How to Boost EHR Usability Using a User-Centered Design Process

Implementing EHR tools using a user-centered design can boost EHR usability and decrease burnout for ophthalmologists, according to a study published in Ophthalmology and Therapy.

Furthermore, clinicians can utilize these tools and methodologies without high-level EHR training or an advanced technological background.   

While approximately 98 percent of hospitals have an EHR in place or plan to install one shortly, similar adoption rates occur in ophthalmology. However, ophthalmologists believe EHR usability leaves a lot to be desired and it often leads to increased clinician burnout and reduced time with patients.

HIMSS defines EHR usability as “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.”

To maintain and enhance EHR usability, providers can conduct EHR optimization to push central usability issues to the forefront. As more health organizations work to optimize their EHRs, they should look at the current status of their EHR usability and assess interface usability.

Researchers concentrated on a user-centered design to fix usability issues.

“The final product should suit the users, rather than making the users suit the product,” explained the study authors.

Researchers aimed to provide methodologies and usability analysis skills that clinicians can use to aid in EHR design and initiate conversations with EHR vendors during the development stages. As of now, users lack usability analysis skills and it only provides EHR vendor accountability during the development and design process.

Using a literature search, researchers identified six methodologies and tools based on a user-centered design process and summative testing process to improve EHR usability:

Shadowing: Researchers follow participants over a period of time and document user actions

Autoethnography: The researcher becomes a user to see the thought process and documentation process

Semi-structured interviews and questionnaires: Researchers provide users with open-ended questions which are analyzed by researchers

Card sort and reverse card sort: Researchers identify common issues and ask participants to group topics into specific categories

Retrospective think-aloud protocol: The participants carry out tasks silently and then communicate their thoughts after the process

Wireframing, screenshot testing, and heat maps: Researchers develop a two-dimensional prototype of the EHR interface. The participants complete tasks through the prototype, which generates a visual map to see standard EHR interface clicks

Providing users with these methodologies and tools could educate clinicians from a usability standpoint to generate conversation with EHR vendors during the design process to boost clinician and patient satisfaction and safety.

“These tools should not be used in isolation but rather in conjunction with other EHR developmental processes such as utility analysis (whether the system provides features needed by the end user) and prototyping,” wrote the study authors. “It is, however, beyond the scope of this paper to explore the full details of the EHR development process. The development and refinement of EHRs should be a continuous and iterative process, in which changes at one stage may require evaluation and changes at another stage.”

Overall, clinicians and users should be involved in EHR usability testing, limiting potential future issues.

“This is very much like post marketing safety evaluations of technology and medications used in real-world clinical settings,” concluded study authors. “With these tools that can be deployed in any clinical units away from resource-rich research centers, we hope that clinical information leads can work together with EHR vendors and various stakeholders to continuously improve the usability of EHRs.”