Could poor training be behind the failure of the electronic health record?

The electronic health record (EHR) system has received billions of dollars in funding but has failed to fulfil its potential to significantly lower care costs and improve caregivers experience. Poor user training may contribute to this.

The aim of the Electronic Health Record (EHR) is to improve patient data gathering and data quality, ultimately seeking to improve patient care due to improved clinician information.

Research lead by Christopher Longhurst, University of California San Diego Health (CA, USA), on behalf of the Arch Collaborative (UT, USA), has exposed substantial discrepancies in user competency of the EHR system. The study surveyed over 72,000 professional caregivers, from 162 organizations to identify opportunities for deriving greater benefit from the EHR that is currently lacking.

This finding does not undermine the need for continual system design improvement and update; however, it highlights EHR user training and education as a crucial opportunity to potentially benefit from the system even further.

Less than 20% of variation in EHR use experience was found to stem from differences in the EHR software employed.  However, over 50% of the total variation could be ascribed to differences in individual physician use.

Because every major U.S commercial EHR software was measured in this survey, these data show that factors specific to individual physicians must be considered in order to reduce the scope of this variation. Reducing this variation is important as this may improve the quality of care physicians are able to deliver.

In 475 cases with two physicians of the same discipline, using the same EHR, in the same organization, one “strongly agreed” that the EHR helped them to deliver high-quality health acre, whilst the other “strongly disagreed” with the same statement.

In over 89% of these cases, the physician who “strongly agreed” with the statement concurrently reported overall better EHR training, including higher quality training and more training efforts.

Physicians who report poor training are more than three and a half more times likely to also report that they feel that the EHR does not enable them to deliver quality patient care.

Survey responses of collaborative participants show significant increases in users’ overall satisfaction with the system for each additional hour of EHR education they received. EHR users from organizations that provide less than 4 hours of EHR system training report low proficiency of system use and are less likely to indicate that the EHR aids their delivery of quality patient care.

Particularly lacking is training that helps users personalize the information they want from the EHR for their specific purposes.

In the study, the authors concluded: seeing as “physicians who reported receiving strong EHR training were significantly more likely to report feeling that the EHR enables them to deliver high-quality care (p < .01)”, it would be wise, going forward, for “health care delivery organizations” to “invest in EHR training with a focus on adoption of EHR personalization tools.”

Source: Longhurst CA, Davis T, Maneker A et al, on behalf of the Arch Collaborative. Local Investment in Training Drives Electronic Health Record User Satisfaction. Appl Clin Inform. 10(02): 331-335 (2019)