EHR design is an 'investment' not all vendors embrace

EHR usability is "incredibly complex" and needs specific adaptations of user-centered design (UCD) in order to be effective, according to panelists at a Health IT safety webinar conducted by RTI on behalf of Office of the National Coordinator for Health IT on June 19.

"Standard UCD methods don't apply to healthcare," explains Ross Teague, Ph.D., senior manager of user experience at Allscripts. For instance, clinicians are a different type of user, dealing with patient safety and life-and-death decisions. Healthcare UCD also requires more rigor, more attention to detail and a greater focus on complex socio-technical systems. 

However, while usability is not solely a vendor problem, a number of vendors come up short when it comes to UCD design, Raj Ratwani, Ph.D., scientific director at MedStar Health's National Center for Human Factors in Health Care, said during the webinar, one in a series about health IT safety. One recent study on the usability of computerize provider order entry (CPOE) of 41 EHR vendors found that, "shockingly," 34 percent had no reported UCD process to develop it, even though ONC's EHR certification process requires vendors to have such a process, Ratwani said.

Moreover, while the National Institute of Standards and Technology recommends at least 15 participants to test EHR usability, 63 percent of the vendors used fewer than the minimum number of participants, and many testers had no clinical background in CPOE, he added. Seventeen percent didn't use physicians to test the EHRs, and 5 percent used their own employees as testers, all of which he called a "pretty gross violation of testing standards."  

There are also less obvious problems with EHR usability, Ratwani pointed out. For instance, while studies show that task allocation time returned to pre-EHR levels after clinicians adjusted to the systems, there's a significant increase in the number of tasks to be performed, a "cognitive cost" that leads to increased likelihood of errors as well as more stress and frustration.

Moreover, usability and safety are related but are not the same, and simply having clinicians on the vendor's design staff is not sufficient, warned Kris Engdahl, senior manager of user research for cloud vendor athenahealth, who acknowledged that the healthcare user experience has been "behind those in other industries." She suggested that vendors use a "robust" process to advance safety and usability.

"It's not proprietary and it's not rocket science. It's an investment," she said.  

EHR usability has been a challenge for providers, creating dissatisfaction and raising patient safety concerns. Other studies have found that vendors' commitment to usability varies significantly.   

To learn more:
- check out the the webinars

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