AMA Focus On EHR Usability – Not Enough?

Physicians in general are not satisfied with their EHRs, citing problems related to loss of productivity, difficult to learn tools, and excessive data entry requirements.  The AMA recently announced a framework for EHR usability which is an important component of any effort to improve physician satisfaction.  However, there are several other considerations that would allow marked improvements in user satisfaction with EHRs that do not require modifications to existing systems. These include advanced user training, workflow optimization, and improving the business acumen of EHR users.

The AMA outlined eight key challenges providers face when using EHRs.

  1. Enhance physicians’ ability to provide high-quality patient care;
  2. Support team-based care;
  3. Promote care coordination;
  4. Offer product modularity and configurability;
  5. Reduce cognitive workload;
  6. Promote data liquidity;
  7. Facilitate digital and mobile patient engagement; and
  8. Expedite user input into product design and post-implementation feedback.

All of these represent important considerations that EHR software vendors in particular need to address during software design and software implementation.  Solutions to each of these challenges are discussed in detail in the article (link below).

However, they do not specifically address several areas of need and opportunity that have impacted the use of EHRs. Given competing priorities and the software development life-cycle, in general many of these changes will not reach users for a minimum of 12-18 months. A small but growing number of EHR users have managed to take full advantage of their current systems to create patient care and business environments that have resulted in:

  1. Marked improvements in patient care
  2. High levels of user satisfaction with their EHR systems
  3. Increase levels of compliance with documentation and coding requirements
  4. Significant increases in revenue, primarily tied to increases in patient volume and adherence to clinical guidelines.

How can this be achieved?

1. Gaining an advanced knowledge of the EHR system: Providers rarely have more than a limited understanding of their EHRs.  Financial pressures and limited EHR vendor implementation resources typically result in inadequate implementations. Providers and their staff tend to learn just enough to generate notes, orders, manage results, and submit claims.  They typically do not have a full understanding of the capability of their systems and how it can be customized for marked improvement in workflow proficiency. Practices that become “experts” in their EHR and practice management systems have much higher satisfaction rates than those who only understand its basic features. Seeing a doctor who only has basic knowledge of their EHR is akin to employing an accountant who barely knows how to use a spreadsheet.

2. Assessing office workflow: Dramatic gains in efficiency have been achieved by practices that analyze the role of each office staff member and how the EHR can be used to greatest advantage to protect the practice’s most valuable resource: physician time. This requires knowledge of how other similar practices have achieved optimal results and a comprehensive understanding of the EHR and practice management system’s capabilities.

3. Understanding the business rules of medicine: Providers in general have a fairly limited understanding of specific payer rules on reimbursement tied to documentation and coding.  EHRs generally have automated coding support that when used by someone with advanced coding knowledge can significantly improve the accuracy of coding.  Most providers using EHRs are not aware of data elements supported by evaluation and management (E/M) coding guidelines that are not captured or addressed by their EHR systems.  A example of this is the ability to recognize 3 chronic conditions and their statuses in the HPI, or the ability to recognize that manual review of an image has twice the value of reviewing a report for the same image when determining the level of complexity of medical decision making.  A full understanding of these business rules and many others allow providers to make informed decisions when determining the final E/M code.

The Solution:

A focus on usability, as proposed by the AMA, is an essential aspect of any effort to improve the use and value of EHRs.  In addition, providers, vendors and consultants need to focus on getting providers and their staffs to more fully embrace and understand the features of their EHR and PM systems.  The value of workflow optimization in any industry cannot be overemphasized.  EHRs offer features that allow for significant improvements in workflow and documentation efficiency that users have generally not used to their advantage. No one would challenge a provider earning increased revenue if it was tied to increases in patient volume.  Finally, EHRs are not only clinical tools but also business tools.  A full understanding of coding principles and how a specific EHR supports decision making tied to E/M and other types of coding is greatly empowering to physicians.

Link to AMA Framework Document: Improving Care: Priorities to Improve Electronic Health Record Usability

The information contained within this article, unless otherwise attributed, represent the opinions of its author Michael Stearns, MD, CPC, who serves as a health information technology and compliance consultant.

Please submit comments.  Dr. Michael Stearns can be reached at