AHRQ: Hard data about EMR usability is still scarce

EMR vendors may say they're committed to developing and providing usable EMR products, but best practices and standards of design, testing and usability monitoring of EMRs are not readily available, according to a report funded by the Agency for Healthcare Research and Quality (AHRQ).

Usability is one of the key factors driving the adoption and appropriate utilization of EMR systems, the AHRQ report said. To address gaps and recommend actions to move the field forward, AHRQ contracted with James Bell Associates and the Altarum Institute to conduct a series of interviews with selected certified EMR vendors.

The EMR products discussed came on the market from the mid-1990s to 2007. Although vendors described an array of usability engineering processes and end-user input throughout the product life cycle, practices such as formal usability testing, the use of user-centered design processes and personnel with expertise in usability engineering are uncommon.

Many vendors did not initially address potential negative impacts of their products as a priority design issue, according to the report. Vendors reported a variety of formal and informal processes identifying, tracking and addressing patient safety issues related to the usability of their products.

Most vendors reported that they collect, but do not share, lists of incidents related to usability as a subset of user-reported “bugs” and product-enhancement requests, the AHRQ said.

Based on the feedback gained from the interviews and from their experience with usability best practices in healthcare and other industries, the project expert panel made the following recommendations:
  • Encourage vendors to address key shortcomings that exist in current processes and practices related to the usability of their products.
  • Include a variety of end-user contingents in the design and testing process throughout the product life cycle, and collect feedback from them.
  • Support an independent body for vendor collaboration and standards development to overcome market forces that discourage collaboration, development of best practices and standards harmonization in this area.
  • Develop standards and best practices in the use of customization during EMR deployment.
  • Encourage formal usability testing early in the design and development phase as a best practice and discourage dependence on post-deployment review supporting usability assessments.
  • Support research and development of tools that evaluate and report EMR ease of learning, effectiveness and satisfaction, both qualitatively and quantitatively.
  • Increase research and development of best practices supporting designing for patient safety.
  • Design certification programs for EMR usability in a way that focuses on objective and important aspects of system usability.