HIMSS Report on EMR Usability

Last month, the Healthcare Information and Management Systems Society (HIMSS) EHR Usability Task Force published a report entitled, “Defining and Testing EMR Usability: Principles and Proposed Methods of EMR Usability Evaluation and Rating” (644 K, .pdf).

As can be gathered from the title, the report focuses on the usability of electronic medical records (EMRs).  More specifically, as noted in the scope of the report:

“We discuss the usability of the EMR from the perspective of clinician users (physicians, nurses, pharmacists, physical therapists, respiratory therapists and others) in the ambulatory, inpatient and acute‐care environments. We confined ourselves to issues of user‐centered design and usability evaluation. These concepts apply to vendor product development processes, public product usability rating methods and vendor selection criteria for healthcare organizations. In addition, these methods should be applied in the configuration of highly adaptable systems during implementation. We do not otherwise address concerns of implementation, user training or change‐management, though these issues do affect user adoption success rates” (p. 4).

The report identifies nine usability principles that are relevant to EMRs, including:

• Simplicity
• Naturalness
• Consistency
• Minimizing cognitive load
• Efficient interaction
• Forgiveness and feedback
• Effective use of language
• Effective information presentation
• Preservation of context

The report also discusses different usability evaluation methods (e.g., contextual inquiry, task analysis, expert review, risk assessment, etc.) and metrics (e.g., efficiency, effectiveness, ease of learning, etc.), selecting tasks for evaluation (e.g., find LDL, count CAD risk factors, drug-interaction alert & response, etc.), usability rating systems, and EMR certification.

The report closes with six recommendations that certifying organizations should consider when developing a usability rating program, including:

• Start small
• Develop measurements
• Create a 5-star rating system
• Define the process
• Improve with time
• Encourage others to do their part

As a side note, I was pleased to see the authors address the difference in terminology between electronic medical records (EMRs) and electronic health records (EHRs).  Specifically, they state, “An EMR is a computer system composed of multiple, integrated applications enabling clinicians to order, document and store patient information. The term electronic health record (EHR) is sometimes, and incorrectly, used interchangeably. In contrast, an EHR is patient health information from multiple care delivery organizations’ EMRs, comprising a patient‐centric, longitudinal view of a patient’s encounters with healthcare providers” (p. 4).