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As someone who worked in the electronic health records industry, closely with design teams, and has thought more deeply about certain aspects of this problem th

As someone who worked in the electronic health records industry, closely with design teams, and has thought more deeply about certain aspects of this problem than anyone else in history (not exaggerating), I think you're missing major factors. First, yes, productivity was one of the goals of the forced move to electronic health records systems. The federal government passed the HITECH Act in 2009 creating economic incentives for doctors to switch to EHRs because it would be better for public health, Medicare billing, and also because it would supposedly unlock doctors to spend more time with patients and be more productive, via the use of technology. The reason that third thing has failed, to my mind, is largely because the government, in the same act, required a HUGE list of requirements be met by the software designers making the EHRs. This list, by law, needs to be prioritized in scrums over customer requests and design thinking. Sometimes it makes good UX impossible. Ironically, the government, hearing this feedback, actually added a new requirement to the list: "Safety-Enhanced Design" [0]. Go read that regulatory requirement and see if it makes any sense to you. That's why design sucks in EHRs. [0] https://www.healthit.gov/test-method/safety-enhanced-design https://www.healthit.gov/test-method/safety-enhanced-design

soulofmischief 4y ago
What do you see as the way out of this mess?
- johndhi 4y ago
  Hmm. There are many layers of problems in the healthcare system, EHRs with bad design only one. I will say that small, private clinics who only accept private insurance don't necessarily need to use a federally certified EHR. They are legally allowed to build their own system. One example is OneMedical. When you ask the doctors/PAs/nurses at OneMedical about their EHR, they actually love it. I think the first step would be validating my anecdotal experience here by polling doctors using non-certified EHRs to see if they like them more. If they do by an overwhelming amount, I'd first take that evidence to the Office of the National Coordinator (the government agency created by the aforementioned HITECH Act who makes the certification criteria). I'd tell them that if they vastly simplify the criteria and add more flexibility, they'd make doctors happier. I guess the problem is that happy doctors, unfortunately, isn't necessarily aligned with the existing federal laws. Probably you'd need to pass a new statute at Congress, this time around with the benefit of talking to a lot of people with experience making EHRs.
  - soulofmischief 4y ago
    Do you think this is feasible and could happen within the next decade given moderate effort? I considered targeting standardization in health tech for a while and uncovered a similar layer of red tape as you describe. We can't continue to let our medical system continue to lag behind the rest of the world's and good EHRs are a part of that.

soulofmischief 4y ago

What do you see as the way out of this mess?

johndhi 4y ago
Hmm. There are many layers of problems in the healthcare system, EHRs with bad design only one. I will say that small, private clinics who only accept private insurance don't necessarily need to use a federally certified EHR. They are legally allowed to build their own system. One example is OneMedical. When you ask the doctors/PAs/nurses at OneMedical about their EHR, they actually love it. I think the first step would be validating my anecdotal experience here by polling doctors using non-certified EHRs to see if they like them more. If they do by an overwhelming amount, I'd first take that evidence to the Office of the National Coordinator (the government agency created by the aforementioned HITECH Act who makes the certification criteria). I'd tell them that if they vastly simplify the criteria and add more flexibility, they'd make doctors happier. I guess the problem is that happy doctors, unfortunately, isn't necessarily aligned with the existing federal laws. Probably you'd need to pass a new statute at Congress, this time around with the benefit of talking to a lot of people with experience making EHRs.
- soulofmischief 4y ago
  Do you think this is feasible and could happen within the next decade given moderate effort? I considered targeting standardization in health tech for a while and uncovered a similar layer of red tape as you describe. We can't continue to let our medical system continue to lag behind the rest of the world's and good EHRs are a part of that.