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EHR: how to evaluate and improve usability

February 17, 2022

7 minutes read

Electronic Health Record system (EHR) is the standard practice in hospitals today. But it doesn’t mean that all problems have been solved for healthcare professionals. Besides the great benefits of the care delivery automation, now, for each hour spent in contact with patients, physicians spend another hour operating an EHR, which often takes their personal time and leads to burnout.

Low usability of EHR systems is the most common reason for physician burnout. Which, of course, leads to poorer care.

Most common EHR usability problems 

So, the evaluation and improvement of the EHR usability problem have become a crucial issue. Let’s discuss ways to improve the situation.

The most common usability problems in EHRs have two leading causes:

  • The way information is displayed – basic design and interface problems
  • The way information is provided – access to the data

Looking at the problem more precisely, scientists speak about nine significant types of problems with EHR usability:

1. Openness 
The information in the EHR has to be shown naturally. The “natural” workflow of the system refers to how familiar and easy an application is to use and to what extent it follows.

2. Consistency
This principle means that if the user knows how one part of an interface works, he can also operate other parts. 

3. Averting mistakes
The system has to prevent errors from happening in the first place.

4. Minimizing cognitive load
Human short-term memory is limited in capacity. The mental workload for EHR users has to be reduced. For instance, users should not have to memorize system information or database content.

5. Efficiency
The number of steps to complete a particular task has to be minimized, or users need shortcuts provided.

6. Forgiveness and feedback
EHR users have to receive feedback and be informed about the consequences of their actions.

7. Effective use of language
The language must be clear and free of specific terms and abbreviations that may not be familiar to particular users. 

8. User perspective 
The EMR interfaces design should consider a user perspective.

9. Customizability / Flexibility
Customization is the capability of an EMR interface to be modified based on the needs of each health care provider. 

EHR usability best practices

Before improving EHR usability, we should define how physicians work with them. The essential areas for each EHR system are:

  • Demographics
  • Problem list
  • Medication list
  • Medication allergy list
  • Clinical decision support
  • Clinical information reconciliation
  • Electronic prescribing
  • Computerized provider order entry

The most common tasks physicians perform in EHRs are:

  • Receiving drug alerts
  • Accessing patients’ medication and allergy lists
  • Entering and sending medication orders and treatment instructions (ePrescribing)

Best ways to improve EHR usability 

It is important that all areas of EHR are easy to navigate. Let’s see how to ensure the usability of EHR in some specific areas.

Allergies and medications 

Brand names and generic names 

Patients often use brand names of prescribed medications. That’s why doctors need an option in the EHR functionality for switching between generic and brand names.

Practical but straightforward formatting

The drug name in a list is more important to physicians than the instructions about dosage. It is better to bold the word and mute the rest of the text to make it easier to navigate the list when it’s alphabetized.

Medication filtering and sorting 

Interactive medication lists are valuable because when a reason for a change in a patient’s condition is not evident, looking at the medication they’re taking is enough to find a solution. For instance, a physician can use a diagnosis filter and see a needed dosage without making complex calculations.

Icon for maximum dose 

The colored daily dosage icon that indicates whether the patient reached their maximum for that drug can be very helpful.

Allergies list 

The doctors can benefit from using a color-coded list of medication allergies. Allergies can be shown in the order of severity and available prompt when adding a new order or reading a lab report. 

Order entry and prescribing

How to save doctors’ time while prescribing new medications? Below you will find some useful information. 

Prescription fields have to be pre-populated 

The system has to offer suggestions as a user types them in. It makes order entry quicker and more accurate. Some preferred drugs with the dosage and take options can appear at the top of the list in a pop-up. 

Calculations for the dose limit 

To prevent patients from taking several meds containing the same drug, a doctor can add to the EHR a note to not exceed the dosage of a particular medicine. EHR will flag this warning if needed.

Review of order 

Drug alerts or missing elements in a final version of the order must be highlighted and reviewed before sending to make last-minute changes or discuss the prescriptions with the patient. 

Order change has to be easy 

All needed dose, quantity, or frequency corrections have to be easily made without creating an entirely new order or removing the previous.

Medication history 

The complete history of the medications prescribed to each patient and the reasons why the patient stopped taking them are essential. It helps physicians select a new prescription and dosage without going through old records all the time.

Visualization of due dates renewal 

Color-coded bars can help physicians quickly recognize what medications are close to renewal during the patient’s visit. 

Search options

Physicians often can not find the information about particular procedures in the system because of different spelling for specific words. For instance, an EHR might have “chest x-ray” in a database but not “chest xray” or “x-ray chest.” Incorporating common spelling is very important for improving EHR usability. 

Medication alerts

Alerts about adverse medication effects are helpful when actionable, simply designed, and customizable. A warning should not contain information that is not important for making a prescription. Only severe alerts can interrupt the flow after the physician has completed the order. Not very important, alerts have to remain passive, allowing users to detect them with peripheral vision and acknowledge the severity. This distinction lets users avoid annoying skipping of all alerts and probably missing some important.

In some cases, a doctor needs to switch off the alert and not be reminded about minor side effects each time he adjusts a dosage. The number of alerts has to remain reasonable; otherwise, healthcare providers can start ignoring alerts.

How to find EHR with high usability 

How to get from bad to good usability? Below you can find some most common use cases and recommendations. 

Before choosing some particular EHR, you have to go through quite a lot of them. How to get to the most effective one?

We can offer you some recommendations:

  1. You have to check the usability report of the chosen EHR. EHR vendors provide such information for certification. The information is mostly available for free by one of the labs authorized to perform certification. Just google it. 
  2. The following things are not less essential: testing procedure, environment, and participants. Look at the participants’ age, education, computer experience, and role. If you see a mix of admin staff and physicians, people with different tech backgrounds and levels of EHR experience, it is a good sign.
  3. When reviewing the information, look for notes about issues and areas for improvement. If there is no information about some upgrades for a long time, problems have never been fixed.
  4. You can perform your own usability testing by requesting a demo. Let the healthcare professionals perform regular tasks using the new tool. You’ll see if the product satisfies you in all other areas. Consider how those issues can be improved.

The high usability of the EHR can significantly improve the quality of delivered medical care. Sometimes users of the same system can experience different problems because some are more familiar with the software than others. No vendor receives the same satisfaction level among users with high and low experience. That means that EHR education might be the cheapest and the least effort-intensive method to improve your EHR interactions or prepare for EHR implementation, at least for the time being, before the upgrade or redesign.

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