The Fundamentals of EHR User Experience (UX)

Fundamentals of EHR User Experience


The use of electronic health record (EHR) systems have consistently been on the rise. In fact, in recent years, the number of in-office healthcare professionals using EHRs increased from a minimum 20.8 percent to an impressive 82.8 percent according to statistics provided by The Office of the National Coordinator for Health Information Technology (ONC). Additionally, the use of electronic systems is projected to continue to grow, with Healthcare IT News indicating that this market alone will increase at a rate of 7-8 percent (or by $35.2 billion) by the year 2019.

These numbers are particularly impressive considering that some studies have also found that two out of every three chiropractors still don’t have an EHR system in place. These figures also indicate that the chiropractic profession is falling behind in a healthcare industry that is increasingly moving from paper to electronic records. And the growing demand for this is the need for more efficient and effective healthcare management.

Indeed, there are many different EHR systems available, making it difficult to select the best one for your chiropractic practice. But whether you’re purchasing an EHR for the first time or you currently have an EHR, and you’re looking to update it or switch to a newer, better system, there are four elements you’ll want to consider before making your final buying decision.
These are:

  1. Functionality
  2. Adoptability
  3. Usability
  4. Customizability

This guide intends to go through each one more thoroughly, providing you with the information you need to help you select the best EHR system for your specific chiropractic office.
With that in mind, let’s look at what each area means and how it can impact your office by choosing an EHR that meets specific guidelines within it.

Fundamental #1: Functionality

When talking about the functionality of an EHR, the big question you want to answer is: Does it work as it should? In other words, is the EHR going to provide you with all of the essential functions to run your office?

To best answer these questions, you’ll want to think of whether it offers integrated practice management, certification, 3rd party software integration, and automation—four primary factors of a functional EHR system. Let’s begin with discussing integrated practice management.

Integrated Practice Managemnt
Integrated Practice Management refers to the system’s ability to manage multiple functions within your chiropractic office. GetApp, a company specializing in business-related software, explains that using all-in-one solutions like integrated practice management functions offers many benefits.

For instance, you don’t have to switch between different programs, windows, or browsers just to complete one function and all functions work together in a more seamless process. They also point out that you’ll likely “spend less using an all-in-one solution,” than purchasing and updating individual programs.

At a minimum, an EHR needs the capability of handling all of the following functions:

  • Patient scheduling (including sending reminders, alerts, and messages)
  • Patient sign-in kiosk
  • Patient billing and claims processing
  • Patient portal accessibility
  • The ability to run business-related reports and statistics
  • Marketing capabilities
  • Inventory control

Also, keep in mind that, as your practice continues to grow, you’ll want an practice management system that will adapt. Even if you do not need for some of these functions now, you may anticipate them in the future. The last thing you want in a busy office is to switch to a more complex EHR system.

EHR Certification

Another factor to consider about functionality is whether your EHR is government certified. The Centers for Medicare & Medicaid Services explain that using a certified EHR provides “assurance to purchasers and other users that an EHR system or module offers the necessary technological capability, functionality, and security.” In essence, a certified system automatically satisfies many of your EHR needs.

If you’re choosing a certified EHR, you need to know if the certification is modular (where some EHR components are certified) or complete (where all EHR components are certified). This factor is essential when demonstrating Meaningful Use. Because, a modular system will require the use of 1 or more 3rd party programs, whereas a complete system will not. So the one that is best for you is based solely on what type of functions you want and need for your chiropractic practice.

Additionally, you’ll want to verify that the EHR is HIPAA (Health Insurance Portability and Accountability Act) compliant. This criterion ensures all data is adequately secure and legally protected.

Integrated Applications

EHR functionality is also affected by the system’s ability to interact with your other office-related equipment and programs. Ideally, when it comes to integration and interaction, you want an EHR that is capable of communicating directly with the diagnostic tools you use (enabling you to update patient records easily) as well as your clearing houses (for easier claims processing). It’s also helpful to select a system that enables both office staff and patients to log in securely, gaining access to the information each one is entitled.

These functions can save both you and your staff a tremendous amount of time because you only have to input information once. Additionally, you minimize data entry errors when there is no need to enter duplicate data in multiple places or multiple programs. As reports the average error rate with manual data entry is roughly one percent (or one error for every 100 pieces of data entered).

Automated Functions

Finally, any EHR that uses automated tasks will significantly improve its functionality at the same time reducing the risk of data errors. Examples of EHR automation include linking SOAP notes to billing, automating fees for covered and non-covered services (based on the individual insurance companies), calculating coinsurance and deductible charges up front, auto-posting insurance claims, and creating automatic treatment protocols.

The simple reason for automation is the less a person has to do manually, the higher the productivity. In fact, one case study involving 369 university library employees found that automation helped them “complete tasks faster, reduced work repetitiveness and enabled them to control tasks at hand.” Just think of the money you’d save if your staff were able to get more done in less time.

Fundamental #2: Adoptability

The second fundamental of the EHR user experience is adaptability. This concept refers to selecting an EHR system that is super easy to set up. Consider these three factors before purchasing; the ease of installation, the speed of setup, and the quality of training. In other words, you want a system that makes it easy to start using and has a low learning curve.

Ease of Installation

Ease of installation refers to how easy the software and subsequent updates are to download, and whether the download process itself is simple to follow. By choosing an EHR that offers ease and simplicity in these areas, you can save yourself and your staff a lot of frustration.

Additionally, ask if installation covers one computer or multiple PCs. Obviously, you want to have the convenience of accessing your data from a variety of locations within the office. In this case, you would need a local area network where all office computers would access the same data on one computer. For example, your main front desk computer would connect to kiosks within your reception area and workstations within your treatment rooms.

This setup enables you to have access to the most current patient information before treatment so you can provide better care. It also gives you the opportunity to enter the most detailed information during the session itself, which is essential for billing purposes as well as for documenting the treatment for reference at future patient sessions.

Speed of Setup

Adoptability is not only affected by the speed in which you’re able to start entering data for new patients but whether or not the EHR can import information from your existing patient records. If it doesn’t have this ability, you could spend costly time and money manually.

For instance, if your chiropractic office has records on 1,000 patients and the system doesn’t automatically transfer information from your existing system, even if your staff is extremely quick and can manually enter the information within 15 minutes per patient record, that is still 15,000 minutes total, or 250 hours of time—time that you’ll have to pay for solely because you didn’t select an EHR that could take care of this for you.

Access to Learning Resources

A third factor to consider when it comes to adoptability is whether the EHR system comes with access to the resources you need to use and understand the system. The most notable resource to consider is one-on-one training as this provides you and your staff the opportunity to learn the system with someone guiding you every step of the way.

This particular approach offers the most significant value according to one study published in AMIA Annual Symposium Proceedings Archive. In this case, after surveying 129 clinicians, researchers found that “improvement in the use of electronic medical record was greatest following one-one-one training.”

Other learning resources that are helpful when utilizing a new EHR system include those that are accessible online. These types of learning tools allow the user to access information from any location at any time with the most current and up-to-date information.

The online resources to look for about your EHR are:

  • Online tutorial videos
  • Online support forums
  • Searchable online owner’s manual

When you have access to these kinds of resources, you’ll always have answers to your EHR questions right at your fingertips with a simple click of the mouse.

Fundamental #3: Usability

Usability is the third fundamental of the EHR user experience, and it relates to how well the EHR system operates. The four areas that cover usability are ease of navigation, intuitive workflow, responsiveness interface, and visual design.

Ease of Navigation

Have you ever used a computer program that took so many clicks to use it that you ultimately gave up before you were able to gain some level of comfort because it simply took too much time?
That’s why ease of navigation is so critical. The fewer steps you have to complete your work, the lower your level of frustration.

For an EHR to be considered easy to navigate, all areas of the program should be accessible with the least amount of click-through steps. Additionally, displaying information in tabs as opposed to pop-up windows allows users to toggle back and forth between the different views quickly.

Lastly, having an EHR that enables both accounting and scheduling on dual monitors makes navigation more comfortable and significantly improves productivity. Two monitors give your staff the ability to see separate areas of information at the same time without opening and closing windows.

Intuitive Work Flow

Another factor affecting EHR usability is how it flows from one task to the next. The workflow when accessing and recording data should feel natural and based on the unique way you manage your patients. In other words, is the EHR intuitive to use?

Having an intuitive workflow also means selecting an EHR that doesn’t store duplicate or redundant information within the system, taking up unnecessary space or forcing you to scroll through information. This extra information is not only distracting but takes up viewing area; space needed for more valuable information.

Responsiveness Interface

Possibly the most important factor in usability has to do with an interface that is instantly responsive. The reason responsiveness is so important is due largely to a phenomenon called “Cognitive Drift.” Cognitive Drift is the sustained lapse in mental focus that occurs with delays in your EHR system when accessing or recording data.

And even a slight delay matters as Dr. Macaulay A.C. Onuigbo, Associate Professor at the College of Medicine, Mayo Clinic, shares that a mere 1-second lapse can easily lead to a higher number of errors. It also increases stress levels for the practitioner using the system by having to deal with the delay.

Some areas of EHR responsiveness to pay special attention to when selecting your EHR include:

  • The reaction time when accessing data
  • The reaction time when entering data
  • The reaction time when opening and close windows
  • The reaction time to operate software functions and controls

Responsiveness in these areas can also affect your level of patient care. For example, one study published in Health Systems found that some healthcare providers spend as much as 49.6 percent of their patients’ visits engaged with the computer.

Therefore, if much of your time with patients is spent dealing with a slow EHR system, that will dramatically affect the quality of your care. And your patient’s will notice. They will not want to hear you say “Sorry, my system is running a slow today.”

It’s also important to inquire about system responsiveness after entering all of your patient data. While it may be fast when you only have a couple of people entered, it might bog down once you start adding more and more data.

Visual Design

The fourth factor of usability involves the visual design of the EHR. For instance, does the program look professional? Is it pleasing to the eye? Are images and colors used in a way that helps you better locate and use the data?

This concept primarily refers to an EHRs graphical user interface (GUI). An EHR that maximizes a GUI interface dramatically improves data recognition and input. That’s because the brain processes images 4000 times faster than text.

Fundamental #4: Customizability

The fourth (and final) fundamental to consider when choosing the best EHR for your chiropractic practice deals with customizability of the system. Precisely what you want to ask is whether it can be designed specifically for you. You want to ask if it offers the ability to create and modify templates and macros and if it provides purchasing options in regards to EHR features and financing.

Specialized Design

Specialized design means two things. First, you want an EHR that was designed specifically for the chiropractic professional. Because your office operates differently than other healthcare professionals, you will have unique needs. In this case, it’s also helpful to choose an EHR that was designed by a chiropractor.

Second, you also want an EHR designed for your individual needs; needs that will allow you to select specific functions based on how you run your office. Here is were customization takes place using templates, macros and other options to manage your system.

Templates and Macros

At a minimum, an EHR should include the ability to create and modify templates, macros, or the forms your office repeatedly uses for billing, claims processing, patient relations, or other office-related functions.

Another way to customize the system is to change the layout of software functions and controls to best suit your chiropractic practice. The more you can tailor these to your office individually, the less time you’ll spend correcting notes and forms.

Choice of Purchasing Options

True customization of your EHR also means that you have access to several additional options, such as:
Purchasing options (for packages or add-on features)

  • Optional support features
  • Upgrade options
  • Subscription, lease or finance options

By being able to make more buying decisions in these individual areas, you’re ready to truly customize your EHR to precisely what you need without paying for anything extra.

Putting It All Together

When you choose an EHR system based on the four fundamentals of being functional, adoptable, usable, and customizable, you’ll increase the likelihood that you’ll purchase a system suited for your chiropractic office.

Admittedly, it can take a lot of time and effort to do your homework up front, researching all of the EHR systems available and studying whether or not each one will meet your needs, but this is time well spent. Especially considering the time, money, and stress that choosing the right system can save you over the course of the next 10, 20, or 30 years.