What Makes an EHR User Friendly?

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According to recent statistics, 54% of U.S. physicians are unhappy with their EHR’s interactivity. Why are so many doctors unhappy with their current EHR?

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There seems to be a one-word answer to this question: usability.

Electronic health records often exhibit a tendency to obfuscate rather than clarify procedures and processes, forcing the user to waste precious time and energy trying to figure out a non-intuitive system. This is no good for physicians, who are usually strapped for time and often overworked.

What exactly is it about EHRs that hinders usability? And what can EHR developers do to remedy the situation? Read on to find out:

The Trouble with EHRs

The most common, frustrating aspects of EHRs as they are designed today are numerous. They include:

  • Prevention of multitasking. Many EHRs force physicians to work through tasks one step at a time. This cuts down on doctors’ ability to multitask, thereby robbing practice workflows of efficiency.
  • Out-dated interfaces. Many EHRS have interfaces that look shoddy next to an Android or Apple platform. Users’ standards have been raised by these sleek, accessible interfaces, which are simultaneously simple and sophisticated; but many EHR user interfaces have yet to catch up with these trends.
  • Ignorance of physician needs. Unfortunately, EHR vendors often don’t consult practicing physicians as they develop EHRs. Many EHRs, then, have not been tested within the environment in which they will be used.  This results in EHR systems that don’t actually meet the needs of physicians.
  • Lack of customizability. While many EHRs initially include customizable features such as templates, it frequently happens that upgrades to a more recent version of the same EHR breaks those customized fields.
  • Nondisclosure contracts. Oftentimes, vendors compel EHR users to sign nondisclosure agreements that prevent the users from publicly revealing any details of the EHR. This means that vendors do not have the incentive of public criticism to improve their EHR.

All these problems result in EHRs that are not user-friendly and that don’t suit the needs of the practices and the physicians that use them. This is an unfortunate situation for everyone involved: Physicians can’t work with the EHRs they have; patients can’t get the care they need; and vendors are losing customers due to dissatisfaction. What’s to be done?

The first step in the solution to this problem is to understand just what does make an EHR usable:

Anatomy of a Usable EHR

An optimally usable EHR has five main characteristics:

  • Capability. A capable EHR leads to successful patient outcomes in most, if not all, cases. Thus, at its best, an EHR can help a doctor be even better at his or her job of caring for patients.
  • Efficiency. An efficient EHR should be able to keep track of all of a patient’s relevant data, lead to the optimal outcome, speed up a practice’s workflow, and increase a physician’s productivity.
  • Accuracy. An accurate EHR helps physicians significantly cut down on documentation errors. Again, this always leads to better patient outcomes.
  • Simplicity. An EHR should be simple enough that physicians and other users do not have to overcome a major learning curve in order to use the program effectively. A truly usable EHR can be used easily on the very first day a practice implements it.
  • Design. An EHR should be attractive enough that a doctor who has to spend all day using it does not come to hate the program because it is ugly and/or boring. In other words, having an aesthetically pleasing design gives an EHR lasting power.

Furthermore, a major key to usability is sufficient vendor support. EHRs that come with a comprehensive training program and excellent customer support are much more user-friendly than systems that do not. Vendors can also share tips from previous customers with new customers.

The next question to answer, then, is how can EHR developers create systems that meet these requirements?

Making Usable EHRs

In order to develop an EHR that meets the requirements for optimal usability, there must first be more widespread communication among all potential users and vendors of EHRs. This includes not only doctors and vendors, but also patients:

  • Physicians. Since they are the primary users of their EHR, physicians should be proactive about offering feedback to a vendor about their software. As mentioned above, it is practicing physicians who can provide the most insight into how to improve the usability of an EHR.  Doctors also need to talk to their patients about their experience using the EHR as patients, ascertaining what kind of data patients want access to and how.
  • Vendors. Vendors who listen to the feedback given to them by physicians and patients and who act on that feedback have the most success when it comes to improving the usability and all-round efficacy of an EHR.
  • Patients. Patients should maintain a high level of involvement with their electronic data, making sure they have at least some degree of access to it in the same form in which their physicians see it. They can then have an informed conversation with their physicians and other healthcare providers about that data, how much of it they are allowed to see, and why they might not have access to certain data. Patients can also weigh in through forums or discussions with the vendors.

Once a vendor has a better idea of what practicing physicians need in an EHR, they can start developing one that better meets those needs.

An important part of this development is designing an EHR that is compatible and up to standard with the platforms that are currently used most widely. For instance, Microsoft users are accustomed to certain features and structures in the PC environment. Developers need to do the following to ensure that their EHR meets those expectations:

  • Place controls consistently. Readers’ eyes move down the page and left to right, so initiation controls need to be in the top left, and end controls need to be in the bottom left. “OK,” “Cancel,” and “Apply” buttons need to be at the bottom right, since that’s where PC users consistently look for them. Control buttons should also have the same or similar placement from page to page so users can easily find them.
  • Write task sequences consistent with how users complete them. Again, this implies a task sequence that moves from the top down and from left to right. Also, just like with controls, task sequences need to be standardized across the whole program so users can learn to use them easily.
  • Don’t require instant recall. Users shouldn’t have to remember something from one page so they can plug it into the next.  A good way to avoid this is to institute tabbing support, whereby the user can use only the keyboard to select fields and controls.
  • Structure lists intuitively.  This means structuring the list for easy reading and according to what makes sense given how the list is used. In some cases, alphabetical order is the better option. However, in other cases, it’s more intuitive for items to be listed from “used most frequently” to “used least frequently.”
  • Always prioritize easy use. It all comes down to what is easiest for the user. This includes minimizing scrolling, especially in the horizontal direction; sizing windows appropriately; and using low character counts for warning messages.

Although this list is written with PC users in mind, most of the suggestions can be extended to the Apple environment as well.

The Future of User-Friendly EHRs

The burden of developing more user-friendly EHRs lies primarily on the vendors, of course. However, physicians–and patients, to a certain extent–must also take some responsibility for keeping vendors informed about their needs and requirements. By listening to and acting on physicians’ feedback, EHR vendors will see more customer satisfaction and therefore more customers, so everyone will be happy!

What makes your EHR user-friendly (or not)? Feel free to add your thoughts in the comments below!

Looking for Electronic Medical Records software? Check out Capterra's list of the best Electronic Medical Records software solutions.

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About the Author

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Helen DeCelles-Zwerneman

During the school year, Helen puts her love of physics and people to good use teaching high-school math and science. During the summer, she blogs for Capterra, a privately held technology and online media company that brings together buyers and sellers of software. In her free time, you're most likely to find Helen reading or spending time with her family and friends.

Comments

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I know how great the EHR is. When I go to see my Doctor, she immediately knows everything about me. The nurse and doctor know what vitamins and medications I take. They have access to all my past visits. When I go to another clinic, they can also see my medical history.
When I want to see my history and results of tests, I can go online and get all the information. Awesome!
Roberta M Bradley

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ONC’s adoption of NIST’s 7804 protocol would address the most egregious of these problems, but it has refused to do so. This insures that usability will remain a major, chronic problem.

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