The first national study of Electronic Medical Record (EMR) systems in Australia has found they rate poorly for usability and benefits with hospital doctors.
The survey that drew responses from 224 doctors (143 hospital-based and 81 GPs) found that EMRs were perceived by most in the hospital system to be difficult to use, of poor technical quality and with limited or no benefits in terms of preventing errors or sharing data with other health providers.
Many of the problems were blamed on the systems being developed for the US market with a focus on data collection and billing rather than supporting clinicians to improve workflow for better patient care.
Responses from doctors using hospital-based EMR systems general scored about half of those of doctors using EMR systems designed for GPs, perhaps reflecting the wider adoption and longer experience of EMR systems in primary care, the study investigators from Griffith University said.
“Software glitches, dropdown menus, clicks, alerts and the disconnected patchwork of systems without seamless interoperability have been linked to ‘near misses’ and a higher risk of professional burnout,” they wrote in the International Journal of Medical Informatics.
The results showed that a low proportion of hospital doctors agreed with the following statements about EMR:
- Stable technical functionality (does not crash, no downtime) – 59% hospital vs 82% GP
- EMR responds quickly to inputs – 47% hospital vs 82% GP
- Information sometimes disappears – 41% hospital vs 21% GP
- Ease of use: fields and functions arranged logically – 28% hospital vs 69% GP
- Titles and labels clear and understandable – 35% hospital vs 79% GP
- Routine tasks straightforward without need for extra steps – 22% hospital vs 58% GP
- Can be used with a lot of training – 17% hospital vs 57% GP
- Easy to obtain patient info – 36% hospital vs 71% GP
- Data entry is quick, easy and smooth – 22% hospital vs 65% GP
- EMR system helps prevent medication errors – 38% hospital vs 75% GP
- EMR systems support information sharing between clinicians in same service – 62% hospital vs 74% GP
- Supports information sharing between clinicians in different health services – 17% hospital vs 21% GP
- Supports information sharing and collaboration between clinicians and patients – 9% hospital vs 31% GP
Study authors Dr Sheree Lloyd from Griffith University’s School of Applied Psychology said the findings had important implications because EMR usability was critical to reduce complications such as missed care, medication errors, compliance, and re-presentation.
“As well as the likelihood of increased errors, problems with EMRs can lead to fatigue and burnout,” she said.
“In the middle of a global pandemic, now more than ever we need to have a digitised system that is effective and easy to use for both medical and nursing professionals across sectors, but what we have found is that most EMRs have been designed as data collection tools rather than collaboration tools.
“In addition, most EMR systems used in Australian hospitals were developed in the US and may not be aligned to the workflows and practices of the Australian health care system.”
The authors added that the poor ratings for EMR may have arisen because hospital-wide systems have tended to be implemented later than those in the primary and community care sector, and have had a narrow focus.
“EMRs have traditionally targeted the role of doctors and have been designed from a biomedical perspective but now there’s much more emphasis on a collaborative approach to health and wellbeing with a variety of clinicians providing medical care to patients,’’ said Dr Chris Bain, a Professor of Practice in Digital Health at Monash University.
The investigators said they intended to repeat the survey in 2022 and aim for a larger representative sample of EMR users across Australia.