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and that only two of the EHR systems could perform all 12. Vendors received anonymity in exchange for their par- ticipation in the project. The completion-time analysis


showed that among the use cases, clin- ical summary took the longest time on average to complete at 338 seconds, or about 5.6 minutes. The computer- ized physician order entry (CPOE) task took the next-longest time, with a mean of 326 seconds. The body mass index (BMI) task took the least time on average, with a mean of 16 seconds. Across the five EHRs, the expert re-


view portion identified 1,135 usability problems. Out of the 12 clinical tasks, the CPOE task produced the most us- ability problems, with a mean of 58 per system. Clinical summary was sec- ond with a mean of 53. The BMI task had the fewest, with a mean of nine usability problems per system. Problem list and medication list


tied for the highest average usability problem severity rating at 2.6. The growth chart and BMI tasks had the lowest mean severity ratings at 2.3. Ultimately, the project’s evaluation


of the EHR products’ collective us- ability was consistent with a previous Institute of Medicine (IOM) report on patient safety and health informa- tion technology, researchers note. The IOM report cited “poor interface de- sign, poor workflow and complex data interfaces” as serious threats to pa- tient safety in a clinical environment. “Time(s) for experts to perform meaningful, use-related tasks in ex- isting EHRs were high,” researchers wrote in Better EHR. “These times are predictive of errors in routine perfor- mance and would likely be higher in actual clinical practice. Users face nu- merous usability problems as they use systems in real-world clinical practice. Poor usability is a critical challenge limiting the adoption and safe use of EHRs.” Dr. Walji notes that by the end of


the RUA process, researchers gave participating vendors a list of usabil- ity problems and benchmark times


by which they could measure and im- prove their own systems. “All the systems had some vio-


lations of good design,” said Amy Franklin, PhD, an assistant professor at UTHealth and a project researcher.


“So making sure that usability is a pri- ority, usability is part of the workflow in the development, the creation, and maintenance of the system along the


design of new components, is [some- thing vendors] could all do.”


WHAT VENDORS SAY The project also included interviews with 11 EHR vendors to better under- stand to what degree — if any — the vendors practiced user-centered de- sign (UCD). As the name implies, in a UCD approach to designing a product


MEASURING USABILITY


In the Strategic Health Information Technology Advanced Research Projects, including a study on patient-centered cog- nitive support, known as SHARPC, researchers looked at rapid usability assessment and evaluated 12 clinical tasks across five electronic health record systems. Here are the average results for each clinical task, ranked from highest average time to perform to lowest:


Task


Clinical summary CPOE*


Medication list Problem list Medication allergies E-prescribing Demographics Vital signs E-copy


Smoking status Growth chart Body mass index


Average Time to Perform, in Seconds


338 326 161 138 121 65 62 54 39 36 29 16


*Computerized physician order entry


Source: Better EHR: Usability, Workflow, and Cognitive Support in Electronic Health Records


September 2015 TEXAS MEDICINE 41


Average Number of Usability Problems (Average Severity)


53 (2.3) 58 (2.4) 21 (2.6) 21 (2.6) 17 (2.5)


26 (2.5) 17 (2.5) 16 (2.4)


34 (2.4) 10 (2.5) 17 (2.3) 9 (2.3)


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