The University of Nebraska Medical Center has received a $2.5 million grant to make the electronic health record (EHR) more useful for health professionals and safer for patients.
The five-year grant was awarded by the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality (AHRQ) to measure best practices across existing EHR systems, listen and learn what providers believe to be the ideal system, then build and test a model EHR system that can improve patient care.
John Windle, M.D., professor and chief of cardiology at UNMC, said the funding came from an understanding that the intended consequences of EHR adoption also had significant unintended consequences. His preliminary research suggested that physician’s resisted EHR adoption because they felt it adversely affected their workflow, communications among the health care team and ultimately adversely affected patient care.
"EHRs were originally designed, developed and optimized as a financial system and a way to document payment and services rendered," said Dr. Windle, principal investigator of the grant. "But the EHR really has never been designed or developed for the people using it to take care of patients. We've been adversely affected by it because of how we take care of patients. It slowed us down. It was a barrier to communication."
The project is a partnership between UNMC and the University of Nebraska at Omaha. Ann Fruhling, Ph.D., director of the Interdisciplinary Informatics School at UNO, is co-principal investigator of the grant and will lend her expertise in human-computer interactions to build models of the optimized EHR.
The study will involve measuring how cardiologists at diverse health care systems use their EHRs. Sites are: Duke Medical Center in Durham, N.C.; Christiana Health, a large multi-center hospital system in Delaware, Parkview Health, a community-based hospital system in Ft. Wayne, Ind.; and Faith Regional Health Services in Norfolk, Neb.
Dr. Windle said the research team expects to be able to identify even at the end of the first year, four or five best practices on how to improve efficiency, effectiveness and safety of the EHRs. While focused on cardiovascular patients, the results, which will translate across the health professions, will be shared with vendors of EHRs.
Unique to the grant is the development of realistic, complex clinical scenarios and the use of research team members trained as simulated patients to test EHR functionality. "The use of well-defined clinical scenarios and simulated patients allows us to obtain detailed measures of usability without violating privacy or security concerns."
The impact of this study could be huge, said Dr. Windle, noting that J. Marc Overhage, M.D., Ph.D., one of the original pioneers of EHRs, published that the EHR added about two minutes per patient in outpatient clinic visits.
"When you realize that there are 1.2 billion clinic visits a year in the U.S., that equates to a loss of a staggering 40 million hours of physician productivity," Dr. Windle said. "The EHR impacts not only physicians, but it affects nurses, technologists, pharmacists and the overall effect is a much larger impact.
"There is potential for the EHR to do good things. I think the impact of this small grant is going to ripple. We're just learning how to appropriately use this very powerful technology."
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