Rasu Shrestha, MD, Vice President, Medical Information Technology, UPMC

Rasu Shrestha, MD, is Vice President of Medical Information Technology at the University of Pittsburgh Medical Center (UPMC). He is also the Medical Director of Interoperability & Imaging Informatics and Division Chief of Radiology Informatics.

To Interoperability and Beyond!

brain hooked up to a computerWhile the federal meaningful use program aimed to incentivize adoption of new health IT, outdated interfaces and the lack of interoperability remain significant impediments.
July 21, 2014 AT 7:15 PM

As a clinician, I find the usability of clinical information systems challenging at best, horribly inefficient and fraught with risks at worst. Unfortunately, we as a health IT community have learned to tolerate these challenges. As a result, clinicians find themselves playing detective rather than clinician, as they hunt for information and navigate through a sea of applications, tabs and folders. We are functioning in an environment where we are data rich and information poor. 

Electronic Medical Record (EMR) adoption rates have been slower than expected, and one of the key reasons often cited is the lack of efficiency and usability of the EMRs currently available.

While Meaningful Use is intended to encourage adoption of health IT, the reality is that challenges with data interoperability and universal adherence to data standards have slowed our progress toward reaping the real benefits of interoperability. Even healthcare institutions like ours, with advanced data interoperability efforts in place, continue to deal with daily challenges of true data sharing and information flow across multivendor EMR settings. 

The problem is that EMR vendors have not been incentivized to universally adopt true data interoperability, opting instead to either not move very quickly away from proprietary standards or to just adopt standards on an as needed basis, primarily to meet the minimal standards dictated by Meaningful Use regulations. 

Consequently, existing clinical information systems are still using antiquated user interfaces with variable reporting formats that display results as incomplete, hard to read, fragmented data. Clinical information systems also lack adherence to basic design principles, and seem to be clunky and antiquated. 

In essence, a system with good usability is easy to use and effective. It is intuitive, visually pleasing and allows one to perform necessary tasks quickly, efficiently and with a minimum of mental effort. Tasks which can be performed by the software (such as data retrieval, organization, summary, cross‐checking, calculating, etc.) are done in the background, improving accuracy and freeing up the user's cognitive resources for other tasks.

As the healthcare IT community continues to move from analogue to digital, it is critical for us to focus on usability. It is not enough merely to replicate paper-based workflows with clinical information systems. We must bring our patients' stories to life in a visually rich, contextually relevant, highly usable format. 

Interoperability is a noble mission, and the task at hand is not just to stand up a data aggregation platform, or enable a rudimentary level of clinical data exchange – the real mission is to enable better clinical workflow. I should not have to struggle to piece data together from multiple locations – and my cognitive resources should be freed up for other tasks, such as more meaningful interaction, face to face, with my patients. 

Improving clinical workflow begins with interoperability and ends with a serious focus on usability, design, clearer information visualization and actionable intelligence at the point of care. Better usability should mean efficient, safer, higher quality, better coordinated care, and it should be a goal for every EMR vendor, developer, designer, programmer and clinical informatician.