- The number of health IT developers and products has increased significantly as a result of federal incentives for EHR adoption but correlates with the rise of provider dissatisfaction with the usability of these systems.
What providers expect from their EHR systems and what health IT developers deliver have proved not to be one in the same. This disconnect points to the need for the latter to focus on the needs of the former and deliver EHR technology that is user-centered.
Therefore, collaboration between health IT developers and clinical end-users is key to ensuring EHR systems are user-friendly in an industry rapidly adopting new technologies year after year to tackle new initiatives such as population health management and value-based care.
Collaboration between both sets of stakeholders begins by answering a simple but important question: What does EHR usability mean to clinicians?
What is EHR usability?
EHR usability comprises the extent to which clinicians can easily perform daily clinical tasks without struggling to grapple with complex technology.
If a system is difficult to navigate, providers could miss out on the tools and advantages built into their EHR systems to improve patient care delivery and health outcomes.
While the term is thrown around loosely in the healthcare industry today, the Healthcare Information Management Systems Society (HIMSS) summarizes the concept with the following definition:
Usability is the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment. In essence, a system with good usability is easy to use and effective. It is intuitive, forgiving of mistakes and allows one to perform necessary tasks quickly, efficiently and with a minimum of mental effort.
Because EHR usability is largely subjective, determining the usability of a certain system is not a precisely quantifiable measure.
However, there are ways for developers and providers to begin a conversation about the usability of EHR systems.
The American Medical Association (AMA) and MedStar Health National Center for Human Factors in Healthcare together developed the following measure categories to determine EHR usability:
- User-centered design process
- The number and clinical background of participants
- Use case rigor
- Measures of effectiveness, efficiency and satisfaction
- Described areas for improvement
If an EHR system performs well according to these measure categories, chances are physicians and healthcare organization staff will have an easier time becoming acclimated to the technology in ways that do not significantly detract from their focus on clinical tasks.
Is one metric enough?
While measure categories such as these can be helpful in determining EHR usability, a single system gauging approximate usability is not enough to guarantee a system is user-friendly. Considering multiple perspectives is a more thorough approach.
Furthermore, research suggests directly asking physicians may be the most effective method of gauging technology usability.
A research team headed by Anne Press, MD, found user feedback to be the key to integrating effective new specialty functions into EHR systems that assist physicians.
Researchers tested a substance abuse screening tool by integrating the technology into both paper and EHR health record workflows at a hospital and then surveyed medical office assistants and physicians for a read on how usable the new tool was after two research phases.
Researchers determined crowdsourcing feedback from physicians and medical office assistants was the best way to gain insight into the usability of the tool.
“This study demonstrates the importance of usability testing during initial design,” the researchers explained.
While innovators can estimate how a certain technology will be received by physicians, only the users themselves can accurately attest to the usability of a tool.
“This study also demonstrates how clinical practice is dynamic, and therefore tools should also be flexible and easily edited,” researchers stated. “Usability testing a year later was able to identify new barriers and direct a new iteration of the tool. Using the SBIRT screening tool as a clinical case to constant usability testing highlights how other clinical decision support tools and electronic screening tools should consider periodic usability testing.”
Asking physicians about EHR usability and the usability of other tools is imperative to proliferating the implementation of the technology and promoting interoperability.
Keeping pace with a fast-evolving industry
Increasing EHR usability and interoperability are necessary for an industry undergoing regulatory and cultural change, such as the push for improvement in care coordination and quality as part of value-based reimbursement.
With EHR adoption rapidly spreading to healthcare organizations worldwide, ensuring technology is user-friendly has become a patient safety issue.
In March, the ECRI Institute published a report on the top 10 patient safety concerns for healthcare organizations and cited EHR-associated patient harm and data management as one of the most significant threats to patient safety in the industry today.
In response, healthcare organizations and federal agencies such as ONC are attempting to avoid patient harm through improved usability.
ONC earlier this year issued updated SAFER Guides as part of its Health IT Playbook to promote EHR usability in an effort to help providers curb patient harm when using new technologies in care delivery.
The federal agency offered guidance for providers involved in high priority practices, contingency planning, system interfaces, computerized provider order entry with decision support, clinician communication, organizational responsibilities, system configuration, patient identification, and test results reporting and follow up.
The guides are in high demand with over 52,000 users accessing the educational materials since their initial release in January of 2014.
With so many new technologies entering the healthcare industry, usability is a top priority among providers.
All ONC SAFER guides are also accompanied by expert recommendations, checklists, and note templates allowing providers to self-examine the safety and usability of their own EHRs.
Updates to the guides also included the following additional information from associations of EHR specialists and providers including AMA:
- A new recommendation to the Test Results and Follow-up Reporting Guide to improve communication of abnormal results to patients which is based on recommendations from the National Academy of Medicine.
- An update to the Contingency Planning Guide reflecting best practices for prevention and mitigation of ransomware attacks as well as new recommendations about “downtimes,” those times when systems are partially (response times are unacceptably slow) or completely unavailable. These both represent multiple safety issues.
Modifying the guides to accommodate developing technologies and associated safety threats ensures providers are equipped to handle the stresses of an ever-expanding health IT landscape.
According to ONC, improved EHR usability will increase rates of sending, receiving, locating, and integrating health data into clinical workflows resulting in optimized patient care delivery.
EHR developers have used the SAFER guides to create their own usability and safety manuals to assist providers in navigating specific systems.
Along these lines, integrating physician feedback into EHR usability guides could further enhance the value of the recommendations by including advice for users, by users.