Pinpointing what makes EMRs so annoying

Across systems, nurses and GPs are more comfortable with med tech than hospital-based doctors.

---

The poor usability of key hospital records-keeping systems must be addressed if they are to live up to their potential as a clinical tool, rather than a data repository, according to new Australian research.

Virtually every GP clinic, public hospital and private specialist now uses at least one form of electronic medical record (EMR) system to store and share patient information.

Despite this proliferation, there is a relative lack of quantitative research looking at how these systems are used in practice, and what features make them usable.

Building on research carried out in Finland, a recent paper published in the International Journal of Medical Informatics is the first study examining the usability of Australian EMRs.

Led by Griffith University health informatics researcher Dr Sheree Lloyd, the research looked at the experiences of community-based GPs, hospital-based clinicians and hospital-based nurses.

“What makes the system usable is when it complements clinicians and supports their clinical team,” Dr Lloyd told The Medical Republic.

“It’s not just a nurse or a doctor, it’s a complex team of allied health professionals working together, and if EMR can support that collaboration, then that makes it more usable.”

While the researchers found varying levels of approval for EMRs among each cohort, the group that expressed the most frustration with important usability features were hospital-based specialists.

“Usability features of information exchange and collaboration for clinicians across services and with patients is critical to reduce complications associated with missed care, medication errors, compliance, and re-presentation,” the researchers wrote in the international Journal of Medical Informatics.

“Most EMRs, however, have been designed as data collection tools (forms-based screen design) rather than collaboration tools.

“Medical professionals have the authority to discharge and prescribe and their needs for collaboration with other clinicians and providers are traditionally greater than for nurses.”

Meanwhile, GPs generally viewed the particular systems they used more positively – something Dr Lloyd theorised could be due to greater familiarity with EMRs and closer working relationships with vendors.

“Because general practices run as individual businesses, they need the systems to work well – and they’ve been using systems for far longer than the hospital sector – so they’ve been able to work with vendors to improve some of the features,” she said.

EMRs were considered most useful in supporting GPs to identify medication errors, and least useful in supporting hospital-based clinicians to do routine data-collection tasks.

“Processes to enhance usability in the context of health care delivery in Australia should robustly underpin future development of EMR systems if we are to fully realise the benefits of EMRs,” the researchers wrote.

“Design of EMR and interfaces should support clinicians to deliver care, reduce administrative burden, aid collaboration, and prevent errors and mistakes in medications.”

Dr Lloyd and colleagues hope to run further iterations of their study in the coming years in order to better understand the perspectives of nurses and midwives.

International Journal of Medical Informatics 2021, online 20 July