Pushing back on the digital filing cabinet toward EHR usability
Photo: Oscar & Associates for HIMSS
LAS VEGAS – One major purpose of the electronic health record is to help doctors organize information about their patients so they can deliver effective diagnosis and treatment. But because of the way these systems are designed, they are often failing at that task, according to Dr. Yaa Kumah-Crystal, assistant professor of biomedical informatics and pediatric endocrinology at Vanderbilt University Medical Center.
Kumah-Crystal spoke at HIMSS21 here yesterday about the concept of skeuomorphism: the act of designing a digital product to match a physical product with which consumers are already familiar. Skeuomorphism can be a useful tool, especially when trying to encourage widespread adoption amongst a population that isn’t necessarily tech-savvy. But it can also be limiting.
“I would like to wager that our EHR is a skeuomorphic filing cabinet,” Kumah-Crystal said. “You go to the filing cabinet, and you unlock it. You have a tab called ‘chart review.’ You open up that tab, and you go to a place called ‘labs’ that also looks like a file from a filing cabinet. And you scroll through to find the thing you need, just like searching through a file folder. And then you double click, or you pull out the piece of paper you need. All of that to get the information. You are literally going through the motions of a filing cabinet, an archaic device, to get information out of this digital EHR.”
This design is more than just clunky – it also means that most data elements in the EHR are discrete and disconnected, meaning the physician has to piece together the full picture of their patient.
“Every piece of content in the EHR, every clinical encounter, every lab stands alone,” Kumah-Crystal said. “There’s this disconnect of the way we’re using our data that defeats the whole purpose.”
At Vanderbilt, Kumah-Crystal and her team are testing VEVA (Vanderbilt EHR Voice Assistant), a voice technology that lets the doctor interact with the EHR in a much more natural way, asking questions about the patient and quickly getting answers both verbally and on the display.
Kumah-Crystal admits that VEVA, and voice in general, may not be the answer or the only answer. But it’s important to push the boundaries of how doctors relate to their computers.
“Right now, computers are like an intrusive third party. And you’re staring trying to figure out where the heck a piece of data is, because it was scanned in by PDF because we don’t have interoperability, and your patient is thinking, ‘Why’s it taking so long, is something wrong with me?'” she said. “If we could remove that barrier and have that computer deliver that information, where and when we need it. … It doesn’t have to be voice. But just the concept of being able to query and understand the problem you’re trying to solve and having the standards in place so anyone at any time can ask a question and get the same answer, and train it to respond back and explain its level of confidence, that’s the end in mind.”
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