EHR Usability — Are the Guidance Criteria Appropriate?

The National Institute of Standards and Technology (NIST) is seeking comment on a draft document titled “Technical Evaluation, Testing and Validation of the Usability of Electronic Health Records” (NISTIR 7804). The public comment period is from October 3 through November 10, 2011.

NIST states:

Usability is “the extent to which a product can be used by specified users to achieve specified goals with effectiveness, efficiency and satisfaction in a specified context of use [ISO9241].” Usability represents an important yet often overlooked factor impacting the adoption and meaningful use of electronic health record (EHR) systems. Without usable systems, doctors, medical technicians, nurses, administrative staff, consumers, and other users cannot gain the potential benefits of features and functions of EHR systems.

The wide variation in design of EHRs, including graphic user interface, workflow processes, and optimization for different form factors, is challenging for evaluators, particularly those who have experience using a specific EHR system. In order to standardize the design and evaluation process, NIST has put forward a three-step process for design evaluation and human user performance testing for an EHR. This process is focused on increasing safe use of the EHR and increasing ease of use of the EHR by users. The steps are as follows:

  • Usability/human factors analysis of the application during EHR user interface development
  • Expert review/analysis of the EHR user interface after it is designed/developed
  • Testing of the EHR user interface with users

In 2009, HIMSS published a document titled: “Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” (.pdf) and also provides a number of additional resources on EHR Usability.

HIMSS states:

Usability is one of the major factors — possibly the most important factor — hindering widespread adoption of EMRs. Usability has a strong, often direct relationship with clinical productivity, error rate, user fatigue, and user satisfaction–critical factors for EMR adoption. Clinicians lose productivity during the training days and for months afterward as they adapt to the new tools and workflow. Adoption rates by physicians and hospitals have been slower than expected in the US, in part, due to poor efficiency and usability.

A podcast on EMR Usability and Human Factors is available through AmericanEHR — Click here to listen.

Despite the importance of usability, it is very difficult to get the mix of factors just right. Apple engineers are masters when it comes to usability; however, other manufacturers have failed repeatedly where Apple has succeeded. Having a comprehensive set of guidelines, evaluation criteria, and processes will be a very useful building block in the creation of more usable EHR solutions. If you have some time to comment, download the NIST document and add your voice to the discussion.

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