The public should know which vendors take usability seriously

Many electronic health record studies seem to state the obvious.

But every so often, a study delves into new territory and makes one sit up and take notice.

That's how I feel about this new study in the Journal of the American Medical Informatics Association about EHR usability.

Most surveys on EHR usability focus on the end user. For instance, there have been many reports about providers' frustrations with how their EHRs work.

But this latest study takes a novel approach and addresses how various vendors view EHR usability

I found it eye opening how varied the vendor responses were.

The researchers studied 11 different EHR vendors, including meeting with employees personally to learn more about how the vendors approach usability and user-centered design (UCD), a requirement of the Office of the National Coordinator for Health IT's 2014 edition certification criteria. Surprisingly, despite the requirement, the researchers found that the vendors' commitment to usability varied so much they placed them into three categories: those with well-developed UCD, those with basic UCD, and those who don't all take usability seriously, which the researchers referred to euphemistically as vendors with "misconceptions of UCD." As the researchers explain:

These vendors "do not have any UCD process in place, although they believe they do through mechanisms like 'web forums that allow [their] users to post suggested features and vote on these features.' Vendors in this group generally have a misconception about what constitutes UCD. One prominent misconception is the belief that having an infrastructure for responding to users' feature requests and complaints is what constitutes UCD. Extensive methods to collect and respond to user feedback have generally been developed, and the vendors highlight these methods as evidence of their UCD process. These vendors generally do not have usability experts on staff, and the leadership of these vendors often lacks an appreciation for UCD."

While the vendors' identities were not revealed, there were some interesting statistics. Of the 11 vendors studied, two had more than 30 employees identified as "usability staff" experts. But five of the vendors listed this as "N/A," which I take to mean that they either had no usability experts on staff or failed to identify any. One of these vendors had estimated revenue of more than $1 billion and another reported an estimated revenue of more than $100 million. For that amount of revenue, one would think that they'd at least make an attempt to take usability more seriously.

But evidently not. According to the study, one vendor in the misconception category stated, "Our product is used by thousands of people every day. So if it was that bad, it would already be out of the market."

Interesting point, but not illustrative. There must be some reason that providers are using the product. Is it less expensive? Is it marketed a particular way? Is it harder to change to a different vendor? Have providers created workarounds? Is it so simple that it's pretty easy to use? 

Regardless of the reason, it does illuminate at least one vendor's rather cavalier attitude toward its product and the customers that use it.

The good news is that some vendors have actually read the memo and do take EHR usability seriously. The bad news is that here we are in 2015, and not all of them do.

The bottom line on usability, of course, is that if EHRs are hard to use, people either won't use them or will make more mistakes, which threatens patient safety.

I hope that ONC takes a hard look at which vendors are complying with this particular certification criterion.

I also hope that those vendors that are dedicated to improving the usability of their EHRs identify themselves and get credit for it. It may not necessarily mean that their products are more usable (you still have to check), but if I were in the market for an EHR, this would be a factor I would consider strongly when making my purchasing decision.

Vendors, if usability is important to you, stand up and be counted. The public wants to know who the good guys are. - Marla (@MarlaHirsch and @FierceHealthIT)

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