Evaluating EMR Usability

Recently, we suggested that innovative business models can drive vendors to produce breakthroughs in EMR usability. We subsequently argued that market forces are more efficient than regulation as a means to assure rapid dissemination of usable EMRs. If the market is to work its magic in this regard, physicians need simple ways to compare EMRs when it comes to usability.

The Regional Extension Centers, the American College of Physicians, KLAS and other organizations provide comparative data on EMR usability, but their evaluations are subject to financial conflicts involving the very EMR vendors that they evaluate. For example, some of these entities require vendors to pay for the right to be evaluated. Sometimes, the financial viability of the entity providing the evaluations depends upon its ability to cut deals with EMR vendors which allow the entity to generate revenue for itself (usually through advertising or by charging providers joining fees or implementation support fees).

Many physicians worry that these conflicts can bias the evaluations produced by these entities. Others object to the “hidden costs” of EMR acquisition that are passed on to them as a byproduct of the deals involving EMR vendors and the evaluating agencies.

Even if these issues are of no concern, many physicians prefer to assess EMR usability for themselves. After all, the best Consumer Report on the planet can’t replace the test drive you take before you buy a car—and the same logic applies here.

There is a problem, of course. Even though physicians understand that EHR usability will have a large impact on their productivity, the quality of their care and patient safety as well, most of them have little experience evaluating EMR usability.

Can physicians rely on HHS certification—the criteria for which will soon be finalized by the Office of the National Coordinator for Health Information Technology—as a proxy for EHR usability? Alas, no. The ONC criteria do not address the matter at all. Many cumbersome, poorly designed EMRs will get certified. That is a stone cold truth.

It appears therefore, that physicians would benefit from a quick review of EMR usability, followed by the presentation of a simple tool they can use to carry out their own assessments. That’s what Practice Fusion is providing this week.

In the remainder of this post, we introduce the concept of EMR usability. In Part II of the series (appearing Wednesday), we complete the introduction and begin offering specific guidance about how to evaluate EMR usability. In Part III (on Friday), we provide a simple evaluation tool that physicians can use to assess EMR usability.

To create this series of posts, I condensed and modified a superb literature review on EMR usability that was produced by a HIMSS Task Force one year ago.

What Makes an EMR Usable?
An EMR is usable to the extent that it lets someone (a physician, a nurse practitioner, or front-office staff) complete a task in an efficient and effective manner. Efficiency refers to the ease and speed with which the user accomplishes the task. Effectiveness refers to the accuracy and completeness with which the task is completed. In short, a usable EMR is one that feels intuitive and easy to use. People like it!

Dimensions of EMR Usability
By most accounts, there are at least 10 dimensions of EMR usability: simplicity, naturalness, consistency, minimizing cognitive load, efficient interactions, forgiveness and feedback, effective use of language, proper use of color, readability and preservation of context. We’ll introduce the first few in this post, and finish the discussion on Wednesday.

This involves displaying the right amount of information and functionality needed to carry out a task. There is no visual clutter. A “less is more” design philosophy prevails.

This involves conveying a sense of familiarity and ease of use. Naturalness is achieved in part by using terminology and screen flows that match users’ prior experiences.

There are 2 categories of consistency. External consistency is the extent to which the EMR user’s experience matches that achieved with other software applications. By allowing users to apply what they have learned while using other applications, external consistency hastens mastery of the EMR. In contrast, internal consistency refers to the use of similar layout designs and conventions across workflows. Internal consistency boils down to predictability.

Minimizing Cognitive Load
This involves presenting all information needed for the task at hand so that the user doesn’t have to change screens or think about the application at the time she prepares to make a decision. When reviewing results of a cholesterol test for example, the user needs to see prior results and a medication list at the same time.

Glenn Laffel, MD, PhD
Sr. VP Clinical Affairs
Practice Fusion EMR