Lack of Testing Adherence Related to Poor Usability of Electronic Health Record Products

Usability testing should include at least 15 representative end-user participants.

A lack of adherence to usability testing standards may be at the heart of poor usability for electronic health record (EHR) products, according to a recent report. Many EHRs have poor usability, leading to user frustration and safety risks.

The US Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) has established certification requirements to promote usability practices by EHR vendors as part of a meaningful use program. In order to successfully develop a certified EHR, vendors must attest to using user-centered design (UCD), a process that places the needs of the frontline user at the forefront of software development. In addition to this, vendors must also conduct formal usability testing on 8 different EHR capabilities to ensure the product meets performance standards.

EHR vendors are also required to provide a written statement naming the UCD process they used, as well as the results of usability tests. The ONC has endorsed guidelines from the National Institute of Standards and Technology stipulating that usability testing should include at least 15 representative end-user participants, according to background information in the article.

Reports must be made public once the EHR product is certified. In an analysis of 50 EHR vendors between April 2013 and November 2014, researchers found that 41 were available for review and the remaining 9 were not publicly available. Of 41 vendors, 34% had not met the ONC certification requirement of stating their UCD process, 46% used an industry standard, and 15% used an internally developed UCD process.

The report additionally found that of the 41 vendors, 63% used at least 15 participants with clinical backgrounds. One of the vendors used no clinical participants, 17% used no physician participants, and 5% used their own employees. Of the available vendors, 12% lacked enough detail to determine whether physicians participated and 51% did not provide the required demographic details.

“The lack of adherence to usability testing may be a major factor contributing to the poor usability experienced by clinicians. Enforcement of existing standards, specific usability guidelines, and greater scrutiny of vendor UCD processes may be necessary to achieve the functional and safety goals for the next generation of EHRs,” the study concluded.