A mixed-methods evaluation framework for electronic health records usability studies.

BACKGROUND: Poor EHR design adds further challenges, especially in the areas of order entry and information visualization, with a net effect of increased rates of incidents, accidents, and mortality in ICU settings. OBJECTIVE: The purpose of this study was to propose a novel, mixed-methods framework to understand EHR-related information overload by identifying and characterizing areas of suboptimal usability and clinician frustration within a vendor-based, provider-facing EHR interface. METHODS: A mixed-methods, live observational usability study was conducted at a single, large, tertiary academic medical center in the Southeastern US utilizing a commercial, vendor based EHR. Physicians were asked to complete usability patient cases, provide responses to three surveys, and participant in a semi-structured interview. RESULTS: Of the 25 enrolled ICU physician participants, there were 5(20%) attending physicians, 9 (36%) fellows, and 11 (44%) residents; 52% of participants were females. On average, residents were the quickest in completing the tasks while attending physician took the longest to complete the same task. Poor usability, complex interface screens, and difficulty to navigate the EHR significantly correlated with high frustration levels. Significant association were found between the occurrence of error messages and temporal demand such that more error messages resulted in longer completion time (p = .03). DISCUSSION: Physicians remain frustrated with the EHR due to difficulty in finding patient information. EHR usability remains a critical challenge in healthcare, with implications for medical errors, patient safety, and clinician burnout. There is a need for scientific findings on current information needs and ways to improve EHR-related information overload.

Understanding the Impact of Clinical Training on EHR Use Optimization.

Electronic health records usability creates challenges to the delivery of care. This paper presents a novel approach to user analysis. Fixation counts have been analyzed to identify differences among physicians of 3 experience levels - residents, fellows and attending physicians. The findings indicate that users with different training levels had varied experiences while interacting with the same interface. EHRs will always be used by a variety of user groups, each with their own unique characteristics and therefore user analysis must be an important component of EHR usability testing. Eye tracking technology could serve as a valuable tool in this context.

Novel Eye-Tracking Methods to Evaluate the Usability of Electronic Health Records.

The Electronic Health Record has become a staple today in every hospital and clinic, thanks to policy changes advocating its use. However, its full potential can be realized only when it is easy to use and compliant to the needs of the different user subgroups. This study uses a novel approach of eye tracking to assess and differentiate EHR usability based on gender. Though the findings were not suggestive of a significant gender-based difference, they did indicate that the design and layout of screen elements have a significant influence on the search efficiency for both user groups and this point could be relevant for future EHR design.

Assessing the Satisfaction of Citizens Using Teleconsent in Clinical Research.

Researchers tested the functionality, and evaluated the feasibility of a telemedicine software, Doxy.me, to complete informed teleconsent sessions remotely with prospective research participants. Twenty healthy volunteers completed a teleconsent session, and web survey assessing overall experience and satisfaction with the Doxy.me software. There was a statistically significant correlation found between age and mean response for the overall reaction category (r = 0.398, p = 0.091) and the systems capabilities category (r = 0.380, p = 0.099). Results suggested that younger users are more satisfied than older users with using teleconsent as a modality for informed consenting. This information will be used to improve the software design and functionality of the Doxy.me software to make the teleconsent experience as simple and intuitive as possible.