How Important is EHR Usability to Uptake and Adoption?

How important is EHR Usability to the overall uptake and use of EHRs by clinicians and their practice teams? This is an often ignored, but critical factor. It is also the most difficult to do well and requires multiple product iterations, the input of usability and human factor experts and more importantly, a very clear understanding of the requirements of the EHR from a clinical, workflow and operational perspective.

There are many EHRs that on paper meet all of the criteria required for certification, however usability is more difficult to quantify and to a large degree is subjective. As vendors build out their EHRs to meet Stages 1, 2 & 3 of Meaningful Use, they will need to simultaneously consider how these EHR products integrate new features in a way that fits with clinician workflow. They will also need to do this keeping in mind that many users vary in their keyboarding and documentation skills and can differ quite significantly from a cognitive perspective in terms of how they evaluate a patient encounter and use tools that are available to them to support clinical decision making.

It is hard to project into the future, but I believe that EHR functionality over time will become commoditized. All EHRs will be able to do all of the things required of them for clinical documentation, population health, quality reporting etc. They will differentiate from one another in the areas of support and integration with other health IT systems and diagnostic devices. There will also be a few that will get usability right. Just as Apple seems to repeat their successes over and over by making complex things simple to the end user, vendors that understand and can translate EHR requirements into truly usable tools will be the success stories of Health IT.

In a ‘Viewpoint’ article in JAMIA (The Journal of the American Medical Informatics Association), authors Karsh et al, discuss the fallacies and sober realities of Health Information Technology. JAMIA 2010;17:617-623 doi:10.1136/jamia.2010.005637 – Read the Abstract (Full article requires a subscription to JAMIA.)

How important is usability to you in terms of your selection and use of an EHR? Can you share any experiences you have had with EHRs that highlight the importance of usability? Add your thoughts by clicking on the ‘Comments’ link below.

This post is the personal opinion of the author and does not necessarily reflect the official policy or positionĀ of the American College of Physicians (ACP). ACP does not endorse a specific EHR brand or product and ACP makes no representations, warranties, or assurances as to the accuracy or completeness of the information provided herein.

Comments:

One response to "How Important is EHR Usability to Uptake and Adoption?"
  • October 27, 2010
    Dr Robert Schertzer
    said:

    Alan, you certainly are highlighting the single most important factor that differentiates all the EMRs that are available to us. As there are so very many choices that all can handle most of our needs, the usability should be your guide in the final selection.
    I designed my own EMR in 1994 and have been using quite a few different ones since then. We are indeed finally at a point where there are many and perhaps too many options that all have the features that we want. I have shifted what I use in my practice based on the usability. For the last transition, I needed a solution that was form based to help those key staff members who were too valuable to lose from my practice but too resistant to the move to that EMR. By choosing a form based solution, I was able to customize the exam screens to look just like the paper charts that my office was used to. For my staff, this was the key usability issue.
    With the new EMR we are moving to over the next 2 months, we have identified new frustrations in usability – seeing prior visits. Yes, form based EMRs are great for data entry but I often need to compare a specific part of today’s visit to findings in a prior visit. All the forms are a few clicks away in order to find the correct date on a spreadsheet type screen, open the prior form and compare. Newer solutions make this a single click away without leaving the current active visit.
    Usability is the key distinguishing factor that needs to guide your final choice. Identify what you want to achieve that you are having difficulty achieving with paper charts or your current EMR and find the right EMR for YOUR practice.

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