May 5, 2021

Physicians in the UK find their EHR usability unacceptable


The System Usability Scale was used to study the usability of electronic health records in the UK emergency department among physicians, and the results are (not surprisingly) "unacceptable."

Watch this article as a video

Original article (download the one with the supplementary materials):

Title: Usability of electronic health record systems in UK EDs

Authors: Benjamin Michael Bloom, Jason Pott, Stephen Thomas, David Ramon Gaunt, Thomas C Hughes

Published: Emergency Medicine Journal (of the BMJ), March 2021

Some takeaways

(More detailed commentary in the video attached)

1. It's a short 5-page article. Easy to read in its entirety. Not bloated with useless content.(Download the version with the supplemental material).

2. This is a large survey (1500) of respondents, from roughly one in five members of the Royal College of Emergency Medicine. With good representation across all years of training. It is also a study of 'real world' use - not 'vendor reported' data.

3. Nice application of a standardized industry tool to study the usability of technology, the System Usability Scale. This helps provide 'objective' feedback on the perceived usability of electronic health records compared to other industries.

In short, no electronic health record studied had a mean System Usability Scale Score that was considered "acceptable," aka above a score of 68. Three-quarters of all electronic health records studied fell into the lowest quartile of usability when compared to technology across various industries. (i.e. a score under 55)

4. The System Usability Scale scores did not vary based on level of training. It is not a case of "old people" or "young people" getting/not getting technology. In fact, the physician's perceived ability to use these systems was rated relatively high.

5. There was statistically significant variation in the System Usability Scale Scores depending on where/how these electronic medical record systems were implemented. This is very important. This adds further evidence that one electronic medical record is not particularly "great" or "better" and that the way systems are implemented plays a significant role.

The number of ancillary systems (blood, imaging) that are connected to the single electronic medical record may influence the perceived quality of the electronic medical record.

The number of other systems a clinician has to log into to get notes from different sources (e.g. inpatient, outpatient, general practitioner) may also influence the perceived quality of an electronic medical record.

My Conclusion

The reality is, nobody's hospital is going to be changing their electronic medical record system anytime soon, and (to be honest) there isn't right now a great electronic medical record to jump to. However, physicians should one-hundred-percent be always lobbying and challenging their workplaces to change the parts of the electronic medical record that their hospital and health authority have control over - which is implementation and configuration.

The 'number of clicks' to do something (as Raj Ratwani has shown) can vary greatly between different implementations of the same electronic medical record system. As this paper shows, there is a wide variation in the number of peripheral systems connected. All of this plays an important role in usability, and I believe many usability issues can be improved without changing electronic health record vendors.

I'm not saying EHRs sold today are great, but fixing a poorly configured system may be a realistic step forward for a hospital.

Related article

You may like this artilce I wrote a few years ago, where I estimated the opportunity-cost of time spent for physicians to log into their emergency room computer.

September 5, 2016: Health Authority loses millions of dollars to slow computer logins

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