Usability: Can Every EHR Be Above Average?

Usability is the key differentiator between the long-term success and failure of an EHR implementation. The findings of the recent MGMA study lead to the inescapable and troubling conclusion that too many physicians do not consider their EHRs “usable.” A bad EHR choice is costly for the particular physician(s) and, while it might suffice in the short term for the purpose of earning meaningful use incentives, it will do nothing in the long run to foster sustained EHR adoption. Recognizing this, the HIT Policy Committee’s Adoption and Certification Workgroup convened an 8-hour hearing last week on the subject of how to define and measure usability. Recommendations were offered that mirrored my EHR reform proposal, and various groups/studies are already working on usability testing. One such group is CCHIT, which has introduced a usability rating tool into its commercial certification (not to be confused with government-certification) process. In her testimony, Karen Bell, M.D., Chair of CCHIT, discussed the results (Chart 1) and her recommendations.

So what’s wrong with this picture?

What’s wrong is that, to be useful to physicians, it has to look like this:

This is not meant as an indictment of CCHIT—the organization is to be commended for having taken an important first step in defining usability and creating a process for measuring it. The problem—which Karen Bell did acknowledge when challenged about it—is that if this rating scale were an accurate reflection of usability, there would be many fewer complaints about EHRs and, in my opinion, many fewer failures.

To provide physicians with the objective information that will be valuable to them in EHR purchase decisions, the ratings must be comparative and follow a normal distribution, as illustrated in Chart 2 above. Because achieving this distribution would require more aggressive usability criteria, it would distinguish those EHRs that have the greatest positive impact on productivity and cost savings from those that have a lesser, or negative, impact in these areas.

Even more important, this more challenging evaluation will create a market in which vendors are forced to compete on usability and how to better meet the needs of physicians. Physician satisfaction levels will increase. It will elevate quality across the board and raise the level of the entire EHR industry. Perhaps, as Dr. Ross Koppel testified at the Usability Hearing, if health IT were more usable, we wouldn’t even need incentives to spur EHR adoption!

2 thoughts on “Usability: Can Every EHR Be Above Average?

  1. EHR usability is an issue. Studies are being executed now. I too believe that extensive evaluation will create a market that vendors will be forces to compete on usability. We need to know long term usage ability. Purchasing EHR software is a big decision for many physicians, so having evaluations done will hopefully give more insight to physicians to help make the right decision.

  2. Evan,
    Your observations conform to my experience as a clinician. Despite the fact that CCHIT awarded the highest usability rating to the “top-tier” CCHIT-certified system used by my practice, on a day-to-day basis my colleagues and I find our EHR virtually unusable. Usability testing should not just be about the number of clicks needed to perform a certain task. To be valid, the testing also needs to evaluate high level design issues. Most traditional EHRs have high level design deficiencies which impose a tremendous cognitive burden on the clinician, interfering with patient care. Apparently, CCHIT has defined usability so narrowly as to render their evaluations meaningless.

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