EHR dissatisfaction

What’s the Solution to EHRs’ Poor Usability?


More than 80 percent of medical providers currently use electronic health records (EHRs). EHRs were supposed to streamline the patient visit, reduce doctors’ workload, and make it easier to avoid medical errors. However, the data show that hasn’t happened. A recent report found that physicians’ satisfaction with their EHRs is declining. In 2010, 61 percent of respondents said they were “satisfied” or “very satisfied” with their EHRs, compared with just 34 percent in 2014.

What’s behind this dissatisfaction with EHRs? In a word: usability. Despite their promise, EHRs remain plagued with problems. Not only does this lead to frustration and administrative errors by medical staff, it can put patient safety at risk, too. Here’s a look at the top usability issues, and what can be done about them.

The dangers of poor user design

A 2014 physician survey found that 55 percent of respondents said it was difficult or very difficult to use their EHR to improve efficiency, and 72 percent said it was difficult or very difficult to use their EHR to decrease workload.

Even more concerning is evidence that poor user design can lead to EHR data entry errors and risky workarounds that can compromise patient safety, according to a recent report from the National Institute of Standards and Technology (NIST).

“While EHRs and other health IT applications have led to decreases in some types of patient care errors (e.g., misinterpretations of physician handwriting and lost papers), the use of health care IT has not eliminated all errors and, in some cases, has proven to be a rich source of new errors,” writes health care IT consultant Julie Rennecker, PhD, BSN.

Some common EHR use-related errors include: documenting on the wrong patient’s chart, test results overlooked or misinterpreted, medication dosing errors, and wrong blood product given or given to the wrong patient. While these same errors can occur with paper charts, of course, errors in the EHR are even more dangerous, notes Rennecker. This is because “data entered at one point in the care delivery process are immediately visible to anyone with access to that record, potentially impacting diagnostic and care decisions by clinicians in other departments or facilities.”

The top EHR usability problems

Usability problems in EHRs are well documented. A report prepared for the Office of the National Coordinator (ONC) for Health Information Technology included the following issues observed in multiple EHRs:

  •      Difficult to read displays (gray text; small fonts)
  •      Inconsistent use of color and bolding to indicate important or urgent information
  •      Numbers (e.g., weight) presented without labels
  •      Default units of measure (e.g., English vs. metric; grams v. kilograms) are not apparent or are inconsistent with common practice
  •      Drop-down menus have no discernible order (e.g., alphabetical)
  •      Related functions are not logically grouped
  •      No clear workflow – clinicians uncertain whether they have completed the documentation requirements for a particular step in the care process


The NIST report documented similar findings. “There were several consistent themes across the data, and much of the findings are not surprising,” lead author Lana Lowry told the National Patient Safety Foundation. So if the issues are not surprising, and many of them are easy to fix according to IT experts, then how did these EHRs make it onto the market?

It’s a good question with no simple answer, writes Rennecker. While “the FDA has long required documentation of ‘user-centered design’ practices and usability testing before approving medical devices for clinical use, EHRs and related health IT products do not fall under the purview of the FDA.”

And while the ONC has established certification requirements to promote usability practices by EHR vendors as a part of the meaningful use program, an independent study of EHR vendors showed that only one-third of the sampled vendors had fully complied.

What can be done to fix EHRs?

So what are doctors supposed to do about sub-par EHRs? Raise the bar and don’t accept the status quo, advises Rennecker. In this article, she suggests steps to take before buying a new EHR or related health IT application (e.g., CDS, patient portal), such as performing your own usability testing or hiring others to do so. She also lists helpful resources including a HIMSS guide to selecting an EHR for your practice and an EHR usability toolkit from the Agency for Healthcare Research and Quality.

The NIST report is also available for download. “Hopefully the use-cases developed by NIST will be used to test and improve existing electronic records, and our standardization guidelines will be applied to design safer systems,” said Lowry.

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