Death By A Thousand Clicks: Where Electronic Health Records Went Wrong

Has electronic health record improved the quality of health care?  Physicians, nurses, and others say a resounding NO.

There is a multitude of reasons:

1. Poor interface design, difficult to use, non-intuitive
2. Decreased workflow, fewer patients served.
3. Maintenance costs.
4. Information overload.
5. EHR does not follow the normal clinic workflow requiring workarounds.
6. The electronic health record is designed more like an accounting system, presenting non-relevant information, overloading the user's ability to focus on important data.

FDA Guidance has published information relevant to the design of electronic health records, however, it is generic and poorly focused on the relevant issues, and contains no reference to the quality of the content or usability.

The term 'meaningful use' is an oxymoron because it does not pertain to it's use by users, physicians, hospitals and others.

Early financial incentives brought to market inadequate and poorly designed electronic health records. The federal incentives were designed to enforce compliance with the collection of data, outcome studies rather than the effectiveness of health care using electronic health records.

Raj Ratwani (standing) studies eye-tracking with Dr. Zach Hettinger to see how doctors interact with EHRs.

Analysis of EHR acquisition is misleading. It is largely driven by incentives and a 'jump on the bandwagon' mentality which is directly opposite of how providers adopt new treatments or technology. ie, a technology doomed to fail.

Office adoption of EHR

Hospital adoption of EHR

Why Thousands of Doctors Still Don't Use Electronic Records

Electronic Health Record vendors struggle also to account for errors due to electronic health records and have implemented measures for reporting critical errors using Maude. Even that is highly flawed. Looking at their web site one can see it too is an overwhelming overload of nonrelevant information designed to 'account' rather than report. What physician or hospital would or could use it?

Others have turned to social media to vent. Dr. Mark Friedberg, a health-policy researcher with the Rand Corp. who is also a practicing primary care physician, champions the Twitter hashtag ­#EHRbuglist to encourage fellow health care workers to air their pain points. And last month, a scathing Epic parody account cropped up on Twitter, earning more than 8,000 followers in its first five days. 

Death By A Thousand Clicks: Where Electronic Health Records Went WrongKaiser Health News: Death By 1,000 Clicks: Where Electronic Health Records Went Wrong