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Understanding Effect of EHR Usability on Clinical Workflows

As EHR use becomes ubiquitous in the healthcare industry, questions about EHR usability come into play.

By Sara Heath

Providers use EHRs to perform everyday clinical tasks, manage their workflows, and participate in federal incentive programs such as meaningful use. Because these tools have so many purposes, it is vital that they are navigable and easy-to-use.

But what is EHR usability, and how is it measured? How does EHR usability affect different parts of the healthcare industry?

The Healthcare Information Management Systems Society (HIMSS) defines EHR usability as follows.

"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."

In its 2009 publication Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating, HIMSS explained that factors such as simplicity, naturalness, consistency, and limited likelihood of cognitive overload all contribute to good EHR usability.

The organization also touched on the role that EHR design plays in EHR usability, specifically focusing on the navigability of the technology. With intuitive interface design, EHR users can work with the tool more easily.

The HIMSS report was published in 2009, at the onset of the EHR adoption boom brought about by the EHR Incentive Programs and meaningful use. Although the healthcare industry has since seen a surge in EHR adoption rates, the technology itself, even certified EHR technology (CEHRT), is still plagued by several of the same usability concerns.

Just last year a peer60 report found EHR usability to be a top concern for over 50 percent of EHR users. These usability issues are what drove nearly 20 percent of respondents to state that they were looking for an EHR replacement.

How is it measured?

Given the definition of EHR usability and its emphasis on user satisfaction, usability may be in the eye of the beholder. How an EHR handles a certain workload may be up to personal preference, with some providers finding certain aspects of a tool better than others do.

However, there are some concrete standards sorting the usable from the non-usable EHRs, and some governing bodies have worked to create guideline tools to determine this.

The American Medical Association (AMA) and Baltimore-area hospital MedStar Health National Center for Human Factors in Healthcare, for example, teamed up to create one such guideline. In the fall of 2015, the two created the EHR User-Centered Design Framework to identify traits contributing to high EHR usability.

AMA and MedStar combined both ONC’s user-centered design criteria with other criteria necessary for incentive programs such as meaningful use to develop the following measure categories:

  • User-centered design process
  • The number and clinical background of participants
  • Use case rigor
  • Measures of effectiveness, efficiency and satisfaction
  • Effectiveness
  • Described areas for improvement

How does it tie into EHR interoperability?

EHR usability is also closely tied to EHR interoperability. When an EHR system cannot transmit health data with another system, it becomes less usable because it limits how providers can use it to coordinate care.

This relationship can be seen in the Epic EHR, which last year was rated in a Black Book poll as the lowest ranked emergency department EHR.

Emergency departments have distinct workflow needs due to the time-sensitive nature of the cases seen in the ED. The department also needs an interoperable system to locate and access information efficiently. Given the variables that lead patients into an ED, there is a chance emergency providers will need to access health records from a different facility.

With lacking EHR interoperability, this may present a considerable hurdle and also limit EHR usability.

Interoperability is also a significant usability consideration because of its emphasis in meaningful use and MACRA implementation. Going into Stage 3 Meaningful Use, providers will need to focus on using their EHR systems to exchange health data with other providers and with patients. Providers will also need to demonstrate that capability under MACRA.

Beyond health information exchange, these federal programs are an impetus for improving EHR usability. As healthcare professionals continue to face the demands of both patients and federal programs, they will need EHR technology suited to their needs that allows them to do their jobs more efficiently and with greater ease.

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