What is needed to improve EHR usability?

Many in the healthcare industry have complained that electronic health records are not user-friendly. You know that there's credence to those complaints when a body as august as the National Institutes of Standards and Technology (NIST) agrees and recommends that an EHR usability protocol be developed to tackle the problem.

In a recent draft report, NIST said that EHRs are harder to use than they need to be. The agency suggested that a usability protocol should outline procedures and studies to evaluate the issue.

This is not the first time usability has been an issue for NIST: Last December, the agency discussed "user-centered design" for EHRs, in one report. A second guide, created in conjunction with the Agency for Healthcare Research and Quality (AHRQ) pointed out gaps in many of the processes and practices EHR vendors follow to help ensure the usability of their products and offers a template for testing usability

In this latest report, the authors insist that poor usability--such as poorly designed screens, hard-to-navigate files, conflicting warning messages, and need for excessive keystrokes or mouse clicks--adversely affects clinical efficiency and data quality. They recommend that the protocol, which is being developing in conjunction with the Office of the National Coordinator for Health IT (ONC) and the AHRQ, evaluate EHRs both from a clinical and a "human factors best practices" perspective.

The report also includes steps and consent forms for testing user-participants. NIST admits in the report that its protocol is not looking at innovation, creativity or competitive features; it simply wants to make EHRs more user-friendly and minimize user error.

It's really not disputed that NIST is onto something. The report itself cites several studies, including those from HIMSS and the President's Council of Advisors on Science and Technology, that usability is one of the major factors hindering widespread adoption of EHRs. Anecdotally we've all heard--and seen--physicians who've given up using their EHRs, saying they're not worth the bother.     

Reaction in the blogosphere has been pretty uniform: it's a good idea to improve the usability of EHRs and for NIST to be taking on the task. However, they don't embrace the draft report wholeheartedly, and some have poked holes in NIST's proposal. For instance, self-proclaimed "standards geek" Keith Boone, in a Healthcare Standards blog post, notes that there are glitches in the report, including its use of old data and the cost of validation testing. Dr. Alan Brookstone posted on the AmericanEHR Blog that it's important to improve the usability of EHRs, but that it's hard to get the "mix of factors" to improve them right, unless you're an engineer at Apple.

Others have suggested that the problem lies at the feet of EHR vendors. Mr. HIStalk, for instance, says that vendors should be incorporating usability in early product design. And  "InformaticsMD," posting on the Health Care Renewal blog, says that it's about time that vendors take the blame for design drawbacks that lead to errors that harm to patients.

What do you think? Let us know, or send a comment to [email protected]. NIST is accepting public comments through Thursday, Nov. 10. - Marla

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