Abstract
Background A substantial gap exists between current Electronic Health Record (EHR) usability
and potential optimal usability. One of the fundamental reasons for this discrepancy
is poor incorporation of a User-Centered Design (UCD) approach during the Graphical
User Interface (GUI) development process.
Objective To evaluate usability strengths and weaknesses of two widely implemented EHR GUIs
for critical clinical notes usage tasks.
Methods Twelve Internal Medicine resident physicians interacting with one of the two EHR
systems (System-1 at Location-A and System-2 at Location-B) were observed by two usability
evaluators employing an ethnographic approach. User comments and observer findings
were analyzed for two critical tasks: (1) clinical notes entry and (2) related information-seeking
tasks. Data were analyzed from two standpoints: (1) usability references categorized
by usability evaluators as positive, negative, or equivocal and (2) usability impact
of each feature measured through a 7-point severity rating scale. Findings were also
validated by user responses to a post observation questionnaire.
Results For clinical notes entry, System-1 surpassed System-2 with more positive (26% vs.
12%) than negative (12% vs. 34%) usability references. Greatest impact features on
EHR usability (severity score pertaining to each feature) for clinical notes entry
were: autopopulation (6), screen options (5.5), communication (5), copy pasting (4.5),
error prevention (4.5), edit ability (4), and dictation and transcription (3.5). Both
systems performed equally well on information-seeking tasks and features with greatest
impacts on EHR usability were navigation for notes (7) and others (e.g., looking for
ancillary data; 5.5). Ethnographic observations were supported by follow-up questionnaire
responses.
Conclusion This study provides usability-specific insights to inform future, improved, EHR interface
that is better aligned with UCD approach.
Keywords
electronic health records - interfaces - usability - graphical user interface - clinical
documentation - qualitative - methodology
