News Feature | December 10, 2014

Human-Centered Automation: Keeping EHRs Useful For Doctors, Centered On Patients

By Megan Williams, contributing writer

Managed Services, Backup And Recovery, And Networking News

One of the major complaints you’ll hear about EHRs from clinicians as a solutions provider, is that they distance patient and doctor interactions — bad timing in a healthcare environment that is moving increasingly toward a patient-centered focus.

This article from The Wall Street Journal highlights the detrimental effect increasingly automated healthcare practices and workflows can have on doctor-patient interaction and posits a design-based EHR solution to address the issue.

Is Automation Making Us Dumb?

The article highlights some of the detriments of automation and uses the example of airline pilots who lose their flight skills as a result of too much reliance on autopilot. It also reflects the shift in overall pilot attitude to one of reactivity, instead of proactivity, because of excessive automation in their work.

Healthcare faces similar challenges.

“With the rise of electronic health records, physicians increasingly rely on software templates to guide them through patient exams. The programs incorporate valuable checklists and alerts, but they also make medicine more routinized and formulaic — and distance doctors from their patients.”

Article author, Nicholas Carr, sited a study from 2007-2008 that involved 75 physicians at SUNY Albany, who had been using EHRs. The study revealed that the doctors felt they had a decreased understanding of patients, and that their ability to make “informed decisions around diagnosis and treatment” was diminished.

“Harvard Medical School professor Beth Lown, in a 2012 journal article written with her student Dayron Rodriquez, warned that when doctors become ‘screen-driven,’ following a computer’s prompts rather than ‘the patient’s narrative thread,’ their thinking can become constricted. In the worst cases, they may miss important diagnostic signals.”

The Question Of Human-Centered Automation

The answer, Carr suggests, comes in the form of centering the patient and the doctor in the design of computer information systems. Healthcare data systems, as they stand, are largely process centered — the looming ICD-10, for example, is structured primarily around the purpose of billing, not patient well-being.

Thankfully, research around a new focus in healthcare IT has begun. Work like the paper, “Towards a context model for human-centered design of contextual data entry systems in healthcare domain” by Maxime Baas, Stéphanie Bernonville, Nathalie Bricon-Souf, Sylvain Hassler, Christophe Kolski, and Guy A. Boy, has already begun to examine new models in the medical field. Work like this most importantly includes analysis of questionnaires of healthcare professionals, and acknowledges the roles of both software and hardware in the system.