With NHSX launching a national survey to get views on the usability of electronic patient records, Dr Constantin Jabarin, practising senior A&E clinician at Gloucestershire Hospitals NHS Foundation Trust and CCIO at Allscripts, discusses why accessibility needs to be given greater prominence by both software vendors and NHS IT procurement teams.
Speak to anyone in the NHS and they will be able to tell you stories of frustrations with technology. Stories of having to log in multiple times, often necessitating different passwords and credentials, because patient notes, observations, test results and radiology images are viewed in different systems.
It’s not uncommon to log into all these programmes to view a patient’s information, only to have to change location within the hospital and then start the process again because there is no ‘follow me’ system setup. But not only that – when you have logged in to the right place, it can often take multiple steps, or clicks, to carry out tasks which are repeated many times every day. This is ‘usability’ and is something that is becoming more of a focus point as we understand the impact that this constant frustration has on clinicians, and their patients.
It is my view that usability should be considered in its broadest terms. It is the workflows, or clicks, that a clinician must take when navigating the EPR. But it is also the speed of the solution, which is going to be determined not by the software, but by a hospital’s hardware and infrastructure. Another element is how the user interface looks and specifically, whether it helps the end user navigate the system. Now this may seem trivial but it’s what we have come to expect due to the advancements in technology and our everyday use of apps and devices in our personal lives.
Designed with user in mind
NHSX has launched a national survey to better understand the usability of electronic patient records (EPRs). Its intentions, it says, are to ensure that the technology used every day works for staff, is designed with the user in mind, and that systems deliver all the benefits that they should.
The questions focus on whether current EPR systems in use in the NHS meet certain expectations, such as being easy to learn, integrate in and out of the organisation, are flexible and able to be configured in different ways according to different department needs or specialties, and most importantly, that it keeps patients safe.
Now, the intentions behind the survey are admirable. However, I would urge caution when it comes to the interpretation of the results. For the questionnaire will only prove insightful if it is accurate – if those filling it in know which solution they are responding about. Unfortunately, for most users – not all of them, but most – the company logo that they see when they log into their EPR is the company that they will attribute all problems to regardless of whether there is a third-party solution in play.
Also, the IT solution is just a tool for the clinician to use – a tool that can be used correctly or incorrectly. If a solution hasn’t been implemented properly, or there are issues with data flow or the way the work processes have been mapped, then it is not going to work as it should.
All about efficiency
As a practicing A&E clinician and as CCIO at Allscripts, I probably spend more time than most pondering the issues of usability and the impact that EPR systems have on clinical practice. Systems that are easy to implement and simple to use provide rapid benefits for clinicians and patients.
Efficiency is a key factor for me, and I believe is something that NHSX should be giving more prominence in its survey. Rather than focusing on the inconvenience caused to everyday practice, I feel it would be useful to gain feedback on how solutions are impacting efficiency.
One of the core benefits that a good EPR can have on this measure is the decision support and guidance it can offer to junior members of clinical staff. There is less time now, it feels, for teaching junior clinicians. Medicine is evidence based and so, if clinical decision support logic is built into the EPR, it can provide an element of teaching. Now, this won’t replace teaching from senior staff, but it will provide reassurance and guidance, which shouldn’t be underestimated. It can guide clinicians to do the right thing at the right time which can reduce the potential for harm.
Choosing the right EPR
I view the selection of an EPR to be like choosing a car to buy. You need a car that has the right functionality, is comfortable, affordable, looks nice, and is fit for purpose without too many control panels or switches. The car you need will depend on how you want to use it.
So, like a car, the perfect EPR will have just the right level of functionality that it is easy to navigate and aligns with your budget.
22 November 2021 @ 09:46
Good article. Just noting though that decision support behaving in the EPR as you propose in this article would very very definitely be a Class 2 medical device. Most EPRs in the current market do not consider themselves medical devices at the moment and are not registered as such. Are you aware of any such decision support that is in any EPRs now?
25 November 2021 @ 12:28
Hi Marcus and thank you for your comments – they are appreciated. For me, CDS in its most simplistic for is simple branching logic that is offered in a few of the larger EPR’s that I have used or had exposure in my years as a clinician and CCIO. As a result, they can be built to offer suggested routes or actions to the clinical users – the final decision is of course down to users like myself (when I am practicing that is!). Hence, not a medical device. However, I believe in the future this will change with the introduction of AI in decision making – it will start with ‘supporting’ the users with more targeted offerings, but as time goes on, I can see it driving decisions! In this context I am talking about the EPR solutions that are widely available rather than more bespoke solutions doing a specific role in a specific setting.
Personally, I can’t wait, but this is just my opinion!
Thanks again for the comment.