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EHR Usability, Proficiency Increases with Physician Experience

EHR proficiency gets better over time, research shows, giving insights into EHR usability and health IT interface development.

By Sara Heath

EHR usability increases modestly with long-term use and more experience, according to a new study published in JMIR Human Factors.

physician ehr use ehr usability

A research team led by Martina A. Clarke, PhD, examined physician EHR use and proficiency as they gained experience using the system. This was a test to better understand EHR usability.

The team created groups of novice and expert EHR users and asked them to complete a sample usability test utilizing a realistic but fabricated patient file to complete 19 different tasks. The researchers looked at task success rates, how long each user spent on each task, and mouse activity. The tests also measured a system usability scale (SUS) and provided narrative, qualitative feedback as the user was working on the test.

Each participant completed the test twice, measuring their proficiency after gaining more experience with the software.

The results showed that expert users exhibited moderately higher proficiency along all usability measures.

Novice users’ task success rates improved by six percent between rounds one and two of testing, while experts improved by seven percent. Novice users also saw an improvement in time spent on task (10 percent improvement) and in mouse activity (20 percent improvement).

However, expert users saw slightly higher improvements, with a 21 percent improvement in time spent on task and a 39 percent improvement in mouse activity.

These results may be highlighting an oft-cited steep learning curve for EHR software. Novice users may still need to gain more experience using the EHR before they can make big gains on improving their success rates.

When it came to evaluating overall EHR use, novices showed more improvements, albeit at a marginal rate, compared to expert users.

The overall SUS measures yielded minimal improvement between rounds of testing while expert users showed no improvement at all.

This study is significant in the backdrop of the nation’s debate over EHR usability. As EHR use becomes ubiquitous across all providers, the ability to efficiently and properly use the system is critical. The research team explained that part of their goals in conducting this study was to help influence the direction for EHR interface design and usability training programs.

“The objective of this study was to determine the difference in learnability by comparing changes in performance measures between expert and novice primary care physicians 3 and 7 months after 2 rounds of learnability tests,” the Clarke and her team stated.

In the end, the team maintained that it achieved this part of its goal. By highlighting how EHR use and experience can influence a user’s proficiency, the researchers were able to submit ample data to help influence EHR programs.

“Overall, this study identified varying degrees of learnability gaps between expert and novice physician groups that may impede the use of EHRs,” the research team said. “The physicians’ interactions with the EHR can be communicated to EHR vendors, to assist in improving the user interface for effective use by physicians. This study may also assist in the design of EHR education and training programs by highlighting the areas… of difficulty that resident physicians face.”

Debates regarding EHR usability have been coursing throughout the healthcare space for some time. In 2014, a Frost & Sullivan report showed that EHR usability was a top pain point for hospital CIOs. The trend of EHR usability issues continued from there.

In October 2015, a joint effort from the American Medical Association (AMA) and MedStar Health’s National Center for Human Factors found that several top EHR vendors score low on an EHR usability framework.

"Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products," AMA President Steven J. Stack, MD, stated. "Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems."

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