The Agency for Healthcare Research and Quality (AHRQ), part of the US. Department of Health and Human Services (HHS), recently published an interesting report entitled Electronic Health Record Usability: Vendor Practices and Perspectives . It was not a systematic review but rather a report of a series of structured discussions with eight different well-known EHR vendors describing what type of formal process they went through to determine the usability of their products, from the design and implementation phase to post-deployment. It is not new information that issues with the usability of an EHR – basically how complicated is it to accomplish tasks with the system and how the interface looks and feels – is one of the biggest complaints clinicians have with most systems. The report clearly showed what most of us who work in this area already know – that much more attention needs to be paid to EHR usability, since the majority of the systems out there are often clunky, counterintuitive, and in some cases downright dangerous.

I know many of you are off to the ASCO meeting this week, but it is a pretty short report and worth a read. Here are a few excerpts I thought were interesting and worth posting:

Surprisingly, in many interviews patient safety was not initially verbalized as a priority issue. Initial comments focused on creating a useful, usable EHR product, not one that addresses potential negative impacts on patient safety. Vendors rely heavily on physicians to notice potential hazards and report these hazards to them through their initial design and development advisory panels and postdeployment feedback mechanisms.

Interviewees held mixed opinions on whether the certification process can effectively evaluate the usability aspect of EHR performance. Without exception, participating vendors had concerns about the inherent subjectivity of evaluation of usability, which can be strongly affected by the past EHR experience of the user, the context in which the product is used, and even the education and background of the evaluator.

Vendors noted extensive use of volunteered feedback. Clinicians with a strong interest in technology, the ability to evaluate usability, and the patience to provide regular feedback are not indicative of the typical end user.

The report concluded that formal usability testing by vendors was not done in a systematic fashion, and that not surprisingly there was virtually no collaboration among vendors to define usability standards and best practices, because of market competition. I guess I was slightly encouraged that none of the vendors owned up to any gag clauses or “hold harmless” wording in their contracts prohibiting users from sharing defects with other users, as apparently does happen sometimes in the industry as reported here. I do understand from the vendor’s perspective that this type of testing is expensive, suffers from issues of reproducibility, and the motivation to do it is going to be small if your competition is not. But the focus should be on patient safety and trying to move the field forward to reap the potential benefits of EHRs. I certainly agree with the AHRQ report’s conclusions that usability testing needs to be formalized and that the model most likely to be successful is that there be a vendor independent certification body for collaboration and standards development. Some have suggested – not in this report – that that should be the FDA. Hmmm….

Also on the same topic, there is a very nice study in this month’s Journal of Oncology Practice from UCLA on usability of an oncology-specific EHR.

Hope to see many of you at the EHR Lab in Chicago at the Annual Meeting this weekend.