in hospital and primary care sectors in Australia and Finland.

“Nursing and medical professionals have different experiences with EMR usability,” the researchers found.

“This depends on the sector they work in and the usability feature measured. In our sample, technical quality features were more positively experienced by doctors in the primary care sector than nurses as well as ease of obtaining patient information and prevention of errors.

“In the hospital sector, nurses’ experiences with EMRs were more positive with respect to support for routine task completion, learnability, ease of obtaining patient information and entry of patient data.”

Additionally, a paper with the research team’s qualitative analysis of medical and nursing clinician perspectives on the usability of the hospital EMRs was published in March this year in the Health Information Management Journal.

“In Australia, while an increasing number of hospitals now use EMRs, these EMRs are at various stages of adoption, with each state health department and each private hospital adopting their own approach to implementation,” the authors wrote.

“Although a range of products is available, market share has been dominated by a small number of vendors. Levels of adoption and maturity of EMR systems differ and few Australian hospitals have achieved the highest stage of maturity validation as measured by the Healthcare Information and Management Systems Society (HIMSS) Electronic Medical Record Adoption Model.”

Clinicians reported that the EMR disrupted clinical workflows and increased the time taken to complete routine tasks, such as documentation. 

“Our study found that clinicians working in hospitals experienced a variety of usability concerns, including hybrid record systems, multiple logins, poor integration of the EMR with clinical workflows, limitations in communicating with external care providers, ‘note bloat’ due to copy and paste, potential for new error creation, alerts and warnings, system response time and stability, and lack of intuitiveness/learnability,” the authors concluded.

“If the benefits of EMRs are to be realised there are good reasons to address the usability challenges identified by clinicians. There are solutions to improve the usability experience of hospital-based clinicians, such as resolving sign-on issues, use of templates, and more intelligent alerts and warnings to avoid errors. Improvements to the usability of the EMR system are essential as they are the foundation of the digital health system.

“A strong foundation that collects quality data, averts errors, prevents adverse events, and supports clinicians to provide care and collaborate with colleagues will enable us to move to the next level of digital health transformation and to attain the benefits of patient-centred care. The challenge is for all stakeholders (clinicians, vendors and health IT developers) to implement from the evidence base, proven strategies, and solutions to optimise usability to strengthen EMR systems and hospital-based clinicians user experience.”

Dr Lloyd told TMR the new research aimed to capture impressions of EMR usability from Australian medical, nursing, and allied health professionals working in both primary and acute sectors.  

“As the end users of EMRs, clinicians are best positioned to describe and explain what is needed to improve user experience,” she said.

“By actively engaging clinicians in a conversation about usability, we are more likely to identify the pain points and areas to prioritise in EMR redesign.”

Investment in EMR systems was significant, and with consumer demand for healthcare outstripping available resources, it was “critical that tools such as EMRs integrate seamlessly into care delivery and augment the care provided and not get in the way of achieving good outcomes of care”.

“This research can contribute to strengthening health service effectiveness and ensure positive returns from EMR investment and clinicians/patient/client outcomes,” Dr Lloyd said.