EHR Systems: The devil is definitely in the details.

A few years ago, I was involved in managing a surgical facility during the reaccredited process. I was relieved that we passed with flying colors despite the typical turnover in staff and the number of part time and per diem nurses used over the years since the last survey. I realize turnover and use of part time or per diem staff is not uncommon for most medical facilities, but it does make it harder to ensure everything is done and documented in a consistent way. One of the deficiencies our surveyors noted was with the center’s medical records. The staff was placing allergy stickers only on the charts of patients with known allergies as a way to alert nursing staff. It seems like a good thing to do but what we didn’t realize is that were actually increasing the risk of overlooking someone with an allergy by doing so. As our surveyors pointed out, all it takes is for someone to simply forget the sticker for us to overlook a patient with allergies. The real intention of the sticker is for it to remind the nursing staff to ask the patient about allergies during their admission process.

Like any Administrator, I remember the things that we got wrong more than all the things that we got right. I had planned to remedy the issue by implementing an EHR system the following year. I figured that it would take care of the sticker issue and make charting easier for the staff to do and manage. Unfortunately, my plan didn’t come to fruition because the facility was sold. So this sticker issue has stuck with me since.

I got some insight last week during a webinar on user interface design for EHR systems given by Robert Schumaker, Managing Director of User Centric. To help explain how the user interface affects two key factors of EHR adoption – usability and learning curve – Robert shared some examples of systems used within the industry. He was addressing the impacts of typography on reading speed and comprehension when I saw the electronic version of the allergy sticker. Unfortunately it was highlighted as one of the problems on the screen because it was scrunched into the top right hand corner, written in text smaller than any other on the screen and was underlined rather than colored like all the other links. Despite being one of the most important things on the page, it didn’t seem to get much consideration when the system was designed.

However, it was enough for me to start imagining the possibility of a smart link that uses the allergy information to identify products that could trigger a reaction in the standard course of treatment. A smart link could potentially negate the need for a pretty button if there was an automated warning that popped up in a dialogue box or something. It would be awesome but then I started thinking about the challenge of making something like that work. All the supply lists, preference cards and treatment protocols that would need to be loaded to the system. It’s a lot of data with no easy way to access it or load it. Basically, it’s the same reason most inventory systems don’t get use or used to the fullest extent.

If I was tasked with choosing a system today, I’d dive into the detail to see how much thought has been put into the overall design. Most EHR systems offer features and functions to meet industry standards but it’s the details such as the proper use of color and fonts, optimum sentence length and intuitive sentence structures that improve the quality of data capture and make the system easy to use.