The scoop on our scope
Research is well underway. The team reached out and connected with healthcare providers — physicians, nurses, and other support staff in the medical field — as well as thought leaders, to not only get a better understanding of how EMRs are viewed by those who engage with it the most, but also narrow the scope of our research.
We’re a month in and it’s gone by so, so quick. There’s a ton of information to absorb, so let me distill our findings thus far.
EHRs have a complicated history.
Let’s frame the state of healthcare as we know it and understand how it affects EMRs specifically.
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH Act) came into play as part of the 2009 federal stimulus bill during the Great Recession. Then there’s the “meaningful use” measurement, which was part of a different initiative within The American Recovery and Reinvestment Act of 2009 (ARRA). Medicare and Medicaid Services created the EHR Incentive Program as part of the ARRA, and established incentive payments to accelerate the adoption of EHRs and other health IT. In other words, this meant that doctors would be qualified for Medicare subsidies of up to $44K over a five year period.
And then there’s interoperability, a concept where different EHR platforms, whether it be Epic, Cerner, or AllScripts, are able to freely talk to one another and exchange information. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is tightly intertwined with interoperability. Its overarching objective is to pay participating providers based on the quality and effectiveness of their care rather than fee for service. Finally, the Department of Health and Human Services (DHHS) rolled out an implementation incentive program called Merit-based Incentive Program to evaluate how providers document information on the quality of service given to patients. All of the above affects healthcare treatment, and inevitably, how EHRs and EMRs are designed. Think lots of drop downs, clicks, and information to record. And yes, you and I both wonder how this process can be transformed at its current state for the better.
Providers _________ (fill in the blank) about EMRs.
Secondary research gave us mountains of information on the state of healthcare. Still, user research had to be done to understand how physicians are impacted by EMRs as well as how they treat EMRs. At the discovery phase, we want to uncover patterns of behavior and arrive at a handful of design opportunities. Questions at this phase of research include:
How do providers view EMRs in general?
What does writing an EMR affect a physician’s or nurse’s day-to-day?
Which systems have they used and what do they think of them?
What was their training process like? How was training structured and was it effective?
How do these providers learn best?
What does post-training support include, if any?
EMRs are beloved, and yet, a burden.
Primary research consisted of phone interviews with doctors (including third year residents), nurse practitioners, and registered nurses. Though care providers are scattered across different departments, roles, and specialities, there’s a general agreement on EMRs: patient engagement is the first priority and EMRs come second. EMRs, though a necessary and mighty resource of patient history, aren’t flexible systems that work alongside and in favor of providers. They’re too big to function optimally — a behemoth of text requiring more of the physician’s time than they can offer.
Secondary research echoes these very findings. Though an older article, this doctor’s thoughts on digitized medicine still remain true, that is, “doctors and nurses are now tethered to computer appliances.”
Healthcare is moving towards ambulatory care.
Finally, like any other industry, our secondary research tells us that this space is evolving. Its climate is changing as large healthcare organizations are purchasing physician practices and consolidating the little guys. Too, there’s a movement towards pushing inpatient procedures and services to ambulatory facilities. The movement towards ambulatory care is largely a response to cost, but also other factors such as better patient satisfaction rates and an avoidance of the big hospital groups that inevitably have bureaucracies.
Design has the potential to bring meaning to this space.
Given the state of healthcare, its changing operational and business motivations, and potential for design to make an impact for our client, our team is honing in on exploring ambulatory EHRs further.
Thanks for sticking around this far down the page. Jia Liu has got a nice post on our research plan coming up next week. It’s going to be a good read. ;)
Cheers,
Daphne and the HIT Squad
