We were thinking about the differences between EHR interfaces - and they are vast. Even for a single EHR system, each implementation can be customized and wholly unique. Many clinicians work in different EHR systems and implementations with varying interfaces, not due to changing jobs, but in the course of regular work. Examples include doctors like anesthesiologists and cardiologists who work in both ambulatory and acute care and the increasing number of clinicians who work locum tenens. Using one system requires extensive training due to the complexity involved. Even after the training, the systems are still difficult to navigate and can add administrative burden, cognitive load, and stress to a busy rotation. Multiple disparate systems add another layer of difficulty for those that have to use them.
What if EHR interfaces and workflows were standardized?
Medical records have made the switch from paper to electronic. It was a difficult process, and institutions did the best with what they had at the time. To fulfill their potential, EHRs need continually improve, but they seem to have stagnated. Feedback drives improvement, and a lot of what we hear coming from clinicians is that EHRs are complex systems that take time to learn. People are developing enhancements and best practices to improve usability, but those are locked into individual organizations, making them difficult to share and easily lost - when the individual driving the improvements moves to another position. With many different people making customized improvements to the EHR, each system evolves into something different. If we shared improvements and standardized them, everyone would benefit.
What would be the advantages of standardization?
Clinicians would have to learn a system once. All of the time spent on training wouldn't be lost encountering a new system. Having standard navigation and intuitive workflow would improve patient safety and reduce mistakes. The information would be more easily accessible, which is especially important in emergencies.
For example, newer airplane cockpits are highly computerized. Aircraft designers have combined analog gauges into a single screen. The new design reduces the cockpit complexity, but the pilot needs to know precisely where the information exists on the computer interface, especially in an emergency. If you are certified to fly a Boeing 737, you see the same standardized layouts and workflows programmed into the interfaces in every 737. It is safety in standardization.
What are the disadvantages?
Some won't like the lack of choice or the idea of reduced custom configuration. Standardization takes away the ability to customize around the nuanced needs of an institution. EHRs would still need to account for the unique needs of different roles when standardizing; A clinician in the lab needs different information than a clinician making rounds on the hospital floor. Without the ability to create customizations, it may be difficult to implement, capture and share innovative ideas.
How could we standardize at this point?
Standardization would likely require intervention from a governmental body, similar to what is being pursued currently with interoperability. An effort like this would require overwhelming data to show the benefit. The EHR companies might want to protect their individual designs to have a degree of differentiation but would have to agree on some uniformity in EHR design. The government would need to appoint industry-based mediators, and all stakeholders would need representation, most importantly, those who interact with the EHRs on the front lines from all roles.
Right now it would just be nice if we had an incredibly intuitive out of the box setup. Standardized or not, any move toward a more intuitive interface that supports commonly understood role-based best practices is a step in the right direction.