Can the EHR be fixed by eliminating typing and clicking?

In a recent Harvard Business Review article, two prominent healthcare experts call for fixing what is wrong with electronic health records. And they find a lot wrong. 

As they see it, if an array complexities were eliminated, it would not only alleviate physician burnout, it would also dramatically improve healthcare.

Robert Wachter, MD, who heads the Department of Medicine at the University of California, San Francisco, and Jeff Goldsmith, national adviser to Navigant Consulting and an associate professor of public health sciences at the University of Virginia, collaborated on the article.

"Clinicians are spending almost half their professional time typing, clicking and checking boxes on electronic records," they write.

EHRs, they said, "can and must be made into useful, easy-to-use tools that liberate, rather than oppress, clinicians."

Mashing up functions such as charting, clinical ordering, billing/compliance and quality improvement inside the EHR has been a disaster, they argue.

Why? "Because the billing/compliance function has dominated."

Wachter and Goldsmith note that dropdown menus, data input by typing and navigation by point-and-click are not working.

"These antiquated user interfaces are astonishingly difficult to navigate," they write. "Clinical information vital for care decisions is sometimes entombed dozens of clicks beneath the user-facing pages of the patient's chart."

The authors call for a revolution in usability – one in which care of the patient is primary.

"Typing and point-and-click must go," they say.

Instead, Wachter and Goldsmith favor voice- and gesture-based interfaces – noting that using a keyboard and mouse is not only clunky but is also unsanitary.

There's much more to their vision: They suggest roles for AI, groupware, patient portraits, decision rules, data visualization, voice commands, alert systems and improve clinical workflows.

"Today, one can see a path to turning the EHR into a well-designed and useful partner to clinicians and patients in the care process," they write.

Twitter: @Bernie_HITN
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