Should the federal government get involved in the design of electronic healthcare record systems? It's easy to dismiss the idea out of hand. If the camel is a horse designed by committee, then an EHR designed by a federal workgroup could also bomb by lacking a unifying vision and missing the sweet spot between being productive and appealing to use.
Of course the federal government does not want to direct commercial EHR interface design. But it does want designs that make it as likely as possible that care givers will easily take up new electronic tools. And it wants to make sure the design of those systems ensures the highest possible safety and reliability.
The Office of the National Coordinator has billions of dollars riding on EHR usability. Yet it has placed most of its financial muscle behind incentives for physicians to use EHRs in ways that will improve treatment outcomes: higher quality, lower cost, effective disease management.
And between those goals and the physician lies the labyrinth of interconnected screens and links that define the health IT user experience. For the federal government, the ingenuity and reliability of its design will be a deal-maker or deal-breaker.
As a federal official in our cover story in this issue put it: "The success of the HITECH Act is really going to hinge upon whether physicians actually make the leap to adopt electronic health records and whether they use the systems.
"There's a lot of attention paid to meaningful use, but then there's the whole issue of whether physicians are going to integrate the electronic health record into their life and be satisfied doing it. And usability is a key piece of that."
The federal government's primary goal is to raise the visibility of the issue within the health IT industry, according to our story. With so much riding on physician adoption, that's understandable. The government's goal is to encourage development of common principles"even measures" of health IT usability to balance the natural market focus on features and functionality.
In addition to improving the uptake of EHRs, the government has another reason to get involved: to foster the safest possible practices in using the technology. In this area federal health IT policymakers are heeding the experiences of the Nuclear Regulatory Commission, which pioneered the development of high stakes industrial safety standards. Certainly health IT practices should be no less safe and reliable.
