Lessons from EHR’s and Affordable Care Act website

fpm20070300p26-uf1 It is a mandate that requires physicians to transition to computerized versions of patients’ paper charts by 2015, according to healthit.gov, and is another unfortunate arm of the Affordable Care Act.  Doctors who don’t jump on board will lose 2 percent of their Medicare reimbursements starting in 2017. The government believes that electronic medical records will save Medicare funds and improve patient care.  According to the small-scale study of one ED, physicians spent 44% of their time entering data in their EHR. They spent 28% of their time in direct patient care, 12% reviewing test results and records, 13% in discussion with colleagues, and 3% on other activities.

The number of mouse clicks required for common charting functions and certain patient encounters ranged from six for ordering an aspirin to 227 for charting the ED stay of a patient with right-upper quadrant abdominal pain. During a typical 10-hour shift, a doctor clicked up to 4,000 times if he or she saw an average of 2.5 patients per hour.


Recent studies point to significant and growing problems with the usability of electronic health record systems and their effect on physician productivity. Some of these issues appear to be related to the addition of extra features to meet the meaningful use requirements, such as quality reporting and patient portals. Many physicians also have trouble documenting patient encounters in EHR drop-down boxes, which is an example of the poor usability of user interfaces. Moreover, current EHRs do not fit clinical workflow well, and practices have had to develop numerous workarounds to get their daily tasks accomplished.

Medical Transcription in EHRs vs Click Click Clickety Clack Typing

Key findings on a survey around EHR’s  include the following:

  • The percentage of clinicians who would not recommend their EHR to a colleague increased from 24% in 2010 to 39% in 2012.
  • Clinicians who were “very satisfied” with the ability of their EHR to improve care dropped by 6% compared with 2010, while the percentage of those who were “very dissatisfied” increased by 10%.
  • Thirty-four percent of users were “very dissatisfied” with the ability of their EHR to decrease workload — an increase from 19% in 2010.
  • In 2012, 32% of the responders had not returned to pre-EHR levels of productivity, compared with 20% in 2010.
  • Dissatisfaction with ease of use increased from 23% in 2010 to 37% in 2012, while satisfaction with ease of use dropped from 61% to 48%.

The Affordable Care Act website

It’s hard not to read about the problems around the ACA website.  There are two distinct problems; usability for consumers and access due to heavy demand.  The first issue, usability, could have resolved very easily if the government had conducted usability studies with the target audience rather than developing the website in a vacuum.   As for demand, they could have easily load tested their site and mirrored it on other servers to help with demand.

Key Lessons/Takeaways

(1) Usability studies should always be conducted with your target audience.  In the case of EHR’s software developers should have first studied the way physicians enter data and provided a workflow that was more intuitive.


(2) Anticipate demand.  When I launched Cialis online we were expecting a very heavy demand so we had our site mirrored on other servers to provide 99.9% uptime.

(3) You can never have enough lead time to develop a critical healthcare website.

database structure

2 thoughts on “Lessons from EHR’s and Affordable Care Act website

  1. Great post. Having been through systems development in a nonprofit, it is no surprise to me that healthcare.gov is a debacle. The EHR mess is another government-inspired IT project whose benefits are elusive. The figures you cite on keyboarding are pathetic. There is much copying and pasting happening to no real benefit to patient, provider, or payer.

    All these are perils native to the beast. But I agree that UX testing could mitigate many of them, especially the burdensome data entry imposed on clinicians.

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