Healthcare providers may soon have guides that describe the usability of electronic health records designed to make adopting and using healthcare information technology clear and transparent – and improve patient safety.

The National Institute for Standards and Technology (NIST) is developing a set of procedures that are objective and repeatable for evaluating, testing and validating the usability of electronic health records and other health IT systems, said Lana Lowry, NIST health IT usability project lead.

NIST plans to present the specifications at a workshop June 7, she said at an informational hearing sponsored by a panel of the federal Health IT Policy Committee.

With meaningful use, providers will expect more functionality and robust performance from their EHRs. But providers and health IT researchers say there is uneven usefulness, ease of usability and user satisfaction among EHRs.

As a result, the ONC will develop guidelines to measure an EHR's usability in coordination with public and private organizations and NIST, said Farzad Mostashari, MD, national coordinator for health information technology.

“All too often we hear from providers that they look forward to the day when the technology works for them instead of them working for the technology,” he said at the meeting April 21.

Usability has implications for patient safety, adoption, and effective health IT implementation and for hospital and physician productivity.

[See also:  EMR usability seen lacking.]

“We hear from providers that they really didn’t know what they were buying until they bought it, and didn’t understand what it would be like to use the system until they used the system," said Mostashari. "We also hear about potential safety issues with respect to poor usability and errors attributed to the human-computer interface."

NIST’s process will focus on usability factors associated with critical safety issues and technical evaluation protocols for making sure that EHR developers have a method to understand how usability affects safety issues in patient care, Lowry said.

“Applications should be designed to eliminate the causes of error, including human error,” she said.

The goal is to help systems developers and vendors assess and demonstrate that their software is free from design-induced user error. But NIST "will not dictate particular user interface designs,” said Lowry.
EHR developers would also report the results of usability testing in a standard format by NIST in November 2010.

In another effort, Jiajie Zhang, principal investigator for the SHARP-C Project at the University of Texas (pictured at right), has evaluated EHR usability and is developing measures that assess it. The Strategic Health IT Advanced Research Projects are funded by ONC to overcome hurdles in health information technology.

[See: ONC awards $60M for health IT "breakthroughs'.]

Satisfaction of users with their EHRs can be established through surveys. And measures of EHR efficiency in terms of times and steps are also well established and realistic to put into operation, he said.

The Texas project is currently validating measures for effectiveness for a few EHRs. They can be performed, “but the resources needed to do it are still overwhelming,” said Zhang, who is a researcher and professor in biomedical informatics at the University of Texas at Houston.

[Read a Q&A with Jiajie Zhang: Seven questions with Jiajie Zhang.]

Providers can also drive improvements in usability, said Mike Smith, general manager, KLAS Enterprises, a healthcare market research firm.
“Providers need to set a higher bar for what technology can bring to the table and drive vendors toward usability,” he said.

Those providers could come together to discuss and agree on what the higher bar should be and then use their collective voice to drive change, he said, adding that “ultimately, providers will vote with their wallets.”