Nine Types of Usability Problems with Electronic Health Systems


By Bennett Lauber, Chief Experience Officer, The Usability People
Twitter: @UsabilityPeople

There is no shortage of complaints about the usability of Electronic Health Record systems (EHRs). More and more evidence is emerging regarding the lack of EHR usability. Speaking at the 2013 Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition, Michael S. Barr, MD, MBA, FACP, of the National Committee for Quality Assurance (NCQA) warned that:

“Satisfaction and usability ratings for certified electronic health records (EHRs) have decreased since 2010 among clinicians across a range of indicators.”

Barr’s presentation at HIMSS focused on “ the need for the Meaningful Use program and EHR manufacturers to focus on improving EHR features and usability.”

The healthcare industry in the United States is facing a crisis as medical facilities have spent hundreds of billions of dollars implementing electronic health record (EHR) systems, yet many patients and the physicians and nurses that care for them are seeing few benefits.

In a recent article published in the The Journal of the Human Factors and Ergonomics Society examined 50 studies with the keywords: electronic medical records and electronic health records combined with interface design, usability, safety, and errors published after 2000. Their review of EMR and EHR usability studies revealed nine major types of problems:

  1. Naturalness
    All information in the display should appear in a natural order. Naturalness also refers to how familiar and easy an application is to use and to what extent it follows the “natural” workflow of the system.
  2. Consistency
    This principal basically means that knowing one part of an interface should be relevant for use of other parts. A particular system action should always be achievable by one particular user action.
  3. Preventing Errors
    Interactive system interfaces should be designed in a way that prevents errors from happening in the first place.
  4. Minimizing Cognitive Load
    Human short-term memory is limited in capacity (Miller, 1956). Interfaces should be designed in a way to reduce mental workload for users. Users should not have to memorize system information or database content (Molich & Neilsen, 1990).
  5. Efficient Interaction
    Human–computer interaction should be designed for efficiency by minimizing the number of steps to complete a task or providing shortcuts for users (Belden et al., 2009).
  6. Forgiveness and Feedback
    Molich and Nielson (1990) wrote that interactive systems should provide feedback in real time in order to keep the user informed about what is currently going on. Appropriate feedback should also inform users about the consequence of actions they are going to make (Belden et al., 2009).
  7. Effective Use of Language
    Molich and Nielson (1990) wrote that all dialogs should be presented with clear words and phrases that are familiar to users. In the health care domain, there are many terms and abbreviations that may be familiar to specific users but may be meaningless to others.
  8. Effective Information Presentation
    The design of EMR interfaces, in terms of the amount, type, and organization of information, influences complexity and usability from a user perspective.
  9. Customizability/Flexibility
    Customization is the capability of an EMR interface to be modified based on the needs of each health care provider. Flexibility, or the capacity of an interactive system to be customized, is one of the 14 usability principles identified by Zhang and Walji (2011) in their research toward developing a unified framework of EMR usability.

Given that these nine types of usability issues persist across many Electronic Health Systems, it is the responsibility of all EHR vendors to reach out to specialists in Healthcare Usability, and solve them. Usability in healthcare is unique in that the creation of more usable systems not only can save these companies money—with reduced development, training, support, and documentation costs—it can save lives!

About the Author: Bennett Lauber is the Chief Experience Officer (CXO) for The Usability People. An executive User Experience (UX) and usability team leader with experience managing cross-functional teams responsible for designing, developing and testing healthcare, consumer, and enterprise-class data management systems for desktop, mobile and tablet devices. Member ONC HITPC Implementation, Usability, & Safety Workgroup. This article was originally published on The Usability People and is republished here with permission.