Believe it or not, EHR usability has worsened from 2014-2016 according to a study published in JAMA Network Open.
There was no statistical improvement in EHR SUS scores between products certified according to 2014 and 2015 standards. One-third of 2014 products and one-quarter of 2015 products fell below the average benchmark SUS score. Despite the implications of EHR dissatisfaction on clinician burnout and patient safety, SUS scores decreased by 44% of vendors from 2014 to 2015. We identified the 70 EHR vendors with the most attestations to meaningful use from health care facilities between July 1, 2016, and April 30, 2018. For inclusion in analysis the vendor must have had an EHR product with computerized provider order entry functionality, certified according to the safety-enhanced design criterion, and a reported SUS score for the 2014 and 2015 certification requirements. For each vendor, the usability report for the most recent version of the product meets the 2014 certification requirements (ie, before January 14, 2016, when the 2015 certification requirements became effective) and the usability report for the most recent version of the product meets the 2015 certification requirements were retrieved, and the SUS scores were analyzed. A paired t-test, with a 2-tailed P < .05 indicating statistical significance, was used to determine differences in SUS scores between 2014 and 2015, with means and standard deviations reported. All statistical analyses were performed with SPSS statistical software version 25 (IBM Corp).
Comparing the two years, EHR usability for 12 EHR products decreased, 13 increased, and two remained unchanged. During that same time period, one-third of the products in 2014 fell below the average benchmark, while one-quarter of the 2015 products fell below the average benchmark. Forty-four percent of SUS scores even decreased from 2014 to 2015.
“With the widespread adoption of electronic health records (EHRs), there is an increased focus on addressing the challenges of EHR usability, ie, the extent to which the technology enables users to achieve their goals effectively, efficiently, and satisfactorily,” the team wrote. “Poor usability is associated with clinician job dissatisfaction and burnout and could have patient safety consequences.”
Data confirms that the lion’s share of clinician burnout stems from hard-to-use EHRs, with most providers giving their tools poor ratings. Separate studies have linked EHR usability with patient harm, suggesting that poor navigability and EHR design can lead to patient safety issues.
Some efforts are underway to address the EHR usability problem. The EHR reporting program, which is a new program mandated by the 21st Century Cures Act, could also address EHR usability and drive patient safety.
The Department of Health and Human Services (HHS) and the Office of the National Coordinator for Health IT (ONC) have established a set of safety-enhanced design certification requirements for EHR usability. To satisfy the requirements ONC in August 2018 issued a request for information (RFI) seeking public comment about the EHR Reporting Program to inform the development and implementation of reporting criteria.
User complaints began before ONCHIT imposed meaningful use requirements and standards for interoperability were established. (2006). Thirteen years is a long time for a response from Congress for a vital system in healthcare The federal government's definition of meaningful use has nothing to do with usability. HHS's concept of meaningful use is based upon the ability to extract data for analysis. It took several years to establish a certifying body as well as work out the details.
All of this is a small part of the 21st Century Act that was signed into law in 2016. It is 360 pages in length.
EHR Usability Remains Unchanged, Impacts Clinician Burnout: Forty-four percent of EHR usability scores decreased from 2014 to 2015.
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