It is critical to make the electronic health record (EHR) easy to use, to prevent errors that may be harmful to patients. This is common sense. We have had many fine scholars detail the unintended consequences to patient safety when EHR usability is poor. I work to address these issues in my own research. I write about, evangelize about it, teach my students about it, and incorporate it into my research. So, today I got a full dose of what happens when one of the most common mistakes happens: patient identification error. I brought my daughter to the doctor for her annual physical, and because she is a junior in high school, I waited in the waiting room for her to finish. First of all, we really do respect and like our physician group...but mistakes happen. When the doctor called me in for the conclusion of the visit, both the doctor and my daughter let me know that there was a mix up and that indeed, my daughter was NOT on the three medications they thought she was [she is on no medications]. Apparently one of the office staff members had entered these meds into her chart erroneously... and they've been there on the chart for months. In my absence from the exam room, apparently the conversation from the doctor to my daughter did assume she had the associated health problems that accompany the erroneously listed medications. Luckily my daughter spoke up for herself and let them know that those were wrong, and they must have the wrong information. It was my daughter who said to me... "Mom, what if I could not have spoken up for myself? What if I were unconscious? I am glad I was able to correct it." Now, I realize that this is an all too common mistake... and I realize that the personal example is, luckily, rather innocuous. But, to my daughter's point... it could easily have been worse. And, unfortunately it is worse for so many people. The doctor's office discussed that there are several other patients by the same name, so that is how it happened. Understood. But, this is an excellent example of why a standard in EHR usability would help to prevent this from happening. I am not talking about having all EHRs look and feel the same way. I am, however, talking about standardizing well established design principles that already address patient identification. For example, consider the NISTIR-7804 (https://www.nist.gov/sites/default/files/documents/2017/04/28/EUP_WERB_Version_2_23_12-Final-2.pdf) report to the design recommendation of preventing patient identification error. In other words, let's do a better job immediately on these preventable usability issues. Let's help our medical staff members by making it harder to make an error, and easier to get it right!
Point of care (POC) touch screen wall mounted data capture systems are being used by many long term care facilities (LTC) across the country as an efficient means for nursing assistants / CNAs / STNAs to enter in information on vitals and other daily care updates after they give daily care and assist their patients. Reports indicate an improved user experience when the screens are larger than a standard computer screen (at least 24 inches by 30 inches). When mounted at a reasonable height with a height adjuster arm, these POC screens can enable CNAs to capture the data on a patient's vitals and ADLs right away, instead of having them jot the information down on paper, for the nurse to add to the EHR later. This latter model allows for too much time to go by before nurses and other clinical staff are alerted to a potential health complication. Many LTC facilities have only a few screen monitors, and they are typically mounted in the common hallway for easy access. Privacy can be an issue, as CNAs are entering data in public spaces on large boards. Timed logout for inactivity, as well as easy ways to log in and out aid in improving usability and the over all user experience. Additionally, screen privacy protector elements can be added (so that passers-by cannot see the information from the side)...and have been successful at allowing the CNA to enter data freely without compromising privacy. These devices can help make a difference in patient care, but how long will these be relevant? What further changes can you recommend on improving the user experience of this health IT device to improve patient care? Will these devices become more prevalent? Will they be health IT of the past?
As I am talking with nursing homes and other long term care centers about using health information exchange (HIE), there is a lot of positive feedback, yet, I am encountering a similar story. That is...the facility only trained one person to use HIE, and when that person left his/her job for a new job... no one was left who knows the ins and outs of using HIE. So, what can we do about this? It would be great to train as many staff members as possible for using the system. Perhaps we need to move to a model of not only training more people, but also using a "train the trainer" method. Employee turnover can be problematic for long term care. We need to help ourselves by preparing others in the organization to learn the best ways to use HIE (and other health technologies). Ideally, HIE needs to be easier to use. What can we do to make this easier?
Sociotechnical theory is a lens through which to view how health information technology is ultimately used... especially in the context of long term post-acute care. That is, the technology can provide the right capability, but it needs to fit into the daily workflow of staff members to bring the tech in line with the social patterns of use. Yes, you need "champions" of the system to promote its use. Yes, you need "buy in" from staff members. But, ultimately, you need the end users to see how it benefits them, and how they are required to use it. Little by little, long term care will benefit by health IT advances. Once the health IT is being used, and benefits are derived, and the tech has become part of the social pattern...we will see benefits to our loved ones who may be living there or passing through after a hip fracture. It's a journey...let's go!