A recent evaluation of electronic health record (EHR) technology has revealed that clinician satisfaction with EHR usability is not improving for many widely used products.
The research, published in JAMA Open Network, co-led by Raj Ratwani, Ph.D., director of MedStar Health’s National Center for Human Factors in Healthcare, as well as by Kylie M. Gomes from the University of Virginia, included an evaluation of 27 EHR vendors that met certain meaningful use criteria.
The researchers noted that Office of the National Coordinator for Health IT (ONC) requirements stipulate that vendors must conduct and report results of formal usability testing, including measuring satisfaction with the EHR system. Most of these vendors use the system usability scale (SUS), which provides a score (0 to 100) based on a participant’s rating of 10 statements regarding a product’s usability.
Based on an analysis of more than 200 studies of various products in various industries, an SUS score of 68 is considered the average benchmark, and an SUS of 80 is considered the above-average benchmark, the researchers explained.
Recognizing the importance of satisfaction with EHR usability to clinician burnout and patient safety, for the study, reported product 2015 SUS scores for EHR systems were compared with 2014 SUS scores and with benchmarks to evaluate whether satisfaction is improving.
Comparing the EHR products that were certified between 2014 and 2015, the findings showed there was no statistical improvement in EHR SUS scores. One-third of 2014 products and one-quarter of 2015 products fell below the average benchmark SUS score of 68. The majority of products from both certification years fell into the “at or above average” category, with 67 percent of EHRs in 2017 and 74 percent in 2015 falling into this domain. About four in 10 products in each certification year met or exceeded the above-average benchmark.
What’s more, despite the implications of EHR dissatisfaction on clinician burnout and patient safety, SUS scores decreased for 44 percent of vendors from 2014 to 2015, the researchers found.
The researchers concluded, “Based on vendor-reported SUS scores, clinician satisfaction with EHR usability is not improving for many widely used products. An increased focus on clinician end users during product design and development as well as optimized certification requirements are needed to improve usability.”
To this end, Ratwani is part of broader efforts to improve EHR usability and design. He has been involved in spearheading a recent campaign that aims to push for changes to address the known risks to patient safety and clinician burnout that stem from poor EHR usability.
The initiative from MedStar, the largest provider organization in the Baltimore-Washington metropolitan area, and the American Medical Association (AMA), includes videos from the clinician's point of view that demonstrate the risks and challenges caused by poor EHR usability. The videos have just been made available on a website, EHRSeeWhatWeMean.org, which specifically calls out what multiple stakeholders—policymakers, healthcare providers, EHR vendors and patients—can do in the push to improve EHR usability and safety.
Additionally, an EHR Reporting Program, mandated by the 21st Century Cures Act, is in the process of being established and is intended to increase transparency and awareness of the usability of different products.
