Usability is the most critical issue facing Electronic Medical Records (EMR) today.

A lack of usability is a major reason why EMR adoption has faced considerable resistance from medical practitioners throughout the country. Now, with the new Meaningful Use regulations pending, choosing an EMR plagued with usability problems may very well spell implementation failure for your practice. As a physician, you owe it to yourself, and your patients, to become more familiar with this misunderstood issue.

First of all, you must understand what usability means. Usability means “ease of use”, and should not be confused with “ease of learning.” Think of it this way; it is far easier to learn how to ride a bicycle than to drive a car, but no one would use a bicycle simply because it is easier to learn. Ease of learning is a worthwhile consideration, but it must be balanced with ease of use. If you are buying a product you expect to use over a lifetime, it is worthwhile investing your time to learn how to use the most powerful option available. With EMRs, you should be looking to purchase a software solution that will be part of your practice for the duration of your career. Do not make the mistake of buying an EMR simply because of its rudimentary learning curve; if you do, you are purchasing a bicycle when you really need a Learjet to take you where you need to go in your practice.

You must also clearly understand the root of most EMR usability problems. Most EMRs are only designed to meet the health care industry’s need for standardization rather than the physician’s need for a powerful tool that can help run a more efficient practice. Even worse, most EMRs will pass certification guidelines but have little emphasis on usability in the real world. Unless an EMR is designed for you, the practicing physician, it is bound to be user-unfriendly. Further, when the vendors of these standardized software programs address the new Meaningful Use regulations of the public health sector, you can expect that these EMRs will become even more, unfriendly, cumbersome and inefficient to use. There is a vast difference between a product that meets Meaningful Use, and a product that you can use Meaningfully.

So how do you know if you are looking at a Learjet or a Schwinn bicycle? How do you measure EMR usability?

The first question you should ask yourself is: “Was this product designed with my needs in mind?” To get to the heart of this matter, you should examine the thought process you use as a physician. The logical “inductive reasoning” approach learned by all of us in medical school and to which many of us pay-lip service today is not the way we truly think through a medical case (unless we are medical students, that is). Instead, in the examination room, our minds make use of a semi-conscious Gestalt mental mechanism to process highly complex and subtle data fast and effectively, often making the solution appear like magic in our minds. There is an art to diagnosing a patient.

Most EMR manufacturers do not realize this and as a consequence apply the inductive reasoning approach to their software. The result is the EMR template, the health insurance industry’s dream of standardization come true. For a physician, however, templates are a nightmare. Templates do not help your thinking process; instead, they get in the way. At Praxis, for more than 20 years, we have developed a radically different approach based on the way you think.

When it comes to usability, templates don’t cut it. One cannot boilerplate the personal art that is the practice of medicine- and an art form it is.  If medicine were not an art but a mathematical science, then a computer could easily take your place: The patient would simply input answers to questions on a screen, and then the computer would rattle off the illness, order the correct laboratory and other necessary studies, and provide the correct therapy. Having practiced medicine, you realize how ridiculous this is!

The fact is that no two doctors practice medicine the same way. Your individual training, experience, philosophy, and the clinical and non-clinical conditions surrounding your patient will determine the approach you take with each encounter. Fortunately, cases do tend to repeat themselves; otherwise medicine would be nearly impossible to learn. You constantly, almost semi-consciously, draw upon similar experiences emanating instantly into your consciousness from your own past. For the most frequent cases, this approach works well in the real world. The difficult, time-consuming part is charting it. Generating prescriptions, laboratory orders, procedure reports, letters to referring providers, admitting orders to the hospital, billing forms so you can benefit financially—this is where a computer can help you or can hinder you, depending on whether it works with your mind, or against it. This is where usability comes in! This is the single most important part of an Electronic Medical Record, the area to which you must pay very close attention.

Almost all EMRs are template-based, and templates have low usability.  They force you to adapt your thought process to a standard format. What you need is software that understands how you practice medicine.  Praxis delivers this superbly by learning your thinking process from you.

Praxis uses a neural network engine that continually learns your approach to medicine from each encounter. As you chart a case, Praxis reviews your previous entries and presents you with the medical record from the past that most closely resembles the case you are presently working on. Thus, Praxis not only charts at an amazing speed while generating all your clinical documents, but it reminds you how you’ve done it in the past to help you cross all your t’s and dot all your i’s. No template can do this. Praxis saves you a dramatic amount of time, but also decrease errors, helping you document quickly and accurately. In fact, the more you use Praxis, the smarter and faster it becomes. That is why Praxis is rated #1 in User Satisfaction Surveys in improving quality medicine¹. That is usability!

With the new meaningful use regulations, the government will become involved in the charting process more than ever before. If you ever thought that the Level of Service insanity was bad, wait until you start to deal with Meaningful Use! The new requirements are all about numbers and codes: Think of Levels of Service taken to the nth power!

No one has stopped to think of what Meaningful Use changes will do to you and your practice when using Template-Based EMRs. No one seems to understand that your work is NOT about codes. It is about people and diseases, and diseases are not black and white; they come in all shades of gray. Indeed, isn’t your medical practice based on uncertainties and probabilities?

In software we know what we know, but we don’t know what we don’t know. Third party payers, particularly Medicare, do not seem to understand much about the way you practice. Yet, there is something to be said for attempting to bring the cost of medical care down by making the entire health delivery system more efficient. The understanding of health delivery from a population standpoint will reveal what approaches improve health and at what cost. In fact, these studies may well end up increasing physician salaries rather than lowering them, as folks understand where the value-added comes in and where it does not. The idea of using codes to understand statistical occurrences at a community level is not bad in itself. At issue is how to generate these required codes and this critical communication with you in a user-friendly manner, without driving providers crazy.

In this respect, EMR templates worsen the situation dramatically. Imagine attempting to find codes among a myriad of pick lists provided by different vendors with every patient in every encounter. This is clearly not why you went to medical school!

Praxis EMR, in contrast, presents you with your own text using YOUR English and not “codeese.” Again, we are saying YOUR own English: No two individuals think the same way, and no two people use language the same way. We do not use the same syntax in the same order with the same choice of words to reflect our clinical thinking.  From this it follows that it is much faster and easier for you to read your own writing than someone else’s.

Praxis “finishes the thought” for you since it learned the words from your own previous encounter. This includes putting the crazy codes where they belong, automatically, without costing you anything or taking up your time. In fact, the process is transparent to you as a user. A template could NEVER accomplish this with ease. Remember, sending the codes to Medicare and other third parties is easy. Finding the codes you need exactly when you need them is something no template can do, but Praxis can.

Praxis 5 will help you not only chart at the speed of your mind, but will also generate the correct codes instantly when you need them, and transmit them to Medicare so they can use this knowledge to work on issues of cost-effectiveness and health improvement. Praxis will of course maximize your Pay-for-Performance indices with ease. It will link you to the world of codes and yet still allow you to think and practice great medicine your own way.

That is what usability should be all about!