INTRODUCTION
Electronic health record (EHR) systems are instrumental to modern healthcare but come with challenges in usability that can affect clinician efficiency and patient care. Ratwani, Raj et al.'s paper, “A usability and safety analysis of electronic health
records: a multi-center study”, is a multi-center study that evaluates the variability in usability and safety of EHRs from two major vendors across different healthcare systems, exploring how these differences impact clinical practice.
APPROACH
The study engaged twelve to fifteen emergency medicine physicians from four U.S. healthcare systems using EHR products from Epic and Cerner. Participants performed standardized clinical tasks while interactions were recorded to measure task completion time, number of clicks, and error rates. This approach helped to uncover significant discrepancies in EHR usability and safety, attributed to both vendor design and healthcare system implementation strategies.
RESULTS
The results indicated notable differences between and within EHR systems from the same vendors in terms of efficiency, accuracy, and error types. Some tasks showed up to nine-fold differences in completion time and eight-fold differences in clicks required, with error rates ranging up to 50% for certain tasks. For example, when ordering Tylenol, the number of clicks varied dramatically across sites, ranging from as few as 14 clicks at one site to a staggering 61.6 clicks at another. Such variability highlights the profound impact of local customization and the potential risks to patient safety and clinical efficiency.
DISCUSSION
This highlights the complexity of EHR usability, influenced by a myriad of factors including vendor design, healthcare system customization, and implementation practices. The findings suggest that even when EHR systems are designed with user-centered approaches and pass usability tests, the end product can still vary significantly in real-world settings, potentially leading to user frustration and patient safety risks. The dramatic variation in the simple task of ordering Tylenol exemplifies how inefficiencies can burden clinicians, potentially detracting from patient care.
EVALUATING YOUR CDS USING THESE METHODS
Incorporating the insights from this study into your organization involves a critical review of your current EHR system and implementation processes. It is crucial to engage with EHR vendors to understand the flexibility and customization options that align with your clinical workflows. Regular feedback from end-users should be gathered to continually refine and optimize the system, ensuring that it supports clinical needs effectively while maintaining high standards of patient safety. By closely monitoring metrics such as the number of clicks per task, organizations can gauge the effectiveness of their current EHR configurations and make informed decisions to enhance usability.
Journal Club Source
Ratwani, Raj, et al. “A usability and safety analysis of electronic health
records: a multi-center study”. Journal of the American Medical Informatics Association, 2018; 25(09): 1197-1201. DOI: 10.1093/jamia/ocy088