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KLAS Researcher: Getting to Usability in an EMR is a Long Journey

June 14, 2013
by Gabriel Perna
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Usability in an electronic medical record (EMR) is one of the industry’s hot button issues. One of the complaints often heard from practitioners is that the systems weren’t designed with them in mind.

In a recent report, the Orem, Utah-based firm, KLAS Research looked at the usability in various ambulatory EMR systems. After surveying 163 providers to accumulate its information, most of whom represented physician leadership either as a CMIO, CMO, or medical director, the research company determined that the athenahealth (Watertown, Mass.) and Epic Systems (Verona, Wisc.) products were the most usable. McKesson (San Francisco, Calif.) ended up on the low end of the scale.

Even with this disparity, Mark Wagner, senior director of clinical and ambulatory research at KLAS and the report’s author, contends that the overall consensus is usability is not positive. “Counting clicks, counting downtime, thinking about how often they have to do a particular process and how many patients they have to see, physicians are adding it up and saying, ‘Boy I’m losing efficiency if I’m doing this personally.’ So providers are definitely saying that the usability isn’t where it needs to be,” he says.

Wagner spoke with Healthcare Informatics Associate Editor Gabriel Perna on the report, detailing how providers defined usability, what areas of the EMR most affected their usability score, and what some did better than others.
Excerpts from that interview are posted below.

Mark Wagner

How do providers define usability? How much has to do with how well the vendor can collaborate with the provider?

Getting to usability, it takes effort. Probably the biggest thing we found with this report, regardless of the system being discussed, is that there is no out-of-the-box, completely usable system. Even the vendors whose scores came in high at the go-live, even their providers said there was still quite a bit of work to get where they needed to be.

What’s interesting, and [on the topic of] why we targeted medical leadership, individual physicians within the same organization have different perspectives on usability, based on their individual work styles and technology needs. Having that medical leadership perspective told us what decisions were made at an institution level about how things will be deployed and configured, and can give us perspective how those leaders made decisions for their group. And then they can tell us how much work it took to make the system usable.

What areas of the EMR, ePrescribing, medication reconciliation, physician documentation, etc., were most integral to the companies’ usability score?

Keep in mind some of these things are just coming on for the physician practice.  Medication reconciliation is not one that these vendors have had a long history in doing. It’s coming along but it’s not there.
If you’re looking at what’s integral to the providers’ perspective today, I’d say the key ones are documenting the encounter and seeing the patient information. That patient history is huge because you have to find stuff quickly. But you also have to document efficiently without taking a lot of time and clicks.

What makes athenahealth’s system stand above the rest?

Here’s the reality of the athenahealth EMR. It is the newest of those measured to market. So I’d say one of the advantages is they’ve had time to sit back and watch and develop. And they’ve had time to build to the needs in the current market, without having a lot of historical code to deal with. There is not a lot of baggage with what the athenahealth system was built to be today. It’s easier to be nimble when you don’t have the historical perspective to take into account.

On the other end, what are the McKessons doing wrong with usability?

From the provider’s perspective, there is a combo of challenges for McKesson. One stipulation, this size of the market, is not Practice Partners’ (McKesson’s software) sweet spot, it’s not their forte. But it is selling the product in that market, and it’s a fair representation.

The providers said that there are challenges in terms of the product itself and in terms of the overall relationship. I think part of score is a reflection of not only the pure straight forward ‘here’s my experience,’ but you’re seeing frustration from providers that impacts their perspective. When providers are challenged with new releases that are problematic, and they are challenged with support issues that go unresolved, and they don’t feel like they have a voice with the executive team, those frustrations impact the way they answer the questions.

How do you expect these usability numbers to change as providers get deeper into meaningful use, worse or better?

The vendors, the ones that have the might, depth, talent and resources to stay with it, they will improve pieces of functionality. There is no question they will improve [usability]. You start down the path, you learn some things, you fix it, and it gets better. The scores will get better across the board. The flip side to that is because meaningful use is going to ratchet up the percentages and expectations, there will more pressure, so there may be less tolerance for shortcomings.

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