Current electronic medical records (EMRs) are, at best, just good enough and need to be much better, says one of the leading voices about human-computer interaction.
Ben Shneiderman, PhD, Distinguished University Professor in the Department of Computer Science at the University of Maryland-College Park and founding director of the Human-Computer Interaction Laboratory, understands this both as a professional and as a patient.
“I just came from my doctor, and I asked her if she could tell me what she thought of her experience with electronic medical records. Immediately, her reaction was a wince,” he said. “She confirmed what I’ve heard on many occasions: That these make life difficult for physicians.”
Dr. Shneiderman will deliver The ABOG Educational Foundation Lectureship on Patient Safety and Quality Improvement, “EMRs: The Good, Bad, and Ugly of Patient Safety” at 2:10 pm today in Ballroom ABC. He helped create the highlighted textual link in 1983 and later worked on Spotfire, known for pharmaceutical drug discovery and genomic data analysis.
“More than 1,700 companies provide different components of the EMR system,” he said, but no regulations or widely-accepted guidelines exist to ensure specific quality and design standards. Dr. Shneiderman will make the case for voluntary industry guidelines.
“Physicians are spending a lot of time and effort and anguish dealing with these poor designs,” he said. “We know this is going to get better, but my job is to make sure it gets better in 15 years, not 50 years.”
EMRs have significant potential to improve care by increasing the data that can be collected and improving access to that data. But Dr. Shneiderman noted that this means medical providers ask more questions and risk becoming more form fillers instead of care providers. One study estimates 10,000 clicks for a care provider during a typical day.
One wrong click could mean entering information into the incorrect form, entering data for the wrong patient, or choosing the wrong medication.
“My issue is user-interface design. I see these as design problems, and, therefore, things that can be fixed by better design and better testing,” Dr. Shneiderman said. “Yet, the inherent problems are that the industry has resisted the kind of oversight and regulation that might lead to open, honest reporting of the problem.”
Physicians have told Dr. Shneiderman of finding bugs in EMR systems and informing EMR providers only to learn that the companies knew about the problem without alerting customers. Some companies fear that an admission of previous flaws could open the door to legal issues. Also, contracts between companies and care providers generally stipulate that complaints cannot be made public.
Dr. Shneiderman wants to see the medical field establish a stronger culture of safety and openness about flaws and failures.
“When there’s an airplane problem, Boeing alerts every one of their customers and they go running out to the planes to check what’s going on and inform everybody,” he said. “And yet, with medical care, there’s not the same sense of urgency to rectify even potentially deadly problems.”
Dr. Shneiderman has collaborated with some companies to improve the design and usefulness of EMRs, and he will share some of those during his ACOG presentation. One collaboration, called medication reconciliation, compares patient-provided drug lists with ones from a pharmacy. He also is working on improved processes to enable clinical researchers to find patterns that lead to more successful treatment outcomes.
This afternoon’s presentation will also cover the Learning Health System, a movement to create social and technical processes that improve data sharing and create a world where every patient will be in a form of clinical trial at every office visit.
“My strong argument is that the incentives need to be put in place and the rewards for good behavior need to be made more visible so that the participants in this $2 trillion medical industry really are devoted toward continuous improvements,” Dr. Shneiderman said.