The American Medical Association (AMA) and Washington, D.C.-based provider organization MedStar Health’s National Center for Human Factors in Healthcare have developed a comparative electronic health record (EHR) framework “that shows a lack of focus among regulators and industry on user-centered design and usability testing.”
According to a press release from the organizations, the EHR User-Centered Design Evaluation Framework drills down on the design and testing processes for optimizing usability in 20 common EHR products using information reported by EHR vendors to meet usability certification requirements set by the Office of the National Coordinator for Health Information Technology (ONC). “The framework goes beyond the low gauge set by federal usability certification criteria and evaluates the vendor’s compliance with best practices for user-centered design (UCD) processes according to a 15 point scale developed by MedStar’s Human Factors Center in collaboration with the AMA,” the statement reads.
The ONC requires vendors to report on the UCD processes they followed for only a handful of EHR capabilities. Since the design and testing of most EHR functions goes unverified by the ONC’s certification criteria, an optimal evaluation presented by the framework should not be considered reflective of actual usability experienced by physicians and other end-users. As such, the framework should not be interpreted as a buyer’s guide, the organizations say.
“Physician experiences documented by the AMA demonstrate that most EHR systems fail to support effective and efficient clinical work, and continued issues with usability are a key factor driving low satisfaction with many EHR products,” said AMA President Steven J. Stack, M.D. “Our goal is to shine light on the low-bar of the certification process and how EHRs are designed and user-tested in order to drive improvements that respond to the urgent physician need for better designed EHR systems.”
A principle developer of the framework was Raj Ratwani, Ph.D., scientific director of the Human Factors Center, who also recently led a study about how EHR design shortcomings play in a role in physicians being forced to continuously “task switch” in the emergency department.
What’s more, Ratwani, known for his research on health IT vendors’ insufficient attention to EHR usability, spoke about that during a recent Senate Health Education Labor and Pensions (HELP) Committee meeting on EHRs, noting that “The usability of EHRs, patient portals and personal health records remains subpar and is a significant challenge that we must overcome immediately.” In the meeting, Ratwani said that in most cases, portals have not been designed using methods to optimize the system’s responsiveness to patient needs. “There is overwhelming evidence that usability of health IT systems impacts patient safety, and is crucial to adoption and effective use. There is a common misunderstanding that usability is only about basic screen design such as font size, color, and layout, but a better understanding is that usability needs to support the needs of clinicians of patients,” he said.
As such, the framework further builds on a study Ratwani wrote on EHR usability that was published by the Journal of the American Medical Association in September 2015. In that study, Ratwani, et al, analyzed available reports from the top 50 EHR vendors, as measured by the number of meaningful use attestations made to the ONC between April 1, 2013, and Nov. 30, 2014. The researchers found that a significant percentage of vendors did not even follow basic federal requirements for certifying the usability of their products, yet these products were certified under the meaningful-use incentive program.
In the goals of the framework, AMA and MedStar state, “We believe EHRs should be designed with the end user in mind and that the ONC’s requirements do not go far enough to encourage fully functional and usable products. This framework can be used by the ONC to improve their certification program, and as a method to track improvements EHR vendors make as they recertify their products over time.”
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