A JAMA article penned by two doctors builds upon a recent CMS final rule calling on health systems and vendors to work together to improve EHRs.
New guidelines are needed to minimize the cognitive load imposed by electronic health records, according to a physician-written proposal published last week in JAMA Network Open.
Making Electronic Health Records Both SAFER and SMARTER states that a recent final rule issued by the Centers for Medicare & Medicaid Services should stimulate shared responsibility between EHR vendors and health systems to improve EHRs by reducing the cognitive load on clinicians and making EHRs more readable.
"Cognitive attention of the clinical team is a scare resource – one that is essential for quality health care," say Kevin B. Johnson MD, MS, of the department of biostatistics, epidemiology, and informatics at the University of Pennsylvania, and William W. Stead, MD, who served as chief strategy officer for Vanderbilt University Medical Center from 2010 to 2020.
The authors state the EHR is a "complex sociotechnical infrastructure for automating clinical and administrative workflows within a healthcare facility or system," and it is "not designed primarily to capture and present a patient's record as efficiently and effectively as practical."
The CMS final rule recommends that hospitals assess their healthcare IT for safety and usability, which should spur the needed policy changes, the authors note.
They recommend that health system leaders debunk myths about what clinicians must document, avoid steps or interruptions in clinical workflows unless they are time-critical, and align decision support to role and task.
Other recommendations include supporting goal-oriented searches, automating routine tasks, monitoring care decisions and suggesting alternatives, recognizing trends from idealized patient models, translating actions into documentation, and exposing contextually relevant data.
Today’s focus on interoperability opens the door to integrating novel approaches such as self-documenting clinical environments into tomorrow’s digital connectivity infrastructure, Johnson and Stead concluded.
Scott Mace is a contributing writer for HealthLeaders.