Improving EHR Adoption using HF Methods

Issue
The full potential for electronic health records (EHRs) can only be realized if readily adopted by users. Yet the usability of these systems, while recognized as critical for successful user adoption, continues to be a challenge. Furthermore, despite significant technical efforts towards EHR interoperability, there has been minimal consideration of the impact of combining disparate applications on the end user experience in terms of ease of use and adoption. Through the eHealth Collaboratory, a joint initiative between Canada Health Infoway and the Centre for Global eHealth Innovation, human factors methods were used to evaluate EHR solutions for effectiveness, efficiency and ease of use.

Methods
Heuristic evaluations were conducted to evaluate EHR solutions against known usability principles. To evaluate ease of use, end user evaluations were conducted with family physicians performing realistic tasks with the EHR solution in a simulated physician office at the Centre. In addition, a novel approach called Solution Usability Assessment was developed and employed to evaluate interoperable EHRs for usability. The objective of Solution Usability Assessment approach is to determine how well an interoperable solution meets the needs of end users in terms of workflow optimization, ease of use, and patient safety.

Results
Formal reports with the results from the heuristic evaluations, end user testing and solution usability assessment were issued to each of the EHR vendors for future design refinement and to inform user training. Issues were documented prioritized according to severity and a video reel of specific user testing highlight clips was provided, along with specific recommendations to address potential safety issues and design shortcomings. Employing human factors methods remains critical to the adoption of EHRs by end users and essential to the success of a pan-Canadian EHR solution.

Findings were presented at the 11th World Congress on Internet in Medicine MEDNET 2006 Conference and the eHealth 2007 Conference sponsored by Canada’s Health Informatics Association (COACH) and the Canadian Institute for Health Information (CIHI).