Reasons (not) to Spend a Few Billions More on EHRs: How Human Factors Research Can Help

Summary

Objectives: To select best medical informatics research works published in 2013 on electronic health record (EHR) adoption, design, and impact, from the perspective of human factors and organizational issues (HFOI).

Methods: We selected 2,764 papers by querying PubMed (Mesh and TIAB) as well as using a manual search. Papers were evaluated based on pre-defined exclusion and inclusion criteria from their title, keywords, and abstract to select 15 candidate best papers, finally reviewed by 4 external reviewers using a standard evaluation grid.

Results: Five papers were selected as best papers to illustrate how human factors approaches can improve EHR adoption and design. Among other contributions, these works: (i) make use of the observational and analysis methodologies of social and cognitive sciences to understand clinicians’ attitudes towards EHRs, EHR use patterns, and impact on care processes, workflows, information exchange, and coordination of care; (ii) take into account macro- (environmental) and meso- (organizational) level factors to analyze EHR adoption or lack thereof; (iii) highlight the need for qualitative studies to analyze the unexpected side effects of EHRs on cognitive and work processes as well as the persistent use of paper.

Conclusion: Selected papers tend to demonstrate that HFOI approaches and methodologies are essential to bridge the gap between EHR systems and end users, and to reduce regularly reported adoption failures and unexpected consequences.

 

MissingLinkText

Keywords

Medical informatics - human factors - organizational issues - electronic health record - health information technology adoption

 

 

MissingLinkText

• References

• 1 Health IT Dashboard, Office of the National Coordinator for Health IT (ONC). U.S. Department of Health and Human Services (HHS). dashboard.healthit.gov/
• 2 Nambisan P, Kreps GL, Polit S. Understanding Electronic Medical Record adoption in the United States: Communication and sociocultural perspectives. Interact J Med Res 2013; 2 (01) e5.
• 3 Wright A, Henkin S, Feblowitz J, McCoy AB, Bates DW, Sittig DF. Early results of the meaningful use program for electronic health records. N Engl J Med 2013; 368 (08) 779-80.
• 4 DesRoches CM, Worzala C, Bates S. Some hospitals are falling behind in meeting ‘meaningful use’ criteria and could be vulnerable to penalties in 2015. Health Aff 2013; 32 (08) 1355-60.
• 5 Le coût du dossier médical personnel depuis sa mise en place.. [The cost of personal health record since its establishment.];Cour des comptes 2012 (in French). http://www.ccomptes.fr/Publications/Publications/Le-cout-du-dossier-medical-personnel-depuis-sa-mise-en-place/
• 6 Direction générale de l’offre de soins (DGOS).. Programme Hôpital numérique. Rapport d’activité 2013 http://www.sante.gouv.fr/le-programme-hopital-numerique.html.
• 7 Black AD, Car J, Pagliari C, Anandan C, Cresswell K, Bokun T, McKinstry B, Procter R, Majeed A, Sheikh A. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Medicine 2011; 8 (01) e1000387.
• 8 DesRoches CM, Campbell EG, Vogeli C, Zheng J, Rao SR, Shields AE. et al. Electronic health records’ limited successes suggest more targeted uses. Health Aff 2010; 29 (04) 639-46.
• 9 Bowman S. Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications. Perspect Health Inf Manag 2013; Oct 1 10: 1c.
• 10 American Health Information Management Association (AHIMA).. Data Quality Management Model. Chicago, IL: AHIMA; 2012
• 11 Balka E, Tolar M, Coates S, Whitehouse S. Socio-technical issues and challenges in implementing safe patient handovers: Insights from ethnographic case studies. Int J Med Inform 2013; 82 (12) e345-e357.
• 12 Jenkin A, Abelson-Mitchell N, Cooper S. Patient handover: time for a change?. Accid Emerg Nurs 2007; 15: 141-7.
• 13 Wong MC, Turner P, Yee KC. Socio-cultural issues and patient safety: a case study into the development of an electronic support tool for clinical handover. Stud Health Technol Inform 2007; 130: 279-89.
• 14 Friedberg MW, Chen PG, Van Busum KR, Aunon F, Pham C, Caloyeras J. et al. Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy. Rand Corporation; 2013
• 15 Beasley JW, Wetterneck TB, Temte J, Lapin JA, Smith P, Rivera-Rodriguez AJ. et al. Information chaos in primary care: Implications for physician performance and patient safety. J Am Board Fam Med 2011; Nov-Dec 24 (06) 745-51.
• 16 Showell C, Thomas M, Wong MC, Yee KC, Miller S, Pirone C, Turner P. Patient safety and sociotechnical considerations for electronic handover tools in an Australian e-health landscape. Stud Health Technol Inform 2010; 157: 193-8.
• 17 O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med 2010; 25 (03) 177-85.
• 18 Holden RJ. Cognitive performance-altering effects of electronic medical records: an application of the human factors paradigm for patient safety. Cogn Technol Work 2011; 13 (01) 11-29.
• 19 Samaan ZM, Klein MD, Mansour MD, DeWitt TG. The impact of the electronic health record on an academic pediatric primary care center. J Ambul Care Manage 2009; 32 (03) 180-7.
• 20 Babbott S, Manwell LB, Brown R, Montague E, Williams E, Schwartz M. et al. Electronic medical records and physician stress in primary care: results from the MEMO Study. J Am Med Inform Assoc 2014; 21 e1 e100-e106.
• 21 Flanagan ME, Saleem JJ, Millitello LG, Russ AL, Doebbeling BN. Paper-and computer-based workarounds to electronic health record use at three benchmark institutions. J Am Med Inform Assoc 2013; 20 e1 e59-e66.
• 22 Wears RL, Perry SJ. Shadows and ghosts: the role of hidden information in a US healthcare setting. Proceedings of the International Ergonomics Association 2006 Congress. Maastricht, Netherlands: International Ergonomics Association; 2006
• 23 Wears RL. The chart is dead—long live the chart. Ann Emerg Med 2008; 52 (04) 390-1.
• 24 Buntin MB, Burke MF, Hoaglin MC, Blumenthal D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff 2011; 30 (03) 464-71.
• 25 Turner AM, Reeder B, Ramey J. Scenarios, personas and user stories: User-centered evidence-based design representations of communicable disease investigations. J Biomed Inform 2013; 46 (04) 575-84.
• 26 Mathews SC, Pronovost PJ. The need for systems integration in health care. J Am Med Inform Assoc 2011; 305 (09) 934-5.
• 27 Garfinkel H. Studies in ethnomethodology. NJ: Englewood Cliffs; 1967
• 28 Militello LG, Arbuckle NB, Saleem JJ, Patterson E, Flanagan M, Haggstrom D. et al. Sources of variation in primary care clinical workflow: Implications for the design of cognitive support. Health Informatics J 2014; Mar 20 (01) 35-49.
• 29 Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform 1999; 55 (02) 87-101.
• 30 Norman DA. Things that make us smart: Defending human attributes in the age of the machine. Basic Books (AZ); 1993
• 31 Hutchins E. How a cockpit remembers its speeds. Cognitive science 1995; 19 (03) 265-88.
• 32 Hollan J, Hutchins E, Kirsh D. Distributed cognition: toward a new foundation for human-computer interaction research. ACM Trans Comput Hum Interact 2000; 7 (02) 174-96.
• 33 Zhang J, Patel VL. Distributed cognition, representation, and affordance. Pragmatics & Cognition 2006; 14 (02) 333-41.
• 34 Norman DA. Cognitive artifacts. Department of Cognitive Science, University of California; San Diego: 1990
• 35 Kirsh D. The intelligent use of space. Artif Intell 1995; 73 (01) 31-68.
• 36 Lave J. Cognition in practice: Mind, mathematics and culture in everyday life. Cambridge University Press; 1988
• 37 Gibson JJ. The ecological approach to visual perception. Psychology Press; 1986
• 38 Varela FJ, Thompson ET, Rosch E. The embodied mind: Cognitive science and human experience. MIT press; 1991
• 39 Lakoff G, Johnson M. Philosophy in the flesh: The embodied mind and its challenge to western thought. Basic Books (AZ); 1999
• 40 Clark A, Chalmers D. The extended mind. Analysis 1998; 58 (01) 7-19.
• 41 Goody J. The domestication of the savage mind. Cambridge; New York: Cambridge University Press; 1977
• 42 Park SY, Lee SY, Chen Y. The effects of EMR deployment on doctors’ work practices: A qualitative study in the emergency department of a teaching hospital. Int J Med Inform 2012; 81 (03) 204-17.
• 43 Gille B. The History of Techniques. New York: Gordon and Breach Science Publishers; 1986
• 44 Schuemie MJ, Talmon JL, Moorman PW, Kors JA. Mapping the domain of medical informatics. Methods Inf Med 2009; 48 (01) 76.