An Open Letter to Dr. David Blumenthal

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Below is a slightly expanded version of a letter I recently sent to Dr. Blumenthal, the new National Coordinator for Health Information Technology, and the members of the new national HIT Policy Committee.

Dear Dr. Blumenthal:

I am writing to you on the need for user-friendly electronic health record (EHR) software programs.  As a practicing physician with first-hand experience with hard-to-use CCHIT-certified EHR software, I would like to share with you a solution to this vital issue.

The CCHIT model for EHR software certification is fatally flawed because it mandates hundreds of required features and functions, which take precedence over good software design.  This flawed CCHIT model takes valuable physician time and effort away from patient care and leads to increased potential for errors, omissions, and mistakes.

As a clinician, I have had first-hand experience with a top-tier CCHIT-certified EHR.  Despite being computer literate and being highly motivated, after a year and a half of concerted effort, I still cannot effectively use this CCHIT-certified program.  The poorly designed software constantly intrudes on my clinical thought process and interferes with my ability to focus on the needs of my patients.

Just this year the National Research Council report on health care IT came to a similar conclusion. The report found that currently implemented health care IT programs often

provide little support for the cognitive tasks of the clinicians or the workflow of the people who must actually use the system.  Moreover, these applications do not take advantage of human-computer interaction [HCI] principles, leading to poor designs that can increase the chance of error, add to rather than reduce work, and compound the frustrations of executing required tasks.

Our health care system needs user-friendly EHR software, firmly grounded on what we have learned about how the human brain takes in, organizes, and processes information.

As an example of software based on usability principles, I would like to share with you a new design, the EHR TimeBar, which is one example of user-friendly EHR software design that can dramatically improve patient care.  Please see attached figure and description at the end of this letter.

I have no financial interest in this software design. My goal is to promote the emergence of user-friendly EHR technology that will improve the day-to-day lives of my colleagues and help us take better care of our patients.

We absolutely need standards for data, data transmission, interoperability, and privacy. There is no need, however, to specify the internal workings of EHR software. To do so will stifle innovative software designs that could improve our health care system. If CCHIT is allowed to mandate the meaning of the term “certified-EHR,” the $17 billion allocated for EHR adoption and use will largely be wasted.

The solution is to keep EHR certification rules simple to encourage an open market model. An open market will foster a competitive environment, leading to the emergence of user-friendly EHR software that is simple, helpful, efficient, and inexpensive – software that will improve both patient care and the day-to-day lives of our clinicians.

I appreciate your work and the work of the HIT Policy Committee members in crafting our new national health care IT plan.

Sincerely yours,

Richard Weinhaus, M.D.

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kontraktor pamerantorrentshell vs ventureumang KhetarpalSue ReberJ Bean Recent comment authors
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kontraktor pameran
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torrentshell vs venture
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we, supposed, was designed to attract the neighbouring blacks.

Not only does a digger realize that it’s very possible he may locate a great deal of gold with very little trouble, but, worse still, he knows he or she work very, very hard without getting any gold at all. Finding the Venus reef abandoned he went for the Four Mile, two miles distant, and discovered about fourteen Chinamen camped there.

umang Khetarpal
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umang Khetarpal

I agree with much of what has been said about EMR’s here. i too am very frustrated with my experience with a popular EMR that has forged links with Dell and WalMart. It is a counterintuitive process and makes us clerks instead of thinkers. From time spent on accessing previously scanned data to typing information in, the time committment and data entry is incredibly wasteful. It is a sheer waste of our talent to be spending time on EMR’s to ensure that the clinical info in HPI matches the ROS and that one has to manually enter this information in.… Read more »

J Bean
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J Bean

“It sounds as if AMDIS is describing a high risk of system failure. Could some of the problem be due to poor EHR design?”
Um, well yes. Good system design doesn’t allow the user to make mistakes. Mediocre system design doesn’t prevent user mistakes. Poor system design encourages mistakes.
We’ve already experienced multiple episodes of system failure, fortunately none leading to long term bad consequences so far. Our management intended to do the right thing by adopting an EMR (to replace the paperless system we were already using), but we got burned to the tune of $2M.

Rick Weinhaus
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Rick Weinhaus

From Rick Weinhaus to Scot Silverstein, Scot, thanks for the U.S. Air Force Guidelines (from the 1980s) for designing user interfaces. They still seem completely relevant. I was particularly intrigued by description of system failure: “Probably no single user interface design flaw, in itself, will cause system failure. But there is a limit to how well users can adapt to a poorly designed interface.” In regard to system failure, I was struck that AMDIS (see my reply above to Sue Reber, CCHIT) also recommended deferring CPOE (for hospitals) to 2013 or beyond. The letter states: “Even in the hands of… Read more »

Rick Weinhaus
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Rick Weinhaus

Rick Weinhaus replies to Sue Reber, CCHIT Sue Reber wrote: “You and other commenters may not be aware of CCHIT’s most recent announcement about including new certification programs that focus on the minimum federal requirements (ARRA/HITECH) for both modular EHRs and those developed on site.” Sue, thank you so much for responding as a representative of CCHIT. I welcome the opportunity to exchange ideas. I am aware of the new EHR-M and EHR-S certification programs. My concern is what will be the real life implications of having a three-tiered system. Let me give you an example. Just a few days… Read more »

Rick Weinhaus
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Rick Weinhaus

Rick Weinhaus replies to J Bean: J Bean wrote: “The product that I use now . . . doesn’t even meet the standards of the early 1990s . . . It’s not clear to me why there needs to be money invested in academic study of the [usability] problem.” J Bean, I find it useful to think about EHR human factor issues as high-level (user mental model – overview of how a patient’s health changes over time), mid-level (large scale screen design and UI idioms) and detail-level (number of clicks required, etc). The most usable software designs are those where… Read more »

S Silverstein
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S Silverstein

J Bean wrote: “15 years ago I was writing large scale training software for the military.” Here is mid 1980’s wisdom written for the U.S. Air Force on user interfaces. (Two decades later, healthcare IT design seems to be ruled by Mr. Magoo): GUIDELINES FOR DESIGNING USER INTERFACE SOFTWARE ESD-TR-86-278 August 1986 http://hcibib.org/sam/ SIGNIFICANCE OF THE USER INTERFACE The design of user interface software is not only expensive and time-consuming, but it is also critical for effective system performance. To be sure, users can sometimes compensate for poor design with extra effort. Probably no single user interface design flaw, in… Read more »

Sue Reber
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Dr. Weinhaus:
You and other commenters may not be aware of CCHIT’s most recent announcement about including new certification programs that focus on the minimum federal requirements (ARRA/HITECH) for both modular EHRs and those developed on site.
You may read about that here: http://cchit.org
Sue Reber, CCHIT

J Bean
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J Bean

HIT Usability: 15 years ago I was writing large scale training software for the military. We already understood a lot about the human factors of software back in that primitive area. The product that I use now (rhymes with GextNen) doesn’t even meet the standards of the early 1990s. It’s not clear to me why there needs to be money invested in academic study of the problem. When you are wrestling with a product whose GUI is inconsistent from screen to screen much less fails to operate with the standard user prompts that Microsoft uses you are starting from a… Read more »

Rick Weinhaus
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Rick Weinhaus

Reply from Rick Weinhaus to HIT Usability HIT Usability wrote: The industry needs to include folks who are experts at human factors and behavioral sciences (along with the clinicians and IT folks) to study user performance and UI design both in the lab and in the field…. Hit Usability: I’m in complete agreement. As I commented to Sarah Greene, it is puzzling to me that what we have learned from cognitive and human factors research has played such a small role in EHR design. In my opinion, barely usable EHR software (not cost, insufficient training, fear of change or obstinacy)… Read more »

HIT Usability
Guest

Dear Rick, In response to your last comment… “HIT Usability: Thanks for you post and I agree with your suggestions, including that we should promote EHR innovation through user research…” — We’re on the same page and I couldn’t agree more. We are currently investigating and will be applying for funds (HITECH or other discretionary funds from ONCHIT) to study HIT usability with an academic medical center/center of excellence. The industry needs to include folks who are experts at human factors and behavioral sciences (along with the clinicians and IT folks) to study user performance and UI design both in… Read more »

S Silverstein
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S Silverstein

Rick Weinhaus writes: “Scot, I have read your writings on usability and HIT failures with great interest, and it is clear that you have devoted much of your professional life to these issues. I have been particularly struck by your personal examples of how health care IT failures have caused harm to patients and clinicians. I would encourage readers to visit the links that you posted.” Thanks, Rick. However, still have not received any answers from anyone to my questions, the most important one being this. To repeat myself: For about ten years now, a google or other search engine… Read more »

erythropoeitin, md
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erythropoeitin, md

I read recently that before establishing a definition of “meaningful use” of the HIT products currently available, the vendors should be required to sell meaningfully useful technology.

Rick Weinhaus
Guest
Rick Weinhaus

From Rick Weinhaus to everyone, Thanks for your comments and suggestions. What I am most struck by is that all of you clearly have first-hand experience with barely usable EHR software applications based on the CCHIT model, and you all agree that the CCHIT model is flawed to the point that it could sink the entire HITECH initiative. I want to respond to everyone’s thoughtful comments in turn. Wendell Murray asked “What product did you buy.” Wendell, I will be happy to email you the name of the EHR application I am using. To name one or more EHRs here… Read more »