Optimal usability of electronic health records is the goal of a newly developed framework rolled out this week by the American Medical Association and MedStar Health's National Center for Human Factors.
The framework, according to principle developer Raj Ratwani (pictured), the center's scientific director, is based on research he and his team published last month in the Journal of the American Medical Association. The study, which examined available reports from 50 EHR vendors, determined that the Office of the National Coordinator for Health IT for the Meaningful Use program certified many vendors' products even if the vendors didn't follow "basic federal" certification requirements around usability.
For similar research published in the Journal of the American Medical Informatics Association in June, Ratwani and his colleagues visited 11 EHR vendors to analyze their user-centered design (UCD) processes and determine what challenges the vendors face in integrating usability with EHR development. They found that vendors fell into three different levels:
- Well-developed UCD
- Basic UCD
- Misconceptions of UCD, such as believing that simply having the ability to respond to feature requests and complaints constitutes UCD
Ratwani and his team determined that such variability, combined with the fact that some vendors have misconceptions about UCD but still have certified products, suggests that, perhaps, it's time to adjust the certification requirements.
To that end, the new framework examines vendor compliance for UCD processes based on a 15-point scale developed by MedStar and AMA. Ratwani makes clear in an announcement, however, that the framework does not evaluate such processes as experienced by end users.
"Alignment with best practices for user-centered design and testing is a starting point that regulators and industry should meet and exceed," Ratwani says.
Of 20 products currently listed, only three receive a perfect score of 15: Allscripts Enterprise EHR, v11.4.1; Allscripts Sunrise Acute, v15.1-c; and McKesson Specialty Health, Paragon 12&2.0 Inpatient.
A perfect score, however, does not mean that a product has "perfect usability," according to MedStar; rather, it represents that the vendor "meets user-centered design and testing best practices."
AMA President Steven Stack says that usability issues are reasons for low provider satisfaction with EHRs.
"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," Stack says.
The AMA, last fall, developed its own framework outlining eight priorities to improve the usability of EHR systems.