A usability and safety analysis of electronic health records: a multi-center study

Ratwani, Raj M.; Savage, Erica; Javernick‐Will, Amy; Arnold, Ryan; Khairat, Saif; Miller, Kristen; Fairbanks, Rollin J.; Hodgkins, Michael; Hettinger, A. Zachary

doi:10.1093/jamia/ocy088

Cited by 115 publications

(119 citation statements)

References 7 publications

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“…The current variability in EHR usability across health care systems and vendors has been shown to be wide, with certain tasks having an average of a 9-fold difference in time and 8-fold difference in clicks between different EHRs. 42 Therefore, the unacceptably low scores with wide variation reported here are likely representative of the current state of EHR usability; namely, that usability is generally poor but that there is a wide range of EHR usability across systems, specialties, and practice settings. In comparison to other technologies, current EHRs are still in a nascent form and are only going to become more complex moving forward.…”

Section: Discussionmentioning

confidence: 85%

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

Melnick

Dyrbye

Sinsky

et al. 2020

Mayo Clinic Proceedings

258

211

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Objective: To describe and benchmark physician-perceived electronic health record (EHR) usability as defined by a standardized metric of technology usability and evaluate the association with professional burnout among physicians. Participants and Methods: This cross-sectional survey of US physicians from all specialty disciplines was conducted between October 12, 2017, and March 15, 2018, using the American Medical Association Physician Masterfile. Among the 30,456 invited physicians, 5197 (17.1%) completed surveys. A random 25% (n¼1250) of respondents in the primary survey received a subsurvey evaluating EHR usability, and 870 (69.6%) completed it. EHR usability was assessed using the System Usability Scale (SUS; range 0-100). SUS scores were normalized to percentile rankings across more than 1300 previous studies from other industries. Burnout was measured using the Maslach Burnout Inventory. Results: Mean AE SD SUS score was 45.9AE21.9. A score of 45.9 is in the bottom 9% of scores across previous studies and categorized in the "not acceptable" range or with a grade of F. On multivariate analysis adjusting for age, sex, medical specialty, practice setting, hours worked, and number of nights on call weekly, physician-rated EHR usability was independently associated with the odds of burnout with each 1 point more favorable SUS score associated with a 3% lower odds of burnout (odds ratio, 0.97; 95% CI, 0.97-0.98; P<.001). Conclusion: The usability of current EHR systems received a grade of F by physician users when evaluated using a standardized metric of technology usability. A strong dose-response relationship between EHR usability and the odds of burnout was observed. ª 2019 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) n Mayo Clin Proc. 2020;95(3):476-487

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Section: Discussionmentioning

confidence: 85%

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

Melnick

Dyrbye

Sinsky

et al. 2020

Mayo Clinic Proceedings

258

211

View full text Add to dashboard Cite

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“…Consistent with earlier efforts [6][7][8][9], examinations of patient safety reports continue to find evidence of a strong impact of usability problems on EHR safety [10,11]. A laboratory study of two commonly-used EHRs in four healthcare systems found wide variability in task completion time, required clicks, and error rates (ranging from 0% to 50% for various tasks), even though the products had been certified by accreditation authorities [12]. Overly burdensome and often inconsistent EHR documentation practices have also been discussed as a potential source of physician stress and safety risks [13][14][15].…”

Section: Clinical Informaticsmentioning

confidence: 53%

Human-Computer Interaction, Ethics, and Biomedical Informatics

Hochheiser

Valdez

2020

Yearb Med Inform

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Objectives: To provide an overview of recent work at the intersection of Biomedical Informatics, Human-Computer Interaction, and Ethics. Methods: Search terms for Human-Computer Interaction, Biomedical Informatics, and Ethics were used to identify relevant papers published between 2017 and 2019.Relevant papers were identified through multiple methods, including database searches, manual reviews of citations, recent publications, and special collections, as well as through peer recommendations. Identified articles were reviewed and organized into broad themes. Results: We identified relevant papers at the intersection of Biomedical Informatics, Human-Computer Interactions, and Ethics in over a dozen journals. The content of these papers was organized into three broad themes: ethical issues associated with systems in use, systems design, and responsible conduct of research. Conclusions: The results of this overview demonstrate an active interest in exploring the ethical implications of Human-Computer Interaction concerns in Biomedical Informatics. Papers emphasizing ethical concerns associated with patient-facing tools, mobile devices, social media, privacy, inclusivity, and e-consent reflect the growing prominence of these topics in biomedical informatics research. New questions in these areas will likely continue to arise with the growth of precision medicine and citizen science.

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“…We also acknowledge that this study was conducted at only one institution with one EHR system. Previous research [48] shows wide variation in how different institutions use the same EHR product in different ways and how different EHR products offer different functionalities. Another limitation is that this EHR system was implemented only one year before we conducted this study.…”

Section: Limitations and Opportunities For Further Researchmentioning

confidence: 99%

The influence of Electronic Health Record use on collaboration among medical specialties

Vos

Boonstra

Kooistra

et al. 2020

Preprint

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Abstract Background: One of the main objectives of Electronic Health Records (EHRs) is to enhance collaboration among healthcare professionals. However, our knowledge of how EHRs actually affect collaborative practices is limited. This study examines how an EHR facilitates and constrains collaboration in five outpatient clinics.Methods: We conducted an embedded case study at five multidisciplinary outpatient clinics of a Dutch hospital that had implemented an organization-wide EHR. Data were collected through semi-structured interviews with representatives of medical specialties, administration, nursing, and management. Documents were then analyzed to contextualize these data. We examined the following six collaborative affordances of EHRs: (1) portability, (2) co-located access, (3) shared overviews, (4) mutual awareness, (5) messaging, and (6) orchestrating.Results: Our findings demonstrate how an EHR will simultaneously both facilitate and constrain collaboration among specialties and disciplines. Affordances that were inscribed in the system for collaboration purposes were not fully actualized in the focal hospital because:(a) The EHR helps health professionals coordinate patient care on an informed basis at any time and in any place but only allows asynchronous patient record use. (b) The comprehensive patient file affords joint clinical decision-making based on shared data, but specialty- and discipline-specific user-interfaces constrain mutual understanding of that data. Moreover, not all relevant information can be easily shared across specialties and outside the hospital. (c) The reduced necessity for face-to-face communication saves time but is experienced as hindering collective responsibility for a smooth workflow. (d) The EHR affords registration at the source and full registration of activities through orders, but the heightened administrative burden for physicians and the strict authorization rules on inputting data constrain the flexible, multidisciplinary collaboration. (e) While the EHR affords a complete overview, information overload occurs due to the parallel generation of individually owned notes and the high frequency of asynchronous communication through messages of varying clinical priority.Conclusions: For the optimal actualization of EHRs’ collaborative affordances in hospitals, coordinated use of these affordances by health professionals is a prerequisite. Such coordinated use requires organizational, technical, and behavioral adaptations. Suggestions for hospital-wide policies to enhance trust in both the EHR and in its coordinated use for effective collaboration are offered.

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A usability and safety analysis of electronic health records: a multi-center study

Cited by 115 publications

References 7 publications

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians

Human-Computer Interaction, Ethics, and Biomedical Informatics

The influence of Electronic Health Record use on collaboration among medical specialties

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