Ease of ordering high- and low-value services in various electronic health records.

The use of electronic health record (EHR) systems by US clinicians is nearly ubiquitous. One motivation for EHR implementation is the ability to increase provider efficiency and improve patient-centered outcomes. There are no data examining how EHR design aligns with the ordering of high- and low-value clinical services. A survey of outpatient providers utilizing various EHR systems. Five high-value and 5 low-value services that would typically be ordered in a primary care setting were identified. Providers using different EHR systems quantified the number of computer clicks required to order each service. Five unique EHR systems representing those used by nearly two-thirds of health systems were included. No correlation was found between the ease of EHR ordering and the value of the clinical service. Three of the 5 services that were easiest to order were low value, and 3 high-value services were among the most difficult to order. In EHR systems used nationwide, no association existed between the clinical value of a service and the ease of ordering. This disconnect suggests that EHR redesign can significantly improve clinician workflow to facilitate the use of more high-value care and fewer low-value services.