Drega Abdi

For many of us working in healthcare, the Electronic Health Record (EHR) is a constant companion. It is the central repository for patient information, the hub of our daily workflows. While few of us get to choose the EHR our organisation uses, those “lucky” enough to take part in a system switch – whether from paper or another digital platform – quickly learn that a well-designed EHR can dramatically streamline documentation. But what happens when those initially helpful systems become overly complex, riddled with customisations and internal jargon? What happens when the very tool designed to improve patient care actually becomes a barrier to it?

The problem: EHR usability and data quality

As a health informaticist, I often hear first-hand the frustration with EHRs from end-users, particularly when things have gone wrong. As we then delve into the root cause of an issue, a recurring theme emerges: usability. To illustrate the problem, let me paint a picture, one that might resonate with you. Imagine Salma, a senior nurse starting her evening shift on a busy surgical unit. One of her assigned patients is recovering from major surgery and so requires close monitoring, the results of which needs to be recorded in the EHR to paint a clear picture of the patient’s condition. She confidently navigates to the flowsheet in the EHR, the location for surgical drain documentation. But tonight, the flowsheet looks different. The data entry template Salma used to completing for surgical drains has been replaced by a new template, containing a bewildering collection of acronyms and no reference information to help her navigate this unfamiliar view. She feels lost, unsure where to turn, and, most importantly, unable to accurately document the critical information she needs to care for her patient. This feeling of disorientation and frustration echoes what many clinicians I have spoken with have experienced first-hand. It’s a stark reminder of how easily EHRs can become obstacles instead of assets.

Salma’s experience is not unique. It highlights a critical breakdown of technical communication principles within the EHR environment. On one side, we have dedicated multidisciplinary teams, often working tirelessly to implement enhancements and updates, driven by KPIs, deadlines, and the desire to provide clinicians with cutting-edge tools. They are faced with the challenge of balancing system optimisation with the realities of busy clinical schedules, often relying on clinical managers with limited direct EHR experience to provide input and validation during the build process. On the other side, we have frontline staff, like Salma, often overwhelmed by the evolving complexity of the system. While designed for effective patient information management, the EHR is often undermined by the very customisations intended to improve it. These well-intentioned changes, meant to streamline workflows and meet reporting requirements, can result in confusing designs, repetitive data entry, and a flood of jargon, ultimately compromising both usability and data quality. According to Sutton et al. (2020), the documentation burden within EHR systems is a growing concern among healthcare professionals. This burden arises from the need to complete extensive and often unnecessary documentation elements, which not only consumes valuable time but also contributes to burnout. This added pressure only exacerbates the challenges caused by poor technical communication.

This disconnect underscores the crucial role of technical communication, which, as a discipline, focuses on simplifying complex information for a specific audience. Technical communicators aim to create clear, accurate, and accessible content that enables users to understand and effectively use technology, procedures, or systems. In the context of the EHR, this means designing interfaces and documentation that are intuitive for clinicians, reducing the risk of errors and improving overall workflow efficiency. Just as in instructional design, where poorly crafted learning materials can hinder understanding, poorly designed EHR interfaces can impede patient care. The American Medical Informatics Association (Middleton et al. 2013) recommends that: EHRs should be designed to be intuitive, easy to use, and supportive of clinical workflows, ultimately making it easier for healthcare professionals to provide quality patient care. Usability, however, is only part of the equation. Even if clinicians find that an EHR is easy to use, we cannot make the assumption that the data entered is accurate or complete. Madandola et al. (2024) rightly point out that a user-friendly interface does not automatically translate into high-quality data. Ultimately, we need to consider both usability and data quality as separate, but equally important, goals when designing and implementing EHR systems

Solutions for better technical communication in the EHR

Drawing from my experience as a health informaticist and reflecting on the principles of technical communication, here are a few key considerations:

• Eliminate the Jargon: Whenever possible, use plain language. Avoid internal terminology and clinical-specific jargon. If specialised terms must be used, provide a clear and concise definition immediately. Think of it as building a common vocabulary within the EHR.
• Deconstruct the Acronyms and Abbreviations: Spell out acronyms and abbreviations the first time they appear within a section or module. Provide a glossary for easy reference. Resist the urge to create new, internal abbreviations – clarity is always preferable to brevity.
• Design for Usability: EHR interfaces should be intuitive and easy to navigate. Utilise clear headings, consistent layouts, and visual cues to guide users. Solicit feedback from frontline staff during the design and implementation process, not just after rollout. Consider the cognitive load you are placing on the user.
• Regularly Review and Revise: The EHR is not a static entity. It’s a system that requires ongoing maintenance and refinement. Regularly review the terminology, workflows, and documentation practices to ensure they remain clear, consistent, and user-friendly. Conduct usability testing with a diverse group of clinicians.
• Champion Consistent Terminology Standards: Actively advocate for using standard naming conventions for commonly used terms and values.
• Remember the Patient: At the heart of all our efforts should be the patient. A confusing EHR can lead to errors, delays in care, and ultimately, negative patient outcomes. Clear and concise communication within the EHR is essential for safe and effective care.

Conclusion: Empathy and effective communication

Ultimately, effective technical communication within the EHR demands empathy. It is about understanding the needs and perspectives of all users, from senior physicians to newly qualified nurses. Recognising that clarity is not a luxury, but a fundamental requirement, we must strive to make our EHRs more accessible and user-friendly, ensuring they contribute to safer and more effective patient care.

References

Madandola, O.O., Bjarnadottir, R.I., Yao, Y., Ansell, M., Dos Santos, F., Cho, H., Lopez, K.D., Macieira, T.G.R., and Keenan, G.M. (2024) “The relationship between electronic health records user interface features and data quality of patient clinical information: an integrative review,” Journal of the American Medical Informatics Association, available: https://doi.org/10.1093/jamia/ocad188 [Accessed: 10 March 2025].

Middleton, B., Bloomrosen, M., Dente, M.A., Hashmat, B., Koppel, R., Overhage, J.M., Payne, T.H., Rosenbloom, S.T., Weaver, C., and Zhang, J. (2013) “Enhancing patient safety and quality of care by improving the usability of electronic health record systems: Recommendations from AMIA,” Journal of the American Medical Informatics Association, 20(E1), available: https://doi.org/10.1136/amiajnl-2012-001458. [Accessed: 10 March 2025].

Sutton, D.E., Fogel, J.R., Giard, A.S., Gulker, L.A., Ivory, C.H., and Rosa, A.M. (2020) “Defining an Essential Clinical Dataset for Admission Patient History to Reduce Nursing Documentation Burden,” Applied Clinical Informatics, 11(3), 464–473, available: https://doi.org/10.1055/s-0040-1713634. [Accessed: 10 March 2025].