- An evaluation framework jointly developed by the American Medical Association (AMA) and MedStar Health’s National Center for Human Factors in Healthcare claims to identify a lack of EHR user-centered design and testing best practices among several of the most common EHR technologies. The two organizations used the framework to evaluate a score of EHR technologies.
The most glaring of evaluations concerns the ambulatory EHR designed by Epic Systems which scored 9 out of a possible 15 total points for its EHR usability processes.
Negatively impacting the score of Epic's EpiCare Ambulatory 2014 was apparently lack of transparency into its measure for assessing the effectiveness, efficiency, and satisfaction of its product's EHR usability and reporting the success rate of first-time users during summative testing. Epic's EHR technology scored zeroes in these categories. Furthermore, the product only partially met user-centered design best practices for process in two other areas: the rigorousness of its use cases and identification of improvements best on test results.
Other EHR vendor whose products registered low scores were eClinicalWorks (5), GE Healthcare (6.5), and Greenway (7).
Meanwhile, Allscripts and McKesson received perfect scores, the former for two of its products. Also coming in with high scores were athenahealth (13.5), Medical Information Technology (13.5), Practice Fusion (13.5), Cerner, MEDITECH (13), and Modernizing Medicine (13). Rounding out the list were Amazing Chart (12), SRSoft (12), Medhost (11.5), E-MD (11), and NextGen Healthcare (9.5).
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As one of the architects of the EHR User-Centered Design Evaluation Framework warns, the findings do not represent the actual EHR usability of these EHR technologies.
“It is important to recognize that this framework evaluates conformity with best practices identified in human factors and usability literature for user-centered design and testing. We are not evaluating the actual usability of the product as experienced by end users,” Scientific Director of the Human Factors Center Raj Ratwani, PhD, said in a public statement.
“Alignment with best practices for user-centered design and testing is a starting point that regulators and industry should meet and exceed," he continued. "The framework we developed is the first step in bringing greater transparency to the usability processes of EHR vendors."
The designers of the framework maintain that their work is an improvement on the "low bar" set by the Office of the National Coordinator for Health Information Technology in its requirements for EHR usability and user-centered design as part of the EHR certification process.
"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."
The framework comprises eight usability principles culled from a much larger list required by ONC for the certified EHR technology required for the EHR Incentive Programs, including the user-centered design process, testing methodology, and testing results. The website for the framework even states that it could become useful tool for ONC to employ. "This framework can be used by the ONC to improve their certification program, and as a method to track improvements EHR vendors make as they recertify their products over time," it reads.
More than a year ago, AMA released an EHR usability framework to support the creation of more intuitive EHR technology and listed a handful of priorities for EHR vendors to consider when designing their products:
• The EHR must enhance physicians’ ability to provide high quality care by becoming a useful tool instead of a distraction.
• The design and configuration must support team-based care and allow providers to work to the top of their skill sets.
• Software should include features that promote care coordination, including the ability to automatically track referrals and provide tools that track patients along the continuum of care.
• Health IT must be modular and easily configurable, allowing APIs to enhance and expand technical capabilities.
• EHRs should support clinical decision making by presenting pertinent information in an easily digestible format with the help of real-time data analytics.
• Interoperable data standards should be the foundation of EHR technology so that providers can share critical information across care sites and venues.
• EHRs should facilitate patient engagement and welcome mobile technologies that contribute to the patient record.
• Vendors and developers should pay close attention to end-user feedback and be nimble enough to make changes that will enhance the user experience.
According to AMA and National Center for Human Factors in Healthcare, the most recent report is a starting point for EHR usability and not a means of informing EHR selection processes.