Not all vendors take EHR usability seriously

Electronic health record vendor commitment and understanding of the need for usable EHRs varies significantly, according to a new study published in the Journal of the American Medical Informatics Association (JAMIA).

The researchers, from District of Columbia-based MedStar Health and elsewhere, noted that poor EHR usability increases provider frustration, can hinder adoption of the systems and leads to errors that can jeopardize patient safety. The problem is so acute that the Office of the National Coordinator for Health IT's 2014 certification criteria includes a requirement that vendors attest that they use user centered design (UCD) processes and report the results of usability testing.

However, most usability studies focus on providers, not on EHR developers. To learn more about vendor views regarding usability, the researchers visited 11 unidentified EHR vendors to analyze their UCD processes and determine what challenges vendors face in integrating usability with EHR development.

They found that vendors fell into three different levels of UCD:

  1. Well-developed UCD
  2. Basic UCD
  3. "Misconceptions of UCD," such as believing that simply having the ability to respond to feature requests and complaints constitutes UCD

Some vendors, typically the smaller ones, had no staff member experts in EHR usability. The variability seemed surprising, considering ONC's certification requirement to employ UCD processes.

The challenges vendors faced in making their EHRs more usable also varied, depending on which category they were in. For instance, vendors in the well-developed UCD category reported an inability to get providers to share design related adverse events. Vendors with a basic UCD had knowledge gaps and difficulty recruiting participants to discuss UCD. Vendors with misconceptions didn't understand the business case for UCD and the need to invest in it.

"At the policy level, the variability in UCD practices and the fact that some vendors have a misconception of UCD, yet have certified EHR products in the marketplace, suggest that certification requirements may need to be adjusted," the researchers said. They also recommended that usability be examined to determine if there was a relationship between usability and the rigor of the process used.

EHR usability continues to be a sore point among providers, who often resort to workarounds and scribes in an attempt to counter such problems, which in turn hampers design improvement. The American Medical Association, frustrated by the lack of progress, created its own blueprint to improve EHR usability last fall.

To learn more:
- read the study