A bad user interface can turn an EMR/EHR into a minefield of medical errors and inefficiency.

Jen Lau

“Hold on, let me get my reading glasses.” I sat there wheezing.

The nurse was painstakingly trying to enter my basic symptoms on a tablet while I was sitting in the urgent care exam room for what turned out to be acute bronchitis. She had to squint at the minuscule lists and tabs to find and select each symptom, repeatedly stabbing at the small checkboxes with her stylus because of the parallax of the resistive display. This was a computer display interface slapped on a touchscreen. The technology was meant to make it easier on provider and patient, but it just made things more difficult and inefficient.

It’s amazing how noticeable inefficiency is when you can’t breathe. But the experience I had made me wonder about experiences others have at the mercy of an electronic medical record (EMR) or electronic health record (EHR). Looking beyond the functionality, what are the experiential costs of a poor user interface? Here are five user experience (UX) issues I’ve noticed from my work in the field.

Medical Errors

Although EMR/EHRs have improved the risk of medical errors, the poor experience of the interface also has the potential to cause medical errors. Patient information is not often contextualized to bring relevant information to the attention of the clinicians. Trying to find relevant information in a complex system makes it difficult to view what is needed in a timely fashion, which may result in medical errors. Also, many systems do not communicate with one another, resulting in redundant patient entry in which vital information may not get translated to all systems across one institution.

Labor Costs

How many more patients could be seen if the interface was organized more efficiently? Speeding up redundant tasks by minutes a day, multiplied over a year, multiplied by the individuals performing the same redundant tasks can amount to thousands—if not hundreds of thousands—of dollars of labor hours. Of course, that is once you understand the system. What about the additional hours of individual training required to understand such a complex, counterintuitive system?

Quality of Care

Time spent charting, reviewing instructions, and taking down patient notes leaves less time for the clinicians to look up from the screen to interact face to face with their colleagues, let alone patients. At some institutions, time spent with patients is a mandated requirement.

Workarounds

With a cumbersome workflow, workarounds become more of a commonplace occurrence to help accomplish everyday tasks, including passwords written down and hidden beneath keyboards, post-it notes of reminders and communications stuck to workstations and monitors, taking workflow notes on Microsoft Word or notepads to better assess patient care, and more.

Repetitive Motion or Stress Injuries

With more time spent at the computer, the risk of repetitive stress injuries (RSIs) increases, resulting in increased health costs and missed work by employees. The purchase of ergonomic computer hardware and workstations may also be an unintended cost to help prevent RSIs.

Because EHRs/EMRs are externally imposed systems that prioritize security and regulatory requirements, incorporating good user experience is a seemingly nebulous activity in which the social costs of implementation are rarely considered. But if we take a closer look at how users experience a system, we can find myriad ways of saving costs, improving safety and morale, and, of course, improving patient care.

Jen Lau is a UX/UI Designer at Battelle.

[main image courtesy of NAYPONG/FREEDIGITALPHOTOS.NET]