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EHRs dehumanizing patient-doctor interactions

Are EHRs dehumanizing

patient-doctor interactions?

There is nothing more frustrating to a patient than talking to their doctor, wanting advice, and that provider is typing away and looking at a computer screen instead of the patient. That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record.

Dr. Lloyd Minor

Dean, Stanford University School of Medicine

Physicians see EHRs as a storage - not clinical - tool; about half say it detracts from their clinical effectiveness

IMPLICATIONS

Doctors

For Doctors

Rather than focusing on the interaction
with the patient, healthcare providers are involuntarily thinking of what needs to be documented or navigating the complex EHR.

Patients

For Patients

With the doctor distracted with documentation, the human element from the interaction is depleted. The patient is often left feeling unheard.

There lies a pressing need to upgrade the existing system for healthcare providers and practices to improve their relationships with patients and deliver top-notch services.

Our Client

A global leader in healthcare IT, helping over 130,000 doctors and nurses and 850,000 medical professionals worldwide to deliver quality care and industry-leading Practice Management solutions.

THE BRIEF

Create an EHR of the patient's clinical details to enable the provider (user) to view the most important aspects of the patient's health history in order to make the right diagnosis for the patient’s current visit.

CHALLENGE

The focus of the research was to truly understand what patient data is relevant as per the context that it is being viewed in. While the research could help us learn about data that is repeatedly referred to, understanding the latent needs of the providers was crucial, as it enabled decision-making. Uncovering these needs would help us establish data points that passively aid decision-making and diagnosis.

Mission Statement

Enhance the EHR to provide all the vital and relevant information to the primary user (doctor) in a single glance so as to help him make an informed diagnosis.

DESIGN PROCESS

At Koru, our design process is focused on improving the usability, accessibility, and delight provided in the product interaction. Keeping the user in the center of the creative process leads us to create designs that are clutter-free, easy, intuitive, scalable, engaging and provide a fabulous experience to the users.

RESEARCH

  • Understand and review data that a provider would refer to for a patient during the visit
  • Review the visit process from the provider's perspective
  • Review and study documentation generated post appointments

SYNTHESIS

  1. Journey map for office/virtual visits
  2. Clinical information referred to by the physician
  3. Actions that a provider could take
  • Prescribe medication
  • Prescribe lab/diagnosis
  • Refer to another doctor
  • Set a followup appointment
  • Change the parent diagnosis

User Journey For Office Visits

KEY FINDINGS

Information

  1. Patient information is scattered across the system. It is not easy to contextualize it around a specific problem, event or time.
  2. It is difficult to establish the integrity of the information as it is tough to determine when it was last updated, source and point of verification.

Documentation

  1. Documentation is intensive and that impacts the quality of consultation wherein more doctors emphasized on collecting information that was required for documentation and relatively lesser on patients’ description of their condition.
  2. Doctors often struggled with navigating the system and were often seen to be using only a specific set of features potentially due to design debt.
  3. The system did not have the capability to read into the data documented by the providers. Therefore on occasions, doctors would prescribe treatment with incomplete details which would then be left to other entities (nurses/subordinates) in the journey to validate.

Building the Design Brief

FOCUS AREAS

UX Approach

The objective was to create a simplified snapshot of the patient’s vital details so as to enable the provider to process it in a short time and complete his intended action. We had to ensure that the provider be more focused on the interaction with the patient, rather than be distracted by the overwhelming EHR usage.

The idea was to create an EHR tool that’s actually a source of assistance instead of being a source of intimidation.

All the while, we had to ensure that patient safety and compliance standards were fulfilled.

IDEATION

We made multiple variations that were tested with the users. We wanted to evaluate the prototypes on the following.

Direction A

Direction B

usablity

The findings were compiled in the Usability Testing report, and the final design direction was based on those results.

DESIGN

The process of validating the solution begins with transforming the wireframes and prototypes into actual images with themes, components, and styles applied to them.

Design

Highlights

.


Floating toolbar is visible through the scroll, gives for continued access to editing
Easy visibility of context of the patient’s current visit

All the important and relevant details are available at a glance
Patient History is visible as a timeline

Dictation tool records the conversation and lets the doctor proceed with the discussion without having to worry about documenting
Suggested codes during documentation speeds up data entry and reduces erroneous entries
Floating toolbar is visible through the scroll, gives for continued access to editing
Easy visibility of context of the patient’s current visit
All the important and relevant details are available at a glance
Patient History is visible as a timeline
Dictation tool records the conversation and lets the doctor proceed with the discussion without having to worry about documenting
Suggested codes during documentation speeds up data entry and reduces erroneous entries
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CONCLUSION

The EHR system was implemented to create efficiencies in workflow, providing accurate, updated, and complete information about patients at the point of care. Quick access to patient records was enabled for more coordinated, efficient care and improved clinical decision-making.


“An intelligent EHR system is a crucial tool that helps us be proactive and attentive during a patient interaction. With a simple and easy-to-navigate EHR such as this, I am better able to inform patients about trends in their personal data, and provide evidence-based medical care.”

Dr. Harry Nguyen