Since the enactment of the HITECH Act of 2009, EHRs have become a mandatory component of American healthcare. As of 2017, 86% of the practices and 94% of the US hospitals have adopted an EHR. Many advanced and innovative healthcare providers have even started testing AI powered EHR’s. As the majority of the clinical workflows are dependent on EHR, there should be a formal method to conduct an EHR Usability Assessment. EHRs are meant to offer an intuitive user experience to the providers and assist them in their routine tasks, as well as ensuring patient privacy and confidentiality. Instead, if EHR is only adding more burden on an already overworked provider and creating security concerns, it should be discarded immediately.
Metrics to evaluate EHR usability:
Usability is one of the six quality criteria laid down by ISO in its guidelines for evaluation of software quality. To measure the usability of an EHR, HIMSS has laid down guidelines regarding the metrics to consider while performing a comprehensive EHR usability assessment:
- Simplicity (average screen time): Simplicity refers to how easy it is to use an EHR. An EHR should be as easy to use, and providers should not find it cumbersome to deal with the application.
- Naturalness: This metric refers to what degree an EHR is aesthetically pleasing. An EHR should feel intuitive, immersive, and interactive. At a glance, it should show the provider with all vital insights of his practice.
- Consistency: This is a measure of how homogenous the layout of an application is. Different parts of an EHR should give the same look and feel, and the entire experience of using the application should be seamless. It should not feel as if several random components have been welded to create an erratic EHR Programs. Instead, one feature of the application should complement another.
- Forgiveness and feedback: The probability of committing errors can never be ruled out. An ideal EHR should have multiple checks in place, to reduce the likelihood of erroneous data entry, alongside making it easy to undo mistakes. Plus, an EHR should take confirmation from the provider during sensitive clinical tasks, such as dosage calculations and drug prescriptions. This metric analyzes how easy it is to reverse unintentional actions on the EHR.
- Effective use of language: An EHR should have natural language and avoid technical lingos. This metric measures how effective is the choice of words and phrases used in the EHR.
- Efficient interactions: One of the most important metrics in this list, efficient interactions refer to how easy it is to interact with the EHR software. An ideal EHR should reduce the onscreen time of the provider and should get the tasks done in minimal clicks.
- Effective information presentation: This metric examines how information is shown to the provider, in terms of font style, color combinations, charts, graphics, etc. Modern EHRs have advanced dashboards that display vital pieces of information the providers, with regards to the current standing of the practice.
- Preservation of context: This refers to how consistent and stable an EHR feels while using one particular feature of the application. For example, if a provider is making progress notes, e-prescriptions should not jump in. The provider should feel that the application is in his control.
- Minimization of cognitive load: One of the essential reasons why EHRs are there in the first place, this metric attempts to measure how less of a mental stress an EHR is. EHRs should record all information that a practice generates, and nothing should be left for the providers to ‘remember.’ Instead, their sole job should be to assist the patient sitting in front of him.
Criteria to evaluate each metric:
All the above-stated parameters should be given remarks based on these three criteria:
- Effectiveness: Is the EHR accomplishing all the tasks?
- Efficiency: Is the EHR saving time and resources?
- Satisfaction: Does a provider feel gratified with the overall experience of using the particular EHR?
In a research conducted by Annals of Internal Medicine, it has been determined that for every one hour of patient care, a physician has to spend an additional two hours interacting with their EHR. This means that a provider effectively gives 33% of his attention to patients, and the remaining focus lies on operating the EHR properly. One reason for such high rates of screen-time is bad usability of an EHR.
In order to resolve this issue, an independent assessment of the Usability of EHR should be done. This will not only allow providers to identify problems in the EHR but will also enable higher management to take strategic decisions with regards to retaining an EHR or migrating to another one.