Usability Improvements to Electronic Health Records - Finding Realistic Paths to Success (original) (raw)
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A usability and safety analysis of electronic health records: a multi-center study
Journal of the American Medical Informatics Association : JAMIA, 2018
To characterize the variability in usability and safety of EHRs from two vendors across four healthcare systems (2 Epic and 2 Cerner). Twelve to 15 emergency medicine physicians participated from each site and completed six clinical scenarios. Keystroke, mouse click, and video data were collected. From the six scenarios, two diagnostic imaging, laboratory, and medication tasks were analyzed. There was wide variability in task completion time, clicks, and error rates. For certain tasks, there were an average of a nine-fold difference in time and eight-fold difference in clicks. Error rates varied by task (X-ray 16.7% to 25%, MRI: 0 to 10%, Lactate: 0% to 14.3%, Tylenol: 0 to 30%; Taper: 16.7% to 50%). The variability in time, clicks, and error rates highlights the need for improved implementation optimization. EHR implementation, in addition to vendor design and development, is critical to usable and safe products.
Analysis of metrics for the usability evaluation of electronic health record systems
2012
Abstract. Electronic health records are gradually replacing conventional paperbased health records. For a doctor, it is a working instrument, which can significantly reduce the time spent on paper work. At the same time, patients can benefit from accessing the electronic health records even though they usually do not have a medical background. Therefore, when specifying a graphical user interface (GUI) it is necessary to take into account the requirements of the different users: e.g. the functionality for the doctors and the presentation of data in an understandable manner for the patients. The study aims to review and analyze metrics used to evaluate the usability of user interfaces in health information systems. A literature review was performed to identify existing metrics. The scope of the search included the analysis of existing usability evaluation metrics that are applied both in healthcare and other domains, where standards for storage and presentation of information are app...
Usability Measures for Large Scale Adoption of the Standardized Electronic Health Record Databases
Journal of Information Processing, 2014
With the adoption of Standardized Electronic Health Records (EHRs) databases, recent research studies consider-standardization and interoperability. At the same time the need for querying (the archival data) is becoming important. The complex and dynamic nature of these databases give rise to several usability challenges. This study aims to reduce the gap between the designed application flow and user work-flows (anticipated by them) within the system. Moreover, in the case of standardized EHRs databases, there is a need to reduce the dependency on postrelease user-feedbacks and surveys. This will facilitate the task of system redesign (and re-engineering). We assume that socio-technical features of the users and their usage-patterns over the standardized EHRs databases are correlated. Therefore, we propose the application of user-centric design and automated usability support for the standardized EHRs databases. It provides an insight for improving the system on a continuous basis.
Poor usability is a barrier to widespread adoption of electronic health records (EHR). Providing good usability is especially challenging in the health care context, as there is a wide variety of patient users. Usability benchmarking is an approach for improving usability by evaluating and comparing the strength and weaknesses of systems. The main purpose of this study is to benchmark usability of patient portals across countries. Methods: A mixed-methods survey approach was applied to benchmark the national patient portals offering patient access to EHR in Estonia, Finland, Norway, and Sweden. These Nordic countries have similar public healthcare systems, and they are pioneers in offering patients access to EHR for several years. In a survey of 29,334 patients, both patients' quantitative ratings of usability and their qualitative descriptions of very positive and very negative peak experiences of portal use were collected. Results: The usability scores ranged from good to fair level of usability. The narratives of very positive and very negative experiences included the benefits of the patient portals and experienced usability issues. The regression analysis of results showed that very positive and negative experiences of patient portal use explain 19-35% of the variation of usability scores in the four countries. The percentage of patients who reported very positive or very negative experiences in each country was unrelated to the usability scores across countries. Conclusions: The survey approach could be used to evaluate usability with a wide variety of users and it supported learning from comparison across the countries. The combination of quantitative and qualitative data provided an approximation of the level of the perceived usability, and identified usability issues to be improved and useful features that patients appreciate. Further work is needed to improve the comparability of the varied samples across countries.
Human factors, 2015
The objectives of this study were to (a) review electronic medical record (EMR) and related electronic health record (EHR) interface usability issues, (b) review how EMRs have been evaluated with safety analysis techniques along with any hazard recognition, and (c) formulate design guidelines and a concept for enhanced EMR interfaces with a focus on diagnosis and documentation processes. A major impact of information technology in health care has been the introduction of EMRs. Although numerous studies indicate use of EMRs to increase health care quality, there remain concerns with usability issues and safety. A literature search was conducted using Compendex, PubMed, CINAHL, and Web of Science databases to find EMR research published since 2000. Inclusion criteria included relevant English-language papers with subsets of keywords and any studies (manually) identified with a focus on EMR usability. Fifty studies met the inclusion criteria. Results revealed EMR and EHR usability prob...
Journal of biomedical informatics, 2016
Though substantial work has been done on the usability of health information technology, improvements in electronic health record system (EHR) usability have been slow, creating frustration, distrust of EHRs and the use of potentially unsafe work-arounds. Usability standards could be part of the solution for improving EHR usability. EHR system functional requirements and standards have been used successfully in the past to specify system behavior, the criteria of which have been gradually implemented in EHR systems through certification programs and other national health IT strategies. Similarly, functional requirements and standards for usability can help address the multitude of sequelae associated with poor usability. This paper describes the evidence-based functional requirements for usability contained in the Health Level Seven (HL7) EHR System Functional Model, and the benefits of open and voluntary EHR system usability standards.
Development of a Nursing Electronic Medical Record Usability Protocol
CIN: Computers, Informatics, Nursing, 2018
Assessing usability of an electronic medical record is useful for organizations wishing to customize their electronic medical record and determine the impact on usability. The purpose of this article is to describe the development of a protocol to measure electronic medical record usability from a nursing perspective and to develop a scoring methodology. The Technical Evaluation, Testing, and Validation of the Usability of Electronic Health Records (NISTIR 7804), published by the National Institute of Standards and Technology, guided protocol development. Usability was determined by measuring effectiveness, efficiency, and satisfaction. Satisfaction was measured by the System Usability Scale, while effectiveness and efficiency were measured via performance testing by participants, who completed one of three scenarios. A protocol and scoring formula were developed and used to assess nursing usability, resulting in an overall "C" grade for the electronic medical record. Protocol implementation and the scoring/grading calculations can be replicated to assess electronic medical record usability. The three scenarios used in this protocol will be made available upon request from the primary author to promote the use of electronic medical record usability assessment. Using and expanding upon the government's recommended usability assessment guidelines, we were successful in measuring nursing electronic medical record usability and rating an electronic medical record.