AMA: Competition Improves EHRs

There's more than one way to display an electronic medical record--and that's not necessarily a bad thing, says the American Medical Association's board of trustees.

The trustees favor the standardization of EMR features that affect interoperability, yet they also argue for letting the free market sort out the best "user interface," the software that determines how information is displayed and entered into the record. Competition among vendors will eventually develop better interfaces, the trustees say in a new report.

"At this time, any attempts to standardize products would stifle product innovation," the board concludes. "Just as medical practice has evolved, so will the EMR marketplace."

The trustees' recommendations reverse a 2009 AMA stance calling for standardized user interfaces.

"Studies have documented physicians' difficulty in efficiently locating critical patient information on the screen and in the patient record due to poor user interface design," the trustees report. "Examples of design problems include inconsistent or confusing warnings (e.g., notifications of abnormal test results), presentation of data elements without context, separation of actions from results, and confusing navigation paths."

Those challenges are even greater for clinicians who use different EMRs at multiple locations, the report notes.

"Given the immaturity of the market, lack of a robust set of research on this subject, and the diverse variety of clinical settings, it would be premature at this time to suggest a single user interface design for EMRs," the trustees report. "There are, however, key elements of EMR user interface design that should be encouraged in parallel with the ongoing development of this technology."

Those elements are:

• An organized structure based on "clear, consistent models that are apparent and recognizable to users."
• A simple design that streamlines common tasks and communicates clearly in the user's language.
• Easily visible options unfettered by extraneous or redundant information.
• Easy-to-understand feedback that can head off potential errors.
• A flexible and tolerant design that prevents errors and reduces the cost of mistakes.