We’ve got a long way to go before information technology solutions at the frontlines of health care fulfill their enormous potential. The suboptimal, clunky and cumbersome design of most IT systems is responsible for much misery among physicians and nurses on a daily basis. Part of the problem is that hospitals and clinics have rolled out these solutions rapidly and somewhat haphazardly to fulfill meaningful use requirements and gain much-needed federal incentives. Having said that, there’s reason for some optimism ahead, as a movement gains steam to improve on the current situation.
While we are awaiting those “dream solutions” of the future, here are three immediate changes that can be made to the design of our electronic medical records and order entry systems:
1. Click analysis. Conduct a thorough audit of how many clicks and screen interfaces it takes to perform any given task (start with the most common ones such as electronic progress notes and simple medication ordering). This needs to be done with full input and feedback from frontline clinicians. In almost all instances, significant reductions can be made in the number of clicks required to do any specific thing.
2. Logical screen interfaces. In a lot of instances, the screen options do not follow simple logic. For example, the most commonly chosen option will often be listed at or near the end of any given list (instead of at the top), and too much of a screen may be dedicated to things which are irrelevant and rarely looked at. Ask anyone from a successful technology company, such as Apple (or even read any book about Steve Jobs himself), and you will quickly learn a golden rule: design is everything.
3. Comprehensible final output. When you actually view on a screen or on a printed piece of paper, the output that is generated from health care IT — be it a progress note, medication list or discharge instructions — there are few other terms that are more appropriate to describe this than computer gabble. In the past, there were intelligently transcribed history and physicals and discharge summaries, that looked logical and letter-like (in other words like they were formulated by a human being).
Now, instead of something that looks intelligible, we have “computer speak” which produces reams of data in an illogical format that means nothing and is very difficult to understand. If such a style of information was presented on a website, nobody would ever read it. IT folks should remember that physicians (and patients for that matter) are intelligent human beings who appreciate good grammar, sentence construction and paragraphs.
Improving on the above three things will be a good start to solving this problem. Rome wasn’t built in a day, and neither will health care information technology improve by simply doing only a few little things overnight. But taken together with better-designed systems from the bottom up, differences can be made to make IT solutions more seamless, efficient and user-friendly.
Suneel Dhand is an internal medicine physician and author of three books, including Thomas Jefferson: Lessons from a Secret Buddha. He is the founder and director, HealthITImprove, and blogs at his self-titled site, Suneel Dhand.
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