=Paper=
{{Paper
|id=Vol-2903/IUI21WS-HEALTHI-12
|storemode=property
|title=Building interfaces for self-assessment and feedback in the EMR
|pdfUrl=https://ceur-ws.org/Vol-2903/IUI21WS-HEALTHI-12.pdf
|volume=Vol-2903
|authors=Andrew L. Yin,Inna Wanyin Lin,Pargol Gheissari
|dblpUrl=https://dblp.org/rec/conf/iui/YinLG21
}}
==Building interfaces for self-assessment and feedback in the EMR==
https://ceur-ws.org/Vol-2903/IUI21WS-HEALTHI-12.pdf
Building interfaces for self-assessment and feedback in the EMR
Andrew L. Yina,b, Inna Wanyin Linb and Pargol Gheissarib
a
Weill Cornell Medical College, 1300 York Avenue, New York, NY, USA
b
Cornell Tech, 2 W Loop Rd, New York, NY, USA
Abstract
Electronic medical records (EMRs) have played an increasingly significant role in healthcare.
With these major advances, however, have come major pitfalls like the increase in physician
burnout and stress. This position describes interventions that can help to address these pitfalls
by supporting the desires and interests of the clinicians using the EMR. It presents three
augmentations related to self-assessment and feedback to attempt to address these needs: a
retrospective dashboard, a collaboration tool, and a research and note taking interface.
Keywords 1
Self-assessment, feedback, self-learning, electronic medical record, computer-supported
cooperative work, interfaces
1. Introduction clinicians appear to be uniquely burdened –
receiving more messages, spending more time
Since their widespread adoption, there has been after hours, and spending more time on clinical
increasing understanding that electronic activities like note writing, ordering
medical records (EMRs) play a large role in medications or tests, and reviewing patient
physician stress and burnout. Physicians find charts [6]. With this said and all the
themselves working more from home after complexities considered, there continue to be
hours, answering more messages and emails both technical and political advancements that
now sent and received at any time, and encourage and support growth of tools aimed at
suffering through both major and minor improving the EMR for users [2,7].
usability issues [1,4,8]. Clinicians and This position will argue that developing and
technologists alike cringe when reading Atul improving tools and interfaces to facilitate
Gawande’s Why Doctor’s Hate Their hospital clinician self-assessment and feedback
Computers or Schulte and Fry’s Death By can be one component to help address inpatient
1,000 Clicks – disturbed by the time demand of clinician burnout related to the EMR. Many
the EMR, the legal-political complexities, the innovations focus on reducing the time using
introductions of new errors, and the impersonal the EMR but few focus on increasing the
feeling that the whole journey has caused personal value obtained from using the EMR.
[5,10]. These systems appear to do everything Adjusting interfaces to include tools that
to pull clinicians away from the work that they provide physicians the ability to holistically
find most meaningful, a key feature in learn and grow could reduce the frustration and
determining the likelihood of burnout [11]. One burnout associated with using the EMR,
might reasonably think that this problem must improve patient care, and provide a feeling of
be a global issue, impacting all health systems growth to each clinician. We propose features
relying heavily on EMRs. Unfortunately, US for adoption and discuss how they fit into key
Joint Proceedings of the ACM IUI 2021 Workshops, April 13-17,
2021, College Station, USA
EMAIL: aly27@cornell.edu (A. 1); wl676@cornell.edu (A. 2);
pg463@cornell.edu (A. 3)
ORCID: 0000-0002-9560-0169 (A. 1); 0000-0003-2928-0096 (A.
2); 0000-0003-0048-559X (A. 3)
©️ 2021 Copyright for this paper by its authors. Use permitted under Creative
Commons License Attribution 4.0 International (CC BY 4.0).
components of computer-supported individual cases as they deem necessary. With
cooperative work (CSCW), improving the the added information, they could now have a
alignment of the EMR with incentive way to roughly sense whether the changes they
structures, workflow, and awareness [9]. make to their practice are making a difference
CSCW has long had a role in shaping EMR for their patients, comparing themselves from
development but the interplay between policy year to year or identifying trends or themes in
makers, EMR vendors, hospitals, and care their patient population. Clinicians are already
teams continues to make implementation spending large amounts of time finding ways to
complex [3]. These suggested features include tally portions of this information themselves.
ways to retrospectively present previous patient An interface providing this information in a
information, improvements to collaborative readable and concise format will significantly
tools, and tools for learning and research. Such improve the efficiency in their workflow and
features could be integrated into the current allow them to spend time thinking of solutions
workflow of clinicians and could help make the rather than merely tallying data [12]. Given the
EMR a better tool for clinicians on the whole. amount and the scope of clinical data in the
EMR, building such interfaces with existing
2. Discussion data could be an easy, user-focused
implementation with tremendous value-add.
2.1 Improving Review of Previous
Patient Information 2.2 Rekindling peer to peer, genuine
collaborations and connections
EMRs are primarily designed for real-time between clinicians
clinical care as opposed to retrospective use.
However, clinicians spend significant time, Clinicians have a common practice of
often more than they wish, looking up previous discussing challenging or tricky cases with one
patients and assessing themselves based on another, relying on friends or close colleagues
what they find [12]. This aligns with both a in this process. At the same time, clinicians feel
clinician’s personal incentive and interest to relatively isolated in a lot of their work and feel
improve on their work as well as the hospital’s like they are left on their own to manage
interest to improve the quality of care [9]. As patients that may benefit from multiple
simple as this may seem, providing clinicians perspectives and opinions [12]. The EMR has
with the opportunity to see what happens to the opportunity to build on this collaborative
their patients after caring for them and get a nature of medicine. The current workings of
sense of how their patients are doing EMR inboxes/emails have created a level of
collectively is a function that is unavailable to noise and message fatigue that sometimes
most clinicians. Simple information like the discourages genuine conversations between
number of patients treated, number of patients providers [5]. These existing tools meant to
discharged, number of patients readmitted, why improve collaboration and communication
patients are getting readmitted, etc. are have become inundated with bureaucratic and
relatively inaccessible to a clinician without system related messages, losing sight of their
fairly significant additional work. Emergency original intentions. This leaves a gap where
room and inpatient clinicians have little to no personal, formal peer-to-peer interaction is
knowledge of what happens to a patient in the missing in the everyday use of the
long run unless they spend the time technology—a part of a clinicians desired daily
intentionally tracking these patients [12]. workflow that the technology could be
designed to support [9].
We propose the potential value of a simple
dashboard aimed at presenting this information, We propose a focus on using the EMR to
focusing specifically on a clinician’s collective facilitate connections between clinicians rather
patient panel and allowing them to review than isolating them further. It could kindle and
start relationships with other providers to important cases to be reviewed again later,
strengthen the healthcare community and allowing them to insert or connect comments or
improve collaboration on patient care. Tools thoughts to a patient that may not be suitable for
could aim at both communicating with the close the patient record but instead for the clinician’s
friends that clinicians already have as well as future reflection. Tools could help coordinate
finding new ones in different fields and searches among platforms, streamlining the
specialties. These collaborations would be process for the clinician in finding answers to
patient-based, driven by clinical questions and clinical questions. Second, the EMR or a tool
curiosity about active care or retrospective within it has the potential to support the saving
questions looking for feedback or teaching and organizing of these learning points, helping
points. Integrating such interfaces in the current a clinician keep track of them and find them
EMR systems also has the benefit of efficient again later on. These types of interventions
communication that aligns with the privacy could reduce the frustrations associated with
standards in the Health Information Portability inefficient learning and allow clinicians to more
and Accountability Act (HIPPA). Again, the tangibly feel progression in the knowledge they
EMR has an opportunity to reinforce and have achieved.
encourage behaviors that clinicians actively
perform as a way to feel more complementary 3. Conclusion
to their work as opposed to antagonistic.
Although the EMR has revolutionized the
2.3 Streamlining the process of healthcare industry, it has clearly been
research and discovery accompanied by some frustrating side effects
that are creating new problems such as
One of the most enjoyable features of clinical physician burnout and stress. It is important that
work is the continuous learning and discovery one recognizes the components that are
that occurs from patients, other providers, and contributing to these issues, such as increased
the literature. Although EMRs are designed to time using the EMR and reduction in time spent
contain thousands of different alerts to their doing the things that are most important, among
users, the platform does little to reinforce other things. Thus, augmenting the EMR
education or provide the groundwork for new interface to support items that clinicians find
learning to be made. Currently, many EMRs do interesting and help them do those things more
link to open outside learning tools like efficiently is important to explore.
UpToDate, Epocrates, or similar tools but leave This position describes behaviors and content
the user alone in finding and coordinating an that clinicians are already engaging with while
answer – something which might require using the EMR but with inefficient and ill-
multiple resources, websites, and tools. In designed methods. It argues that designing
addition, after finding the desired information, interfaces that intentionally address these areas
there is nothing available for clinicians to more around self-assessment and feedback would be
systematically keep track of the information beneficial in combating these EMR-related
learned, opening the door for inefficiency as the issues, while also providing tools within the
same search may be repeated many times. EMR that are designed for the clinician’s
Clinicians try many different ways to keep track growth. Although there are policies and
of or organize this information but are unable to structures that can make implementation
find reliable and consistent methods [12]. challenging, we believe our suggestions do
We propose that the EMR has an opportunity to little to go outside a clinician’s normal practice,
support providers in these learning aspirations aiming to operationalize these practices. We
by considering their workflow and helping acknowledge that different types of clinicians
coordinate the tools related to them. Such may also experience these features differently
things could allow providers to highlight and would advise a starting focus with
emergency and inpatient physicians as these 12. Retrieved from
groups have little to no systematic follow up https://www.newyorker.com/magazine/
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Arnold Milstein, Christopher D. Sharp,
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